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Title: Aspects of the prevention and treatment of oesophageal cancer
Author: Dallal, Helen Jane
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1999
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This thesis comprises three studies which examine the prevention and treatment of oesophageal cancer. Barrett's oesophagus is a pre-malignant condition. It is an attractive idea that successful eradication of Barrett's oesophagus could reduce the risk of development of an oesophageal carcinoma. In the first study 12 patients with at least two centimetres of specialised intestinal metaplasia were treated with Argon Plasma Coagulation. Multiple biopsies were taken at baseline, and at two and six months following treatment. These biopsies were analysed for histology, p53 immunostaining, and cell cycle abnormalities using flow cytometry. On follow-up three was a trend for an increase in the number of squamous biopsies and a decrease in the number of biopsies showing intestinal metaplasia. Three patients developed persistent buried glands and a fourth patient developed an oesophageal carcinoma during follow-up. There was no significant change in follow-up of either the p53 staining or the flow cytometry. Only about a third of patients presenting with oesophageal cancer are suitable for curative surgery. For the remainder, the aim of therapy is palliation of malignant dysphagia and maintenance of a reasonable quality of life. The second study is a randomised trial comparing the use of Nd:YAG laser therapy or insertion of an expandable metallic stent in 52 patients for the palliation of malignant dysphagia. Patients were assessed prior to treatment and thereafter at two monthly intervals for assessment of dysphagia and quality of life using the SF36,HAD and EORTC-QLQC30-OES-24 questionnaires. The laser patients survived significantly longer than the stented patients, but this must be balanced against the increased cost of the laser therapy. Palliation of dysphagia was disappointing but did not differ between the two groups. Quality of life was globally impaired in both groups at baseline. Notably the stented patients had significantly more pain than the laser patients at the two month follow-up. The last study retrospectively examines the effect of radical radiotherapy on a cohort of 60 patients with oesophageal cancer. This study revealed a one year survival of 40% and a five year survival of 0%.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available