Skip to main content
PMC home page
Gut logoLink to Gut
. 1992 Feb;33(2):155–158. doi: 10.1136/gut.33.2.155

Achalasia complicated by oesophageal squamous cell carcinoma: a prospective study in 195 patients.

M A Meijssen 1, H W Tilanus 1, M van Blankenstein 1, W C Hop 1, G L Ong 1
PMCID: PMC1373921  PMID: 1541408

Abstract

To determine the incidence of oesophageal carcinoma in patients with achalasia and to establish the efficacy of endoscopic surveillance, 195 consecutive patients with achalasia (90 men and 105 women, mean age 52 years), who were treated by pneumatic dilatation in our institution between 1973 and 1988 were prospectively studied. None of the patients had undergone cardiomyotomy. Follow up totalled 874 person years after pneumatic dilatation. In this period three patients developed an oesophageal squamous cell carcinoma. The mean age at diagnosis of the oesophageal carcinoma was 68 years (37, 77, and 89 years). The mean period between the onset of dysphagia and the diagnosis of the tumour was 17 years (19, 28, and 5 years); the mean interval between the diagnosis of achalasia and carcinoma was 5.7 years (5, 8, and 4 years). The incidence of oesophageal squamous cell carcinoma in this series (3.4/1000 patients per year) is significantly higher than the statistically expected incidence (0.104/1000 patients per year) using age and sex specific incidence data from the population of the Netherlands (Poisson statistics: p less than 0.001). The risk of developing oesophageal squamous cell carcinoma in patients with achalasia is therefore increased 33 fold. Periodic endoscopy showed the potential for detecting early stage oesophageal carcinoma in two cases but a larger study with a longer follow up is required to determine the efficacy of endoscopic screening in improving the prognosis for patients with achalasia who develop oesophageal squamous cell carcinoma.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson L. L., Lad T. E. Autopsy findings in squamous-cell carcinoma of the esophagus. Cancer. 1982 Oct 15;50(8):1587–1590. doi: 10.1002/1097-0142(19821015)50:8<1587::aid-cncr2820500820>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  2. BARRETT N. R. ACHALASIA OF THE CARDIA: REFLECTIONS UPON A CLINICAL STUDY OF OVER 100 CASES. Br Med J. 1964 May 2;1(5391):1135–1140. doi: 10.1136/bmj.1.5391.1135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg. 1966 Aug;52(2):164–188. [PubMed] [Google Scholar]
  4. CAMARA-LOPES L. H. Carcinoma of the esophagus as a complication of megaesophagus. An analysis of seven cases. Am J Dig Dis. 1961 Aug;6:742–756. doi: 10.1007/BF02231058. [DOI] [PubMed] [Google Scholar]
  5. Carter R., Brewer L. A., 3rd Achalasia and esophageal carcinoma. Studies in early diagnosis for improved surgical management. Am J Surg. 1975 Aug;130(2):114–120. doi: 10.1016/0002-9610(75)90358-x. [DOI] [PubMed] [Google Scholar]
  6. Chuong J. J., DuBovik S., McCallum R. W. Achalasia as a risk factor for esophageal carcinoma. A reappraisal. Dig Dis Sci. 1984 Dec;29(12):1105–1108. doi: 10.1007/BF01317084. [DOI] [PubMed] [Google Scholar]
  7. Chuong J. J., DuBovik S., McCallum R. W. Achalasia as a risk factor for esophageal carcinoma. A reappraisal. Dig Dis Sci. 1984 Dec;29(12):1105–1108. doi: 10.1007/BF01317084. [DOI] [PubMed] [Google Scholar]
  8. Correa P. Precursors of gastric and esophageal cancer. Cancer. 1982 Dec 1;50(11 Suppl):2554–2565. [PubMed] [Google Scholar]
  9. Eddy D. M. The economics of cancer prevention and detection: getting more for less. Cancer. 1981 Mar 1;47(5 Suppl):1200–1209. doi: 10.1002/1097-0142(19810301)47:5+<1200::aid-cncr2820471325>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  10. FERREIRA-SANTOS R. Aperistalsis of the esophagus and colon (megaesophagus and megacolon) etiologically related to Chagas' disease. Am J Dig Dis. 1961 Aug;6:700–726. doi: 10.1007/BF02231056. [DOI] [PubMed] [Google Scholar]
  11. Guanrei Y., He H., Sungliang Q., Yuming C. Endoscopic diagnosis of 115 cases of early esophageal carcinoma. Endoscopy. 1982 Sep;14(5):157–161. doi: 10.1055/s-2007-1021608. [DOI] [PubMed] [Google Scholar]
  12. Just-Viera J. O., Haight C. Achalasia and carcinoma of the esophagus. Surg Gynecol Obstet. 1969 May;128(5):1081–1095. [PubMed] [Google Scholar]
  13. Just-Viera J. O., Morris J. D., Haight C. Achalasia and esophageal carcinoma. Ann Thorac Surg. 1967 Jun;3(6):526–538. doi: 10.1016/s0003-4975(10)66461-2. [DOI] [PubMed] [Google Scholar]
  14. Lamb R. K., Edwards C. W., Pattison C. W., Matthews H. R. Squamous carcinoma in situ of the oesophagus in a patient with achalasia. Thorax. 1985 Oct;40(10):795–796. doi: 10.1136/thx.40.10.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lightdale C. J., Winawer S. J. Screening diagnosis and staging of esophageal cancer. Semin Oncol. 1984 Jun;11(2):101–112. [PubMed] [Google Scholar]
  16. Lortat-Jacob J. L., Richard C. A., Fekete F., Testart J. Cardiospasm and esophageal carcinoma: report of 24 cases. Surgery. 1969 Dec;66(6):969–975. [PubMed] [Google Scholar]
  17. MATHEWS E. C., VINSON P. P. Carcinoma of esophagus complicating cardiospasm; report of a case. Gastroenterology. 1950 Aug;15(4):747–749. [PubMed] [Google Scholar]
  18. Norton G. A., Postlethwait R. W., Thompson W. M. Esophageal carcinoma: a survey of populations at risk. South Med J. 1980 Jan;73(1):25–27. doi: 10.1097/00007611-198001000-00011. [DOI] [PubMed] [Google Scholar]
  19. Pierce W. S., MacVaugh H., 3rd, Johnson J. Carcinoma of the esophagus arising in patients with achalasia of the cardia. J Thorac Cardiovasc Surg. 1970 Mar;59(3):335–339. [PubMed] [Google Scholar]
  20. Schattenkerk M. E., Obertop H., Mud H. J., Eijkenboom W. M., van Andel J. G., van Houten H. Survival after resection for carcinoma of the oesophagus. Br J Surg. 1987 Mar;74(3):165–168. doi: 10.1002/bjs.1800740305. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES