Primary adenocarcinoma of the upper oesophagus.

Adenocarcinoma of the upper one-third of the oesophagus is an uncommon entity. A review of the literature reveals 20 reported cases. This paper reports an additional case. The lesion may arise from oesophageal glands, foci of ectopic gastric mucosa, or a Barrett's oesophagus. In contrast with squamous cell carcinomas submucosal spread is not prominent; however, transverse penetration through the oesophageal wall is common. The prognosis is grave. Treatment modalities that have been employed include supportive care, surgery alone, pre-operative radiation therapy and surgery and radiation therapy alone. Survival statistics produced by these various regimens are similar. There is little documented evidence for the radioresponsiveness of primary adenocarcinoma of the oesophagus. The case described demonstrates marked tumour regression following a course of external radiotherapy as shown by serial oesophagrams. Optimum treatment for adenocarcinoma of the upper oesophagus remains to be determined. It is felt that the role of radiation therapy should be further evaluated.