Summary
There are 4 types of oesophageal tumour;
adenocarcinoma, squamous cell carcinoma, leiomyoma and squamous papilloma. Squamous cell and adenocarcinoma are by far the most common.
Epidemiology
- 2-3 per 100 000 in the UK and USA. Much higher in Asia and the Middle East
- Male:Female = 2:1
- Peak age of incidence is 60-70
Aetiology
- Eating certain foods, including; cereals, foods containing nitrous amides
- Not eating enough of other foods; vitamins A and C, iron
- Achalasia
- Chewing tobacco
- HPV
Most commonly seen in the upper 2/3 of the oesophagus
Adenocarcinoma
This is only found in
columnar epithelium and thus is strongly associated with
Barrett’s Oesophagus.
Epidemiology
- 5 per 100 000 – thus in these regions it is more common than squamous cell carcinoma
- Incidence has risen greatly in the last few decades – thought to be related to the increase in obesity (and thus the increase in reflux disease)
- Most common presentation is in white, middle-aged males
Aetiology
- Barrett’s Oesophagus. Risk increases with
- Length of oesophagus effected
- Duration of condition
- Obesity
- Smoking
- Alcohol
- Genetic susceptibility
- Age (>45)
- Male
Most commonly seen in the lower 1/3 of the oesophagus
Clinical Features of Oesophageal carcinoma
Disease if often very advanced by the time of symptomatic presentation
- Feeling of lump in the throat – not associated with eating
- Dysphagia / discomfort on swallowing
- Progressive dysphagia – this is a very characteristic symptom
- Regurgitation – may be misinterpreted as vomiting
- Weight loss and anorexia
- Possible palpable lymph nodes, such as Virchow’s node.
Investigations
- Endoscopy. Investigation of choice. 90% of oesophageal tumours can be imaged
- Barium swallow (rare) – may be used if endoscopy cannot be tolerated
Staging
Tumours are staged using the TNM staging system (see full article for further details)
