Summary
Most oesophageal cancers are incurable by the time the diagnosis is made. Treatment
is therefore often palliative, and endoscopic modalities cause considerably less general
upset to the patient than surgery, radiotherapy or chemotherapy. Nd:YAG laser recanalisation
of advanced obstructing cancers is safe and effective for exophytic tumours that are
endoscopically accessible in over 80 % of cases. The risk of perforation is less than
half that associated with insertion of a prosthesis, although it is higher in patients
who have previously been treated by radiotherapy. After laser treatment, half the
patients are able to maintain adequate nutrition until the time of their death from
disseminated disease. The other half get further dysphagia due to recurrent exophytic
tumour or compression from extrinsic tumour. A few develop fibrous stricturing in
the laser treated area. However, many of these recurrences can be treated again with
the laser or by dilatation with or without a prosthesis. The quality of swallowing
is better after laser treatment, as any residual oesophageal muscle function in that
area can be used (not possible with a prosthesis), although several treatment sessions
are usually required. In the future, the precision of laser effects may make it possible
to safely ablate early tumours in their entirety.
Key words:
Oesophageal cancer - Therapy of oesophageal cancers - Laser treatment
