1 / 21

54- year - old woman with newly diagnosed esophageal cancer

54- year - old woman with newly diagnosed esophageal cancer. Associate Professor , Dr. Umut Kefeli, Kocaeli University School of Medicine Department of Medical Oncology. 8 th International Gastrointestinal Cancer Conference 07.12.2018. Case Presentation. 54-year-old ♀ 2 children

Télécharger la présentation

54- year - old woman with newly diagnosed esophageal cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.


Presentation Transcript

  1. 54-year-oldwomanwithnewlydiagnosedesophagealcancer AssociateProfessor, Dr. Umut Kefeli, Kocaeli University School of MedicineDepartment of MedicalOncology 8th International GastrointestinalCancer Conference 07.12.2018

  2. CasePresentation 54-year-old ♀ 2 children ECOG PS 0 Hypothyroidism No history of smoking,alcohol Dysphagia

  3. Upper GIS endoscopy: Thoracalesophagealstricture at nearly 35 cm fromtheincisors. • Thorax CT: 40 mm longirregularwallthickening at distalthoracicesophagus, nearlytotallyobliteratingthelumenwhichsuggests an esophagealmass .

  4. ThoraxCT: - Mass lesioncausesindentations of theright pulmonaryarteryandtheposteriorcontour of theleftatrium. - No clearfatplanebetweendescending aorta andthemasslesion. - Prevascular, paratrachealandrightparaesophageal, 14x7 mm. lymphadenopathies. - Right lungparenchymal, upto4.5 mm three pulmonarynodulesand2 mm subpleural noduleat leftlowerlobe.

  5. PET/CT: - 37 mm long, infracarinalesophagealwallthickening (SUVmax:32) - Right upperparatracheal, bilaterallowerparatracheal, leftprevascular, precarinal, subcarinalandbilateralhilarminimallyincreased hypermetabolic lymphadenopathies (SUVmax:4.9). - No FDG involvement in thepulmonaryparenchymaandabdominopelviclymphnodes.

  6. Histological examination of the endoscopic biopsy specimen demonstrated moderately-differentiated squamouscell carcinoma . • T4(?), N(+), M(-), clinicalstage IVAesophageal cancer was diagnosed.

  7. WHAT WOULD BE YOUR SUGGESTION? A) Neoadjuvant chemotherapy B) Definitive chemoradiation C) Preoperative chemoradiation D) Surgery

  8. Treatedwithdefinitivechemoradiation : 5-Fluoruracil andCisplatinand RT to50.4 Gy. • Patient is re-evaluatedwith PET/CT. • PET/CT reported a nearly total improvement in esophagealwallthickeningwith a total metabolicresponseandminimallyincreased FDG uptake in allmediastinalstationssuggestingreactivedisease. • Thorax CT reported a wallthickening of 8 mm in itsthickestplacewithreversal of esophagealdilatationandmultiplemediastinallymphnodesupto 10 mm diameter.

  9. WHAT WOULD BE YOUR SUGGESTION? A) Surveillance B) Surgery C) Palliativemanagement D) Chemotherapy

  10. Total esophagectomy + leftthoracotomy + witzelljejunostomy (16.11.2017): I. Total esophagectomy + subtotalgastrectomymaterial - Connectivetissuedevelopment, frequentcoagulationnecrosisareas - 1 lymphnode: carcinomametastasis - 9 lymphnodes: reactivehyperplasia II. Subcarinallymphnode: anthracosis, granulomas III. İnferiorligamentbiopsy: histiocytosis, anthracosis, granulomas No tumorsseen at surgicalborders .

  11. There werenoresidualdisease in thepostoperativeCTs.

  12. Capecitabineand oxaliplatin - Capecitabine1000 mg/m2 PO BID on Days 1–14 - Oxaliplatin130 mg/m2 IV on Day 1 - Cycled every 21 days • After 6 cycles of adjuvantchemotherapy, patient is re-evaluatedwith a PET/CT whichshowedno FDG uptake( 04.05.2018 ) • There wasnopathologicallesion in ThoraxCTs (04.11.2018).


  14. CasePresentation -2 79-year-old ♂ 2 children ECOG PS 2 GERD , COPD, CAD Persistentdysphagia

  15. Esophagography (2007): marked dilatation of the esophagus, to about 2 cm in diameter, proximal to the gastroesophageal junction, which was diagnosed as achalasia of the esophagus. • Endoscopic balloon dilatation was performed threetimes from May 2007to 2015.

  16. In September 2015, routine follow-up upper GI endoscopy revealed a shallow depressed lesion(0-IIc) in the proximal esophagus located 25 cm fromtheincisors. • The biopsy findings indicated moderately differentiated squamous cell carcinoma. • Endoscopic ultrasound (EUS) was performed andrevealed a blurring and thickening of the third layer (submucosal layer) but not fourthlayer. • There werenolymphnodesseen. • No metastases on a computed tomography (CT) scan or a positron emission tomography (PET)-CT scan.

  17. ESD was made difficult by bleeding from abundant microvessels in the submucosal layer. • The lesion was excised and pathological findings revealed partial thickening of the mucosa and squamous cell carcinoma (0-IIc, 41 x 57 mm, depth T1a-EP(M1), ly0, v0, pHM0, pVN0).

  18. In May 2017, routine follow-up upper GI endoscopy againshowed a shallow depressed lesion (0-IIc) in the upper esophagus. • An ESD is performedagain. • The pathological examination revealed squamous cell carcinoma (0-IIc, 21 x 13 mm, depth T1b(SM2), ly0, v2, pHM0, pVM0). • Patient refusedsurgery.

  19. WHAT WOULD BE YOUR SUGGESTION? A) Surveillance B) Surgery C) Definitivechemoradiation

  20. Treatedwithdefinitivechemoradiation : Capecitabineandoxaliplatin and RT to 50.4 Gy. - Oxaliplatin 85 mg/m2 IV on Days 1, 15, and 29for 3 doses - Capecitabine 625 mg/m2 PO BIDon Days 1–5 weekly for 5 weeks. • Therewere no pathologicallesions in follow-upimagings. • Since then, the patient has had no recurrence.


More Related