Palliation

Palliation

In the presence of distant metastases, palliation is the aim. Dysphagia is the main symptom to relieve. Placement of a self-expanding metallic stent is simple and e ff ective and allows immediate relief of dysphagia ( Figure 66.57 ). The risks are stent migration, tumour ingrowth, airway compression and tracheal erosion if placed in the mid- and upper oesophagus. Other endoscopic methods, such as dilatation, laser treatment and photodynamic therapy , can be used. Chemotherapy/radiotherapy/brachytherapy can help restore luminal patency; in case of bleeding from OGJ tumours, radiotherapy can be haemostatic. Immunotherapy has promise in selected patients. Henry Stanley Plummer , 1874–1937, physician, Mayo Clinic, Rochester, MN, USA. Porter Paisley Vinson , 1890–1959, surgeon, Mayo Clinic, Rochester, MN, USA. Donald Ross Paterson , 1863–1939, ENT surgeon, Cardi ff Royal Infirmary , Cardi ff , UK. Adam Brown-Kelly , 1865–1941, ENT surgeon, Victoria Infirmary , Glasgow , UK. - - - Summary box 66.8 Oesophageal cancer /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Figure 66.57 Self-expanding metallic stent in palliation of oesopha

geal cancer. Squamous cell cancer still predominates in the East, while Barrett’s adenocarcinoma is more common in the West Late presentation and early spread are reasons for poor prognosis Early diagnosis has the best chance of cure Lymphatic spread can be widespread, from the neck to the mediastinum and coeliac axis Adenocarcinomas around the OGJ are sometimes regarded as proximal gastric cancer and treatment is particularly controversial