Table Of ContentCANCER OF THE OESOPHAGUS
CLINICAL CANCER MONOGRAPHS
Volume 1
Cancer of the Oesophagus
Hugoe R. Matthews, FRCS
Regional Department of Thoracic Surgery
East Birmingham Hospital
Birmingham B95ST
and
John A.H. Waterhouse, MA, PhD, HonFFOM
Jean Powell, BSe, FIS
Janet E. Robertson, BA
Christopher C. McConkey, BSe
Regional Cancer Registry
Queen Elizabeth Medical Centre
Birmingham B152TH
M
PALGRAVE
MACMILLAN
© The Authors 1987
Softcover reprint of the hardcover 1 st edition 1987
All rights reserved. No reproduction, copy or transmission
of this publication may be made without written permission.
No paragraph of this publication may be reproduced, copied
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with the provisions of the Copyright Act 1956 (as amended).
Any person who does any unauthorised act in relation to
this publication may be liable to criminal prosecution and
civil claims for damages.
First published 1987
Published by
THE MACMILLAN PRESS LTD
Houndmills, Basingstoke, Hampshire RG21 2XS
and London
Companies and representatives
throughout the world
ISBN 978-1-349-09076-1 ISBN 978-1-349-09074-7 (eBook)
DOI 10.1007/978-1-349-09074-7
Library of Congress Cataloging-in-Publication Data
Matthews, Hugoe R.
Cancer of the oesophagus.
(Clinical cancer monographs; v. 1)
Bibliography: p.
1. Esophagus-Cancer-England-West Midlands
Statistics. 2. Esophagus-Cancer-Treatment-England
West Midlands-Statistics. I. Title. II. Series.
[DNLM: 1. Esophageal Neoplasms-occurrence-Great
Britain. WI 250 M439c]
RC280.E8M38 1987 362.1'9699'432 87-1910
ISBN 978-0-935859-09-6
Contents
Foreword ix
Acknowledgements x
1 Introduction and Methods 1
1.1 Introduction 1
1.2 Inclusion Criteria 2
1.3 Data Base 2
1.4 Validation Procedures 2
1.5 Survival Data 4
1.6 Statistical Methods 4
1. 7 Population 6
Figure 1.1 1961 and 1981 census population pyramid 7
Table 1.1 Comparison of social factors 8
Table 1.2 Population densities 9
Table 1.3 Populations used for the different time periods 10
1.8 General Arrangement 10
2 Epidemiology: Demographic Aspects 11
2.1 Summary of Findings 11
Table 2.1 All tumours: Number per annum by sex, 1957-81 14
Figure 2.1 All tumours: Number per annum by sex, 1957-81 15
Table 2.2 Incidence rates by quinquennium and sex 16
Figure 2.2.1 Incidence rates by quinquennium and sex (crude) 17
Figure 2.2.2 Incidence rates by quinquennium and sex (age adjusted) 17
Table 2.3 Numbers per annum by site and sex 18
Figure 2.3 Numbers per annum by site and sex 19
Table 2.4 Incidence rates by quinquennium, site and sex 20
Figure 2.4 Incidence rates by quinquennium, site and sex 21
Table 2.5 Site distribution by quinquennium 22
Figure 2.5 Site distribution, 1957-81 23
Table 2.6 Site distribution by quinquennium and sex 24
Figure 2.6.1 Site distribution by sex, 1957-81 24
Figure 2.6.2 Site distribution by quinquennium and sex 25
Table 2.7 Numbers and incidence rates by age and sex, 1957-81 26
Figure 2.7 Incidence rates by age and sex, 1957-81 27
Table 2.8 Incidence rates by age, site and sex, 1957-81 28
Figure 2.8 Incidence rates by age, site and sex, 1957-81 29
Table 2.9 Numbers by age, site and sex, 1957-81 30
v
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Table 2.10 Numbers by age, quinquennium and sex 31
Table 2.11 Incidence rates by age, decade and sex 32
Figure 2.11 Incidence rates by age, decade and sex 33
Table 2.12.1 Incidence rates by age, site and sex, 1962-71 34
Figure 2.12.1 Incidence rates by age, site, and decade, male 35
Table 2.12.2 Incidence rates by age, site and sex, 1972-81 36
Figure 2.12.2 Incidence rates by age, site, and decade, female 37
Figure 2.13.1 Incidence rates in cohorts (males) 39
Figure 2.13.2 Incidence rates in cohorts (females) 39
3 Histology 40
3.1 Summary of Findings 40
Table 3.1 Histological categories 41
Table 3.2 Numbers and distribution - histological type specified 43
Table 3.3.1 Numbers by histology, site and sex 44
Table 3.3.2 Distribution by histology, site and sex 45
Table 3.4 Numbers per annum by histology and sex 47
Table 3.5 Distribution by quinquennium, histology and sex 49
Table 3.6 Squamous-incidence by quinquennium, site and sex 50
Figure 3.6 Squamous - incidence by quinquennium, site and sex 51
