Model Answer
0 min readIntroduction
Oesophageal cancer is a significant global health concern, with varying incidence rates depending on geographical location and risk factors. In India, it represents a substantial proportion of gastrointestinal malignancies. The upper third of the oesophagus is frequently affected by squamous cell carcinoma, often linked to tobacco and alcohol consumption. Early diagnosis and appropriate management are crucial for improving patient outcomes. This answer will detail the most common cancers in India, the clinical features of carcinoma of the upper third of the oesophagus, and a comprehensive management plan for such cases.
(i) Five Most Commonly Found Cancers in India
According to the National Cancer Registry Programme (NCRP) Report of India, 2020 (based on data up to 2019), the five most commonly found cancers in India are:
- Breast Cancer: The most prevalent cancer in women, accounting for approximately 14.8% of all cancer cases.
- Lung Cancer: Increasing in incidence, particularly among men, linked to tobacco smoking and air pollution. Accounts for around 8.1% of cases.
- Cervical Cancer: Remains a significant public health problem, despite screening programs. Represents about 6.5% of cases.
- Stomach Cancer: Incidence varies geographically, with higher rates in certain regions. Accounts for approximately 5.2% of cases.
- Colorectal Cancer: Increasing in urban areas due to lifestyle changes. Represents around 4.6% of cases.
(ii) Clinical Features of Carcinoma of the Upper Third of Oesophagus
Carcinoma of the upper third of the oesophagus typically presents with a gradual onset of symptoms. The clinical features include:
- Dysphagia: Progressive difficulty swallowing, initially with solids, then progressing to liquids. This is the most common presenting symptom.
- Odynophagia: Painful swallowing.
- Globus sensation: A feeling of a lump in the throat.
- Weight loss: Due to reduced food intake and malabsorption.
- Hoarseness of voice: Due to recurrent laryngeal nerve involvement.
- Cough: Aspiration pneumonia due to oesophageal obstruction.
- Neck swelling: Metastatic lymph nodes in the neck may be palpable.
- Regurgitation: Undigested food may be regurgitated.
The location in the upper third often leads to earlier symptoms of dysphagia compared to lower oesophageal cancers.
(iii) Management of Carcinoma of the Upper Third of Oesophagus
Management of carcinoma of the upper third of the oesophagus requires a multidisciplinary approach. The stages of management are:
1. Diagnosis and Staging
- Endoscopy with Biopsy: Confirms the diagnosis and obtains tissue for histological analysis.
- CT Scan (Chest & Abdomen): Evaluates local extent, lymph node involvement, and distant metastasis.
- PET-CT Scan: Provides more accurate staging information, particularly for detecting distant metastases.
- Bronchoscopy: To assess for tracheoesophageal fistula or involvement of the trachea.
2. Treatment
Treatment options depend on the stage of the cancer, patient’s performance status, and comorbidities.
- Surgery (Esophagectomy): The primary treatment for resectable disease. Can be performed via open or minimally invasive (thoracoscopic) approaches. Reconstruction is typically performed with a gastric tube.
- Chemotherapy: Often used as neoadjuvant (before surgery) or adjuvant (after surgery) therapy. Commonly used regimens include cisplatin and 5-fluorouracil.
- Radiotherapy: Can be used as neoadjuvant, adjuvant, or palliative therapy. Often combined with chemotherapy (chemoradiation).
- Combined Chemoradiation: Frequently used for locally advanced disease, aiming to downstage the tumor before surgery.
3. Palliative Care
For patients with advanced or unresectable disease, palliative care focuses on symptom management and improving quality of life.
- Oesophageal Stenting: Relieves dysphagia by keeping the oesophagus open.
- Pain Management: Analgesics to control pain.
- Nutritional Support: Enteral or parenteral nutrition to maintain adequate nutrition.
- Psychological Support: Addressing emotional and psychological needs.
Conclusion
Carcinoma of the upper third of the oesophagus is a challenging malignancy requiring a comprehensive and multidisciplinary approach. Early diagnosis, accurate staging, and individualized treatment plans are crucial for improving patient outcomes. While surgical resection remains the mainstay of treatment for resectable disease, neoadjuvant and adjuvant therapies play an increasingly important role. Palliative care is essential for patients with advanced disease, focusing on symptom control and quality of life. Continued research into novel therapies and screening strategies is needed to further improve outcomes for patients with this disease.
Answer Length
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