Current Issues in Cancer Management of carcinomas of the upper gastrointestinal tract

doi:10.1136/bmj.308.6932.834

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Paul Ellis, senior registrar in medical oncologya,
David Cunningham, consultant medical oncologista

^aCancer Research Campaign Section of Medicine and Gastrointestinal Unit, Institute of Cancer Research and The Royal Marsden Hospital, Sutton, Surrey

Correspondence to: Dr D Cunningham, Department of Medicine, The Royal Marsden Hospital, Sutton, Surrey SM2 5PT Series editor: G M Mead (G M Mead is consultant in medical oncology at the Cancer Research Campaign's Wessex Medical Oncology Unit).

Patients with oesophageal, gastric, and pancreatic carcinomas present a common and difficult problem for the clinician. Surgery is the best option for curative treatment but overall survival figures remain low. Recent improvements in our understanding of the biology of these tumours and improvements in their clinical staging, along with the development of combined modality approaches to local-regional disease, have led to renewed optimism that survival figures may be improved. This is particularly so for oesophageal and gastric carcinomas. In addition, there have been advances in the palliative management of all three tumours. This article examines some of these developments and looks at future prospects.

Epidemiology and pathology

Oesophageal cancer

Oesophageal cancer accounts for around 2% of cancer deaths in the United Kingdom annually. The diagnosis is associated with a median survival of 10 months, and fewer than 5% of patients are cured. In the past, squamous cell carcinomas have accounted for most oesophageal cancers (around 90%) but the incidence of adenocarcinoma of the lower oesophagus is increasing, and these tumours now account for 20-40% of cases. In the Western World the risk of squamous cell cancer is modestly increased with cigarette smoking or alcohol consumption, whereas Barrett's oesophagus is an important risk factor for adenocarcinoma of the oesophagus. Other medical conditions associated with an increased risk include achalasia and the Plummer-Vinson syndrome.

Gastric cancer

Gastric cancer is the second most common tumour type globally and the fourth commonest in Europe. Though the overall incidence has been decreasing over the past few decades, the incidence of adenocarcinomas of the proximal stomach and oesophagogastric junction is rising. Gastric cancer presenting at an early stage can be cured surgically; however, 80% of cases are too advanced at presentation.

The association of gastric cancer with blood group A and dietary factors (particularly increased nitrites in food preservatives) has been established. Other …