The changing face of oesophageal cancer treatment in Northern Ireland.

In the late 1970's the options for treatment of oesophageal cancer were limited. When cure was thought possible, resection was performed by the Ivor Lewis or oesophagogastrectomy techniques. Mortality was high, local recurrence rates disappointing, and long-term survival poor. For those patients whose tumours could not be resected, palliative intubation required open operation with high morbidity, and gave poor quality of life. In 1994, selective screening is diagnosing cancers early, more extensive resections are possible with lower mortality, and fewer local recurrences. Adjuvant therapy is increasing the operability rates. Gradually the facade of poor prognosis is being etched away, so that more patients are being given better quality of life, and cure is a distinct possibility. Palliation can be achieved endoscopically by dilatation, intubation or laser ablation combined with local external beam radiation. Mortality for palliative procedures is now considerably reduced.