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ESOPHAGEAL CANCER. KHANI.M,MD MEDICAL ONCOLOGIST&HEMATOLOGIST ISFAHAN BLOOD&CANCER INSTITUE WWW.IBCI.IR. First step?. CASE NO :1. 55 Y old previously obese man Progressive dysphagia & chest pain & weight loss since 3 month ago Past history of GERD for 5 years+smoking 20p/y - PowerPoint PPT Presentation
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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