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2 - Oesophagectomy for cancer

Published online by Cambridge University Press:  15 December 2009

By
Kathleen M. Sherry
Edited by
Jeremy Cashman  and
Michael Grounds
Kathleen M. Sherry
Affiliation:
Ipswich Hospital NHS Trust Heath Road Ipswich Suffolk IP4 5PD UK
Jeremy Cashman
Affiliation:
St George's Hospital, London
Michael Grounds
Affiliation:
St George's Hospital, London
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Summary

Carcinoma of the oesophagus accounts for 7% of all gastrointestinal malignancies, but there are wide geographical variations in its incidence. In the Western world the incidence of oesophageal carcinoma, particularly adenocarcinoma, has been increasing over the past 30 years and the current rate is approximately 10 per 100 000, of which 5 per 100 000 is adenocarcinoma. Adenocarcinoma is more frequent in Caucasians and squamous cell carcinoma is more frequent in those of African descent. Worldwide the highest incidence of oesophageal carcinoma is in parts of China and northern Iran where the rate is up to 170 per 100 000, most of which are of squamous cell type. Regional differences have been linked to factors such as nitrosamine food preservatives and alcohol consumption. Oesophageal cancer increases with age and the median age at presentation is 70 years. Males more commonly develop adenocarcinoma than females by a ratio of 7:1, and the male to female ratio for all oesophageal cancer is 2:1.

The main risk factors for the development of oesophageal cancer are alcohol and cigarette smoking, which have a synergistic effect for squamous cell carcinoma. Chronic inflammation and stasis, for example, caustic stricture and achalasia, increase the risk for squamous cell carcinoma, as does coeliac disease, Plummer–Vinson syndrome and tylosis (hereditary hyperkeratosis of the palms and soles). Adenocarcinoma is associated with Barrett's oesophagus and the increase in adenocarcinoma in the Western world may be related to an increase in obesity, leading to a high incidence of gastro-oesophageal reflux disease.

Type
Chapter
Information
Recent Advances in Anaesthesia and Intensive Care , pp. 21 - 40
Publisher: Cambridge University Press
Print publication year: 2007

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