ABSTRACT
Oesophageal cancer shows greater geographical variation in incidence than any other cancer. The incidence of oesophageal adenocarcinoma has increased in Western countries by around sixfold since 19753 and is highest in the United States and in Norway where the rise has approached 15% per year. Lymph-node metastases occur early to adjacent or regional lymph nodes, but involvement of coeliac and peri-hepatic nodes is more common with adenocarcinoma because of the location at the gastro-oesophageal junction. Broncho-oesophageal fistulas may occur as a result of destruction of tumour that has invaded the tracheo-bronchial tree. The goals of chemotherapy in patients with advanced oesophageal cancer are to palliate symptoms, especially malignant dysphagia, and to improve survival. Initial trials in oesophageal cancer have demonstrated that photodynamic therapy provides significant palliation from dysphagia in patients with advanced disease or loco-regional failure after chemoradiotherapy.
