Aetiology

Squamous cell carcinoma

• More common in upper and middle thirds of the oesophagus
• Risk factors include age (60-70 years), achalasia, smoking, alcohol use, black race and poor diet (lacking Vit A and C, iron)

Adenocarcinoma

• Reflux disease is biggest risk factor - almost all adenocarcinomas occur in the lower 1/3 of the oesophagus on a background of Barrett’s oesophagus
• Other risk factors include age (50- 60 years), white race, obesity and smoking

Clinical features

• Progressive dysphagia - tumour obstruction
• Feeling of lump in throat
• General symptoms of malignancy (anaemia, weight loss, loss of energy) due to metastases

Investigations

• Endoscopy and biopsy
• Imaging: CT, PET scan for staging

Management

• Surgery - resection (curative)
• Only 40% of patients resectable at time of presentation - palliative measures include stenting and intubation

Complications

• Bronchopneumonia due to aspiration
• Oesophageal-broncho fistulas