Oesophageal cancer

There are two main types of oesophageal cancer, squamous cell carcinoma (SCC) and adenocarcinoma (ACA). SCC usually affects the middle third of the oesophagus and is associated with smoking, alcohol and low socio-economic status. ACA affects the lower third of the oesophagus and is associated with gastro-oesophageal reflux disease. The UK has the highest incidence of ACA in the world and it is rising. Treatment may be palliative or curative. Curative treatment for advanced disease consists of neo-adjuvant chemotherapy or chemoradiotherapy followed by surgery. In the UK, the most common operation is a two-phase Ivor-Lewis oesophagectomy. Increasingly, surgery is carried out with a minimally invasive approach. Modern management has reduced the morbidity and mortality of the perioperative period but progress in long-term survival has been slow. Enhanced perioperative patient pathways and stratified therapies (according to characteristics of the tumour at the molecular level) offer the promise of further improvements. On-going clinical trials are assessing the role of monoclonal antibodies in the treatment of oesophageal cancer.