Current nature and management of cancer of the oesophagus and cardia

Abstract

Abstract Aims To inform the debate about upper gastrointestinal cancer care in the UK, the incidence of cancer of the oesophagus and cardia (OGJ) was determined in the West Midlands, a region covering 10 per cent of England and Wales, with particular reference to the methods of treatment. Methods The case-notes of 2776 patients diagnosed with oesophageal and OGJ cancer in the 5 years from 1 January 1992 to 31 December 1996 were scrutinized by one experienced surgeon. Tumour types were classified by histology and site, and treatment modalities assessed for 30-day mortality rate together with life-table analyses. Results Oesophageal cancer was identified in 2188 patients (61 per cent lower, 34 per cent middle, 4 per cent upper), including 999 squamous carcinomas (27 per cent lower, 64 per cent middle, 9 per cent upper) and 995 adenocarcinomas (97 per cent lower, 3 per cent middle), while there were 588 cases of OGJ cancer (94 per cent adenocarcinomas). Resection was the commonest treatment (865 cases; 31 per cent), with a mortality rate of 10 per cent for oesophageal and 4 per cent for OGJ cancer. Palliative resection had a higher mortality rate than radiotherapy (9 versus 3 per cent), compared with 22 per cent for endoscopic palliation, while the 30-day mortality rate was 30 per cent for the 308 patients given no treatment. Conclusions Squamous carcinomas and adenocarcinomas of the oesophageal body are now equally common; lower-third and OGJ tumours are predominantly adenocarcinomas. This study provides baseline data for critical appraisal of potential changes in the delivery of upper gastrointestinal cancer in the UK.