Question

Post-cricoid carcinoma of the oesophagus is best treated by

• A. Radiotherapy
• B. Total oesophagectomy
• C. Pharyngolaryngectomy with gastric transposition
• D. Intubation through growth

Hint:

Think about which option both removes the tumour completely and reconstructs the swallowing passage.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question asks for the standard curative treatment of a postcricoid carcinoma, a tumour arising at the pharyngo-oesophageal junction just below the cricoid cartilage.

Step 2: Key Concept or Approach:
Postcricoid carcinomas often present late and can involve the lower hypopharynx and cervical oesophagus together, so a treatment that removes the whole affected segment and reconstructs a functional swallowing passage in one operation is preferred for suitable, operable disease.

Step 3: Working Through the Options:
Radiotherapy alone can be used for early or inoperable disease but gives inferior local control compared to surgery for a bulky postcricoid tumour and is not the best option when surgery is feasible. Total oesophagectomy alone does not adequately address the hypopharyngeal/laryngeal extent of the disease and leaves the airway/swallowing reconstruction incomplete. Pharyngolaryngectomy with gastric transposition removes the pharynx, larynx and cervical oesophagus en bloc and immediately restores a conduit for swallowing by pulling the stomach up to the neck, giving both adequate oncological clearance and functional reconstruction, which is why it is the treatment of choice. Intubation through the growth is a palliative measure to relieve dysphagia in inoperable disease, not a curative treatment.

Step 4: Conclusion:
Pharyngolaryngectomy with gastric transposition is the best treatment for postcricoid carcinoma.