Table 3.7 Adenocarcinoma - incidence by quinquennium, site and sex 52
Figure 3.7 Adenocarcinoma - incidence by quinquennium, site and sex 53
Table 3.8 Anaplastic - incidence by quinquennium, site and sex 54
Figure 3.8 Anaplastic-incidence by quinquennium, site and sex 55
Table 3.9 Major histologies-numbers by age, histology and sex 56
Table 3.10 Major histologies - distribution by age, sex and histology 57
Table 3.11 Major histologies - mean age by quinquennium, histology and sex 58
4 Overall Survival 59
4.1 Summary of Findings 59
Table 4.1 Annual rates, crude and age adjusted 60
Figure 4.1 Annual rates, crude and age adjusted 61
Table 4.2 Annual rates, crude and age adjusted by sex 62
Figure 4.2 Annual rates, crude and age adjusted by sex 63
Table 4.3 Annual rates by site 64
Figure 4.3 Annual rates by site 65
Table 4.4 Annual rates by site and sex 66
Figure 4.4 Annual rates by site and sex 67
Table 4.5 Annual rates by histology 68
Figure 4.5 Annual rates by histology 69
Table 4.6.1 I-year rate by histology and site 70
Table 4.6.2 5-year rate by histology and site 70
Figure 4.6 Annual rates by histology and site 71
Table 4.7 Squamous - survival by site and sex 72
Figure 4.7 Squamous - survival by site and sex 73
Table 4.8 Adenocarcinoma - survival by site and sex 74
Figure 4.8 Adenocarcinoma - survival by site and sex 75
Table 4.9 Anaplastic-survival by site and sex 76
Figure 4.9 Anaplastic.,--survival by site and sex 77
Table 4.10.1 All cases -I-year survival by age and sex 78
Figure 4.10.1 All cases -I-year survival by age and sex 79
Table 4.10.2 All cases - 5-year survival by age and sex 80
Figure 4.10.2 All cases - 5-year survival by age and sex 81
Contents vii
Table 4.11.1 Squamous - I-year survival by age and sex 82
Figure 4.11.1 Squamous -I-year survival by age and sex 83
Table 4.11.2 Squamous - 5-year survival by age and sex 84
Figure 4.11.2 Squamous - 5-year survival by age and sex 85
Table 4.12 Adenocarcinoma - I-year survival by age and sex 86
Figure 4.12 Adenocarcinoma - I-year survival by age and sex 87
Table 4.13 Anaplastic - I-year survival by age and sex 88
Figure 4.13 Anaplastic -I-year survival by age and sex 89
Table 4.14 Annual rates by quinquennium 90
Table 4.15 Annual rates by quinquennium and sex 91
Table 4.16 5-year rates by quinquennium and site 91
5 Treannent 92
5.1 Summary of Findings 92
Table 5.1 Type oftreatment: Distribution 94
Figure 5.1 Type of treatment: Distribution 95
Table 5.2 Treatment by histological category 98
Figure 5.2 Treatment by histological category 99
Table 5.3 Treatment by site 100
Figure 5.3 Treatment by site 101
Table 5.4 Treatment by sex 102
Figure 5.4 Treatment by sex 103
Table 5.5 Treatment: Mean age by sex 104
Table 5.6 Primary anti-tumour treatment (PATI): Curative v. palliative 106
Figure 5.6 Primary anti-tumour treatment (PATI): Curative v. palliative 107
Table 5.7 PATI: Curative v. palliative by histology 108
Figure 5.7 PATI: Curative v. palliative by histology 109
Table 5.8 PAT I: Curative v. palliative by site 110
Figure 5.8 PATI: Curative v. palliative by site 111
Table 5.9 PAT I: Curative v. palliative by sex 112
Figure 5.9 PATI: Curative v. palliative by sex 113
6 Survival after Treannent 114
6.1 Summary of Findings 114
Table 6.1.1 I-year rate by treatment 116
Table 6.1.2 5-year rate by treatment 117
Figure 6.1 Annual rate by treatment 119
Table 6.2 I-month mortality by treatment 121
Table 6.3 I-month mortality by treatment and sex 123
Table 6.4 Primary anti-tumour treatment (P A TI): Curative v. palliative 124
Figure 6.4 Primary anti-tumour.treatment (PATI): Curative v. palliative 125
Table 6.5 P A TI: Curative v. palliative by sex 127
Figure 6.5.1 PATI: Curative by sex 128
Figure 6.5.2 PATI: Palliative by sex 129
Table 6.6 PATI: Curative v. palliative by histology 132
Figure 6.6 Curative resection or radiotherapy by histology 133
Table 6.7 P A TI: Curative v. palliative by site 136
Figure 6.7 Curative resection or radiotherapy by site 137
Table 6.8 Curatively treated by sex and histology 139
Figure 6.8.1 Squamous -curative resection or radiotherapy by sex 140
Figure 6.8.2 Adenocarcinoma - curative resection by sex 141
Table 6.9 Curatively treated by sex and site 143
