Oesophageal cancer is the eighth most common cancer and the sixth most
common cause of death from cancer. Histologically, oesophageal cancers are
composed mainly of two variants: squamous cell cancer and adenocarcinoma of the
oesophagus. Benign tumours are rare. The aetiology of squamous cell cancer is largely
unknown but adenocarcinoma progresses from Barrett’s oesophagus. Diagnosis is by
endoscopy and staging is done by a combination of CT, EUS and PET/CT. Many
tumour markers have been elucidated and their potential importance in diagnosis and
treatment is actively pursued. Endoscopic therapy is appropriate for node negative
patients with early cancers limited to the mucosa. Less than 30% of all patients with
oesophageal cancer are suitable for curative treatment. Surgical treatment by
oesophagectomy is appropriate for medically fit patients with T<4, N<3 and M<1
tumours. Neoadjuvant therapy (chemoradiotherapy or chemotherapy) is advocated for
all tumour types. The management of patients with locally advanced or metastatic
oesophageal cancer and patients with poor general medical condition must be
individualised based on stage, characteristics of the tumour, patient’s medical condition
and patient preference. The aim of palliative treatment is to achieve rapid and sustained
relief of dysphagia. Chemotherapy alone or in combination with radiotherapy should be
considered with other palliative measures. Canalisation of the tumour and restoration of
swallowing is best achieved using self-expanding metallic stents. Best supportive care
may be appropriate in frail patients with advanced disease at presentation.
Keywords: Adenocarcinoma, Cancer of oesophago-gastric junction, Non-surgical
treatment, Oesophagectomy, Palliation of oesophageal cancer, Pathology,
Squamous cell cancer, Staging.
