Oesophageal Cancer

Oesophageal cancer is an important gastrointestinal cancer seen in Turkey with an annual incidence of 4.2 per 100,000 people. Histopathologically, it is seen as squamous cell carcinoma (62%), adenocarcinoma (23%) and other rare types (15%). The main risk factors are excessive smoking (>20/day), alcohol consumption (>50g/day) and chronic reflux disease. The presence of Barrett’s oesophagus increases the 10-year cancer risk by 40-fold. The most common symptoms are dysphagia (92%), retrosternal chest pain (78%), weight loss (83%) and hoarseness (32%). The disease is more common in men aged 60-75 years. According to the Sydney protocol, endoscopic biopsy from three regions of the oesophagus is required for diagnosis.

Surgical Treatment

Oesophagectomy is the basis of curative treatment, and the 5-year survival rate varies from 72% in Stage I to 27% in Stage IIIA. For successful surgery, removal of the primary tumour and dissection of at least 15 lymph nodes are required. Reconstruction is usually performed with a gastric tube (82.5%). Minimally invasive surgery provides shorter hospital stays and fewer complications. The R0 resection rate reaches 92% with the CROSS protocol (chemoradiotherapy). The main complications are pneumonia (15.7%), anastomotic leak (11.4%) and atrial fibrillation (8.9%). The 90-day mortality rate is 3.8% in experienced centres. Most patients return to their daily activities within 4-6 weeks.