Figure 6.9.1 Curative resection by sex and site 144
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Figure 6.9.2 Curative radiotherapy by sex and site 145
Table 6.10.1 I-year rate for curatively treated by site, treatment and decade 148
Table 6.10.2 5-year rate for curatively treated by site, treatment and decade 149
Figure 6.10.1 Upper third - radiotherapy/chemotherapy 150
Figure 6.10.2 Middle third-resection 150
Figure 6.10.3 Middle third - radiotherapy/chemotherapy 151
Figure 6.10.4 Lower third - resection 151
Table 6.11 Squamous - resected cases by node status 153
Table 6.12 Adenocarcinoma - resected cases by node status 155
Table 6.13 Anaplastic - resected cases by node status 156
Table 6.14.1 Curative resection by age and sex 158
Table 6.14.2 Curative radiotherapy by age and sex 159
Figure 6.14 Curative resection and radiotherapy by age 160
Table 6.15 No primary anti-tumour treatment 162
Figure 6.15 No primary anti-tumour treatment 163
Table 6.16 Other treatment by histology 164
Table 6.17 No treatment by histology 165
7 Atypical Tumours 166
Table 7.1 Lymphoma, Sarcoma and other Rare Histologies 167
Appendix 1 Birmingham and West Midlands Regional Cancer Registry 171
ALl Beginnings 171
Al.2 Aims 173
Appendix 2 Standardised Rates 175
A2.1 Standardised Incidence Rates 175
A2.2 Survival Rates 176
A2.3 Numerical Illustrations 179
Appendix 3 Census and Inter-censal Populations 181
References 184
Foreword
Although it is now some fifty years since the first successful one-stage oesophagectomy
with oesophago-gastric anastomosis was performed, the management of carcinoma of
the oesophagus continues to present many problems. Not least among these is the fact
that the results of all current methods of treatment, with an overall five-year survival
rate of about 5%, are so disappointing.
Oesophageal cancer is not a common disorder and it is therefore difficult for
individual clinicians to acquire adequate experience regarding the many complex
aspects of the disease and the most appropriate manner in which to manage it.
This report, based on The West Midlands Cancer Registry, seeks to remedy some of
these deficiencies. Because of its ability to collect and collate data on 95% of all
varieties of malignant disease occurring in a population of five million, the Registry has
established an enviable international reputation in the epidemiological aspects of
malignant disease and the results of its treatment.
I commend this study to its readers, for in the pages which follow they will find a
great deal of authoritative facts which will stimulate their interest and improve our
understanding of this dreaded disease. The work is both welcome and timely. I hope it
will be the forerunner of many more of a similar nature, and I warmly congratulate all
those who have worked so hard to bring it to fruition.
London WC2A 3PN, 1986 Sir Geoffrey Slaney, KBE
President
The Royal College of Surgeons of England
ix
Acknowledgements
This book is based entirely on the data in the Birmingham and West Midlands Regional
Cancer Registry.
We thank all those who - over many years - have given so generously of their time
and expertise to ensure the completeness and accuracy of the data in the Registry.
These include:
From hospitals:
Consultant clinicians and pathologists
Administrators
Junior medical staff
Laboratory technicians
Medical records staff
Medical secretaries
From the University of Birmingham:
The staff of the Computer Centre, Director Prof P. Jarratt
Throughout the Region:
Coroners
General practitioners
Staff of family practitioner committees
From the Registry:
All the staff (both past and present) and in particular Ms Claudia Roginski, the
present Deputy Director, who was previously the statistician on the Monograph
Team.
From the Monograph Team:
Mrs Vanessa Chadderton for her indefectible and indefatigable technical and
secretarial help.
The Cancer Registry is supported mainly by the West Midlands Regional Health
Authority.
The Monograph Project has been most generously supported by grants from:
Cancer Research Campaign
Department of Health and Social Security
Medical Research Council
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