Symptoms, investigations and management of patients with cancer of the oesophagus and gastro‐oesophageal junction in Australia

Abstract

Objective: To document presenting symptoms, investigations and management for Australian patients with oesophageal adenocarcinoma (OAC), gastro‐oesophageal junction adenocarcinoma (GOJAC) and oesophageal squamous cell carcinoma (OSCC). Design, setting and participants: Cross‐sectional study of a population‐based sample of 1100 Australian patients aged 18–79 years with histologically confirmed oesophageal cancer diagnosed in 2002–2005, using data from cancer registries and treatment centres, supplemented with clinical information collected through medical record review in 2006–2007 and mortality information collected in 2008. Main outcome measures: Prevalence of primary symptoms, and staging investigations and treatment modalities used. Results: The primary presenting symptom was dysphagia, which was self‐reported by 41%, 39% and 48% of patients with OAC, GOJAC and OSCC, respectively. Less common symptoms were reflux, chest pain, bleeding and weight loss. All patients underwent endoscopy, most had a staging computed tomography scan (OAC 93%, GOJAC 95% and OSCC 93%), and about half had positron emission tomography scans (OAC 51%, GOJAC 44% and OSCC 42%). Pretreatment tumour stage was reported in 25% of records, and could be derived from results of investigations in a further 23%, but the remaining half lacked sufficient information to ascribe a pretreatment stage. Curative treatments were attempted for 60% of OAC, 88% of GOJAC and 65% of OSCC patients. Surgery was performed on 52% of OAC, 83% of GOJAC and 41% of OSCC patients. About two‐thirds of surgical patients received additional therapies. Conclusions: With anticipated increases in oesophageal cancer incidence, the resources required to diagnose and manage patients with oesphageal cancer are also likely to rise. Our data provide a baseline from which to plan for the future care of patients with cancers of the oesophagus.

The influence of prediagnostic demographic and lifestyle factors on esophageal squamous cell carcinoma survival

“…Clinical and pathologic information was abstracted from the medical records retrospectively by trained abstracters, entered on standardized data collection sheets, cleaned and checked. Information was collected regarding each patient's presenting symptoms, their diagnostic and staging investigations, the clinical stage of each patient's disease at diagnosis and their clinical management 21. Pretreatment tumor stage (hereafter referred to as stage) was defined according to the American Joint Committee on Cancer (AJCC) stage groups for esophageal cancer 22.…”

“…Pretreatment tumor stage (hereafter referred to as stage) was defined according to the American Joint Committee on Cancer (AJCC) stage groups for esophageal cancer 22. As previously described,21 for patients who did not have AJCC stage recorded in their medical notes we imputed AJCC stage using tumor‐node‐metastasis (TNM) codes, fluorodeoxyglucose positron emission tomography scan results for M status and endoscopic ultrasound for T and N status. However, for about half of the patients in this population sample, we were unable to impute AJCC stage with sufficient precision and so this group was classified separately as “AJCC stage undetermined.” Tumor grade was defined as well differentiated, moderately differentiated or poorly/undifferentiated.…”

Pattern of care for cancer of the oesophagus in a western population

“…Few studies have evaluated the pattern of care for an entire population of patients presenting with oesophageal cancer . Outcomes can be biased when the entire population with oesophageal cancer is not included.…”

Clinical issues in oesophageal adenocarcinoma: could DNA copy number hold the key?

“…The usual presenting symptom is dysphagia due to obstruction caused by the cancer . Less commonly, patients present with haematemesis or symptoms of anaemia (from chronic blood loss).…”

“…Currently, this involves oesophagectomy, and in the majority of patients, neoadjuvant chemotherapy (CTX) or chemoradiotherapy (CRT). Unfortunately, 40% of patients are unsuitable for surgical resection, and so are either treated with definitive CRT, or palliatively. Response to CTX/CRT may be assessed using clinical information (history and examination), endoscopy +/− biopsy, FDG‐PET or repeat cross‐sectional imaging.…”