ABSTRACT
Carcinoma of the oesophagus is the eighth commonest cancer in Western countries, with an incidence of just over 8:100 0001 and accounting for approximately 5 per cent of cancer-related deaths.2 The disease is rare before the age of 40 but the incidence increases sharply thereafter, with an eightfold increase between the age ranges 45-54 years and 65-74 years. The male-to-female ratio for carcinoma of the thoracic oesophagus is about 2.5:1. This ratio is reversed for carcinoma of the cervical oesophagus, especially for post-cricoid carcinoma, which predominantly affects women. During the past 40 years there has been a significant change in the incidence of the two common histological subtypes.3 In the 1960s, 90 per cent of oesophageal cancers were squamous cell carcinomas, but with a decline in the numbers of these patients and a relentless rise in adenocarcinomas of the lower oesophagus and gastric cardia, adenocarcinoma now represents the most common histological subtype. Despite advances that have been made in surgical and radiotherapy techniques over the past 20 years and the inclusion of combination chemotherapy in treatment programmes, the outlook for oesophageal cancer remains poor. Thus only about 30 per cent of patients present with potentially curable early-stage disease and overall the 5-year survival remains less than 10 per cent.4
