ESOPHAGEAL CANCERKHANI.M,MD

MEDICAL ONCOLOGIST&HEMATOLOGIST ISFAHAN BLOOD&CANCER INSTITUE

WWW.IBCI.IR

First step?

CASE NO :155 Y old previously obese manProgressive dysphagia & chest pain & weight

loss since 3 month agoPast history of GERD for 5 years+smoking

20p/yPHE:cachexia,temporal muscle wasting,no

lap LAB:hb=10,plt=180,000,serum alb=2.5

Endoscopy resultA polypoid 3*3 cm mass lesion in distal

esophageus near z line,multiple biopsy taken the scope don’t pass the lesion so evaluaion of stomach wasn’t possible

Second step?

EUS wasn’t availableThoracic ct scan:mass like lesion in distal

esohagus highly suggest GE junction tumor, regional(diaphragmatic&pericardial) lap present

Echo=EF 65%.mild pericardial effusion

Third step?

Abdominoplvic ct scan: no lymphadenopathy, no metastatic lesion

Laparascopy?PETPET/CTPelvic &cervical ct?

Pathology reportPoorly differentiated adenocarcinomaTumor invades muscularis propria

Clinical stagingT2,N1,M0Stage IIb

Next step?SurgeryRadiationChemoradiation then surgeryDefinitive chemoradiationChemo then chemorad then surgery +-

chemo

This patient recived 2course ECF then chemoradiation then surgery

SURGERYTRANSHIATAL

Post surgery pathology reportPoorly differentiated adenocarcinomaAll margin freeTumor invades adventitia4 out of 4 lymph node free of tumorT3N0/1M0 at least IIA

NEXT?2 more ECFFollow up

Thank You

CASE NO:2A 60 y/o malePMH:CLL BINET B (chlorambucil+pred),SCC

of face skin (surgery+radiation+flap),DM(insulin)

Heavy smoker,Progressive dysphagia&weight loss since 3

mo ago+intractable vomitingPHE:several deformity of face due to flap

with dirty wound,cervical lap 2*3 cm,hoarsness

ENDOSCOPY RESULTA MASS LESION LOCATED IN 25 CM OF

INCISURA TEETH CAUSE NEAR COMPLETE OBSTRUCTION OF LUMEN,MULTIPLE BIOPSY WAS TAKEN

PATHOLOGY REPORTSQUAMOUS CELL CARCINOMA

NEXT STEP?CERVICAL,THORACIC CT SCANABDOMINOPELVIC CT?BRONCHOSCOPYLAPAROSCOPY?PET OR PET/CT?EUS

RESULTSMASS LESION IN THORACIC

ESOPHAGUS,DIMINISH FAT STRIP BETWEEN TRACHEA&ESOPHAGUS WITH MULTIPLE MEDIASTINAL LAP

NORMAL ABDOMINOPELVIC CTBRONCHOSCOPY:NORMAL,NEGATIVE

BIOPSY OF SUSPICIOUS AREA

T3/T4,N1,M0STAGE III

NEXT STEP?SURGERYDEFINITIVE CRTCX -> CRT-> CX ->+-SURGERYCX-> CRT > SURGERY

CRT (50GY+CIS+FU) FOR 5 WEEK

AFTER 5 WEEKCONTINUE DYSPHAGIAENDOSCOPY:DECREASED STENOSIS BUT

PERSISTANT MASSTHORACIC CT:NO OBVIOUS CHANGES

COMPARE TO PREVIOUS CT,NO OBVIOUS OTHER ORGAN ADHESION

PETBIOPSY

RADIATIONSURGERYCX