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Oesophageal cancer: Difference between revisions
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There are two major types of '''oesophageal cancer''', adenocarcinoma and squamous cell carcinoma. Both type typically affect elderly men. Oesophageal adenocarcinoma evolves from the [[Barrett oesophagus|Barrett-mucosa]] and is the most common type of oesophageal cancer in the Western world. Its incidence is rising. It’s usually found in the lower part of the oesophagus. | <section begin="surgery" /><section begin="oncology" />There are two major types of '''oesophageal cancer''', adenocarcinoma and squamous cell carcinoma. Both type typically affect elderly men. Oesophageal adenocarcinoma evolves from the [[Barrett oesophagus|Barrett-mucosa]] and is the most common type of oesophageal cancer in the Western world. Its incidence is rising. It’s usually found in the lower part of the oesophagus. | ||
Oesophageal SCC is more common in developing countries, and the most common type overall. It’s usually found in the middle and upper parts of the oesophagus. Its prognosis is worse than adenocarcinoma. | Oesophageal SCC is more common in developing countries, and the most common type overall. It’s usually found in the middle and upper parts of the oesophagus. Its prognosis is worse than adenocarcinoma. | ||
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Proper evaluation and staging are essential to determine the resectability of the disease. Only around 1/3 of patients are operated on. | Proper evaluation and staging are essential to determine the resectability of the disease. Only around 1/3 of patients are operated on. | ||
In the rare case where very early cancers are discovered, we may use minimally invasive methods like endoscopic resection or laser ablation. | In the rare case where very early cancers are discovered, we may use minimally invasive methods like endoscopic resection or laser ablation. Locally advanced oesophageal cancer is treated with [[neoadjuvant]] chemoradiation, followed by surgery if the tumour is considered resectable on restaging, possibly followed by adjuvant chemotherapy. | ||
Radiochemotherapy, targeted therapy, or immunotherapy may be used as palliative therapy for stage IV (advanced) disease. The placement of an oesophageal stent to keep the lumen open is an important palliative treatment option for oesophageal cancer, allowing for continued passage of food. | |||
After surgical resection of the oesophagus, either total or partial, the resected part of the oesophagus should be substituted with stomach (first choice) or colon. Because of the localisation of the oesophagus, oesophageal surgery may involve the neck, thorax, and/or the abdomen, making for a large and complicated surgery. | === Surgery === | ||
Most patients present in a stage where radical surgery is required for cure. However, oesophageal resection is a large and complicated procedure, and patients often develop post-operative complications like nutritional problems, stenosis in the anastomosis, and slow passage of foodstuffs. After surgical resection of the oesophagus, either total or partial, the resected part of the oesophagus should be substituted with stomach (first choice) or colon. Because of the localisation of the oesophagus, oesophageal surgery may involve the neck, thorax, and/or the abdomen, making for a large and complicated surgery. | |||
Surgery may be performed [[Laparotomy|open]], [[Laparoscopic surgery|laparoscopically]], or in combination. | Surgery may be performed [[Laparotomy|open]], [[Laparoscopic surgery|laparoscopically]], or in combination.<section end="surgery" /> | ||
=== Systemic therapy === | |||
Chemotherapy, most commonly the FLOT regimen, is commonly used in oesophageal cancer. In case of HER2 overexpression, trastuzumab (an anti-HER2 antibody) may be used as targeted therapy. In case of PD-L1 overexpression, pembrolizumab may be used as immunotherapy. | |||
=== Radiotherapy === | |||
Radiotherapy is often combined with chemotherapy for oesophageal cancer. | |||
== Prognosis == | == Prognosis == | ||
The prognosis is very poor, with a 5-year survival of 15%. The 5-year survival of patients treated with curative surgery is around 30 – 40%. Squamous cell carcinoma has a worse prognosis than adenocarcinoma. | The prognosis is very poor, with a 5-year survival of 15%. The 5-year survival of patients treated with curative surgery is around 30 – 40%. Squamous cell carcinoma has a worse prognosis than adenocarcinoma.<section end="oncology" /> | ||
<noinclude> | <noinclude>[[Category:Gastrointestinal surgery]][[Category:Gastroenterology]] | ||
[[Category:Gastrointestinal surgery]] | </noinclude> | ||
[[Category:Gastroenterology]] | |||