Commentary: managing oesophageal cancer in a resource poor setting—a Malawian example

doi:10.1136/bmj.c6723

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Alexander Thumbs, consultant general surgeon1, lecturer in surgery2,
Eric Borgstein, consultant general and paediatric surgeon1, professor of surgery2

¹Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
²University of Malawi/College of Medicine, Blantyre

alex_thumbs{at}hotmail.com

The incidence of cancer of the oesophagus is increasing worldwide.1 Countries with adequate resources now have a range of diagnostic and treatment options for patients with this disease; unfortunately the situation in resource poor settings is hugely different.

Oesophageal cancer is the sixth most common cancer in Malawi2 with almost equal proportions in men and women. By contrast with western Europe, adenocarcinoma is rare; more than 90% of patients present with squamous cell carcinoma. Accepted risk factors such as smoking and alcohol (especially home brewed spirit) play a part in the pathogenesis of this condition in Africa, as elsewhere, but other factors need to be …