cancer

Abstract. The poor prognosis of patients with advanced oesophageal cancer is proof of its ability to spread. Locoregional spread is often discontinuous, i.e. distant regional lymph nodes may be invaded even when local nodes are free of tumour. In patients with potentially curable cancer, we advocate subtotal oesophagectomy pio-neered in the UK by McKeown on the grounds that generous proximal clearance gives the best chance of clea-ring satellite nodules in the submucosal lymphatics and gives the best postoperative function with the least ten-dency for gastro-oesophageal reflux. Patients who have an incurable disease should not be submitted to need-lessly aggressive treatment that simply prolongs the process of dying, so the role of palliative resection is deba-table. Major changes to the management of patients with oesophageal cancer have been made in the 1990s, including increased sub-specialization, better staging by spiral CT and EUS and greater use of adjuvant radio-therapy and chemotherapy. Whether or not these changes have made any difference to clinical outcome is as yet unknown. Most of the patients with unresectable cancer die with severe dysphagia and a poor quality of life. The aim of this article is to evaluate all palliative methods how to relieve dysphagia, which limits the quality of the pati-ent’s life, and the creation of an algorithm of decisions in the management of patients with cancer of the oeso-phagus