Carcinoma of the oesophagus

Cancer of the oesophagus has an estimated incidence of 4600‐ 5600 new cases per year in France and ranks third in frequency among digestive tract cancers after colon and gastric cancer. It is responsible for 3.9% of cancer deaths and is the fourth commonest cause of death after lung, colon, rectum and prostate cancer. The prognosis is very poor; the French registry shows a 5-year survival of only 3‐6%. These recommendations concern only squamous (epidermoid) and adenocarcinomas of the oesophagus and none of the other rarer histological types. These guidelines were validated in April 2000 and an update is planned for late 2000. The diagnosis of cancer of the oesophagus is based on the histopathological study of biopsies taken by oesophagogastric fibroscopy. Staining with Toluidine blue or Lugol can be used to define more clearly the extent of the primary tumour and/or demonstrate a second site of disease (defined as a lesion more than 5 cm away from the primary lesion). Assessment of the extent of disease spread should include (standard) a complete clinical examination (including nutritional state), as well as fibreoptic bronchoscopy to exclude the presence of tracheo-bronchial mucosal extension or a synchronous primary lesion. A formal head and neck examination should be done to look for a synchronous lesion in the oropharynx. Other assessments include an analysis of respiratory function (blood gas analysis) as well as cardiological, hepatic and renal function (standard). Thoraco-abdominal CT scan or abdominal ultrasound, sub-clavicular ultrasound, oesophagogram and oesophageal echo-endoscopy are all options depending on the results of initial staging examinations.