Palliation of Incurable Esophageal Cancer

Generally, cancer of the esophagus and gastroesophageal junction carries with it a poor prognosis. The expected 5-year survival with esophageal cancer is 40%, 21%, and 4%, for localized, regional, and distant disease, respectively.1 Approximately 50% of patients presenting with esophageal cancer are not candidates for surgical resection at the time of diagnosis.2 Unfortunately, these patients frequently have symptoms, particularly dysphagia, that require palliation. Therefore, the first objective of treatment is to adequately assess their symptoms. Establishing the extent of dysphagia (Table 91-1), and assessing accompanying pain, bleeding, aspiration, and other symptoms will assist in determining the best therapies required for effective palliation.