CARCINOMA OF CESOPHAGUS AND CARDIAC END OF STOMACH

Abstract

The patient with a carcinoma of the oesophagus or the cardiac end of the stomach presents no longer the hopeless problem that he had previously. It may be said that this paper presents no argument to prove this, as of the six patients whose histories are presented, but one is still living. This one, however, presented the most difficult operative problem. The other case of oesophageal carcinoma was probably a hopeless surgical problem from the beginning. The patient, however, elected to take his chances. The experience gained from these two cases would lead me to advise any patient with such a lesion to submit to radical operation. The statement made that oesophageal carcinoma is inoperable before it presents symptoms is not the experience met with in these two cases, as these lesions were readily resectable. However, I believe that all cases of oesophageal obstruction occurring in patients of the cancer age should be diagnosed by active means at the earliest moment and if a positive diagnosis cannot be made immediately, the patient should be subjected to an exploratory thoracotomy. Should a carcinoma be found, it can be resected immediately. Carcinoma of the cardiac end of the stomach will always present a difficult problem, as its situation, with consequent lack of mechanical interference with alimentary function, will be responsible for an advanced state of growth before the production of symptoms. Again, unless the radiologist has the possibility of the lesion in mind and looks for it, he may quite easily overlook it. However, when once the diagnosis is made, an exploration is justified, as the lesion may be removable. The mortality, immediate and late, is high. It will be high, as the mortality of any new procedure designed to help very sick people is always high until, with increasing experience, surgeons make fewer mistakes. This is no justification, however, for failing to make the attempt. Without operation the disease is fatal and we now have a way out. The way is hard, but it is possible and should be undertaken.