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Title: Management of early neoplastic changes in the oesophagus in England
Author: Chadwick, Alice Georgina
ISNI:       0000 0004 6495 7661
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2016
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Oesophageal cancer is the 13th most common cancer in the UK, but 6th most common cause of cancer death with only 15% of patients surviving 5 years (1). The disparity between incidence and mortality is due to the fact that a large proportion of oesophageal cancers are diagnosed at a late stage (2). This thesis aims to investigate the patterns of management and outcomes associated with the treatment of early neoplastic changes in the oesophagus in England, in order to try and identify areas where care may be improved. Four separate studies were performed on i) the management of high grade dysplasia (HGD) in England, ii) the proportion of oesophageal cancers missed at endoscopy, iii) the management and outcomes for early oesophageal cancer and iv) the safety and efficacy of radiofrequency ablation and complete endoscopic resection in the management of dysplastic Barrett’s oesophagus . These studies (expect study iv, which is a systematic review) were performed by linking three national databases, the National Oesophago-Gastric Cancer database, Hospital Episode Statistics and Office for National Statistics mortality data. The results of our studies highlight, that 1. a third of patients with HGD are managed by surveillance alone, with patients treated in low volume centres more likely to be managed in this manner, 2. a substantial proportion of cancers were missed at endoscopy, 3. only 6.8% of oesophageal cancers were diagnosed at an early stage, but two thirds of these patients survived 5 years if managed curatively 4. radiofrequency ablation should be used in preference to complete endoscopic resection in the management of dysplastic Barrett’s. Therefore there is still substantial room to improve the quality of care received by patients with early neoplastic changes in the oesophagus in England.
Supervisor: Hanna, George ; Hoare, Jonathan Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral