Current Issues in Cancer Management of carcinomas of the upper gastrointestinal tractBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6932.834 (Published 26 March 1994) Cite this as: BMJ 1994;308:834
- 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 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 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 …