Case report

Asis.Univ.Iulia Ratiu
Department of Gastroenterology and
Hepatology
 Presenting complains

RG 61 years,M,admitted to perform
upper endoscopy
●Dysphagia(only for solids)
●Weight loss(~10 kg in one month)
●APP:HTA,GERD,H.Pylori infection
●AHC:none
●Smoker,heavy drinker
 Clinical examination
●Inspection:Casexia
●Palpation:laterocervical
adenopathies
●Cardiovascular system:HR=80
bpm,BP=140/90 mmHg
 Blood tests
• Complete blood count: RBC =4.78 mil/mmc, Hb =
9.0 g/dl, Ht = 42.6 %, WBC = 9000/mmc (N = 89.8
%, PLT =235000/mmc;
• Chemistry: BUN = 30 mg%, creatinine = 1.1 mg%,
ASAT = 34U/l, ALAT = 40 U/l, BT = 1.3 mg%, INR=
1.3, VSH= 45mm/h; Fibrinogen= 512 mg/dl; CRP=
160 mg/l; Serum iron= 12 ng/ml
• Blood ionogram tests: Na = 142 mmol/l, K = 3.5
mmol/l;
 Paraclinical Examination

●EKG:sinus rhythm,intermediate QRS

axis
●Abdominal ultrasound:did not show
any pathological changes
●Barium X-rays:infiltrative and
exophytic lesions
Upper endoscopy
Upper endoscopy
Upper endoscopy
Esophageal cancer documentation
• Localisation
• Tumor size
• Lesion aspects-exophytic masses with
obstruction
-infiltrative
-ulcerated
• Biopsy:-collecting samples of suspicious tissue
-cytologic esophageal brushing
Histology of esophageal cancer

●Esophageal squamous cell carcinoma

●Esophageal adenocarcinoma
Stadialisation of esophageal
carcinoma
 Stadialisation

●Abdominal ultrasound:no
changes/secondary liver lesions
●CT scan thorax and abdomen with
contrast:secondary lesions and
periesophageal extension
●EUS:can evaluate the depth of invasion
and the presence of nodal involvment.
 Differential diagnosis

●Benign and malignant epithelial

tumors: (squamous cell
papilloma,neuroendocrine tumors)
●Benign non-epithelial
tumors(leiomyoma,lipoma,fibroma,h
emangioma)and
malignant(sarcoma,lymphoma)
 Treatment
Multidisciplinary decision making:
●Surgeon(early stages 0 and I)
●Oncologist(advanced stages II A and
B,III):chemotherapy combined with
radiation therapy or combined
therapy(radio-chemotherpy before surgery)
●Gastroenterologist:metastatic esophageal
cancer(stage IV):upper endoscopy with
stents placement in the esophagus
 Complications
• Severe denutrition due to dysphagia,vitamin and
nutritional deficiencies
• Tracheo-esophageal fistulas
• Compression and invasion of aorta,vena
cava,pericardium.
• Superior vena cava syndrome or the mediastinal
syndrome(edema of the neck-”the collar of
Stokes”,facial edema).
• Secondary lesions:secondary metastatic nodes or
secondary liver/pulmonary lesions.
 Prognosis
• Bad prognosis
• Survival rate: 5 year survival rate is 9%.
• Median survival rate:1 year.
Thank you!