Clinical Case….. ULB - Hôpital Erasme Clinic of Upper Gastro Intestinal Tract Surgery Department of Digestive Surgery Eleonora Farinella

History: January 2014 Clinical Presentation: Vomiting Dysphagia for solid foods Weight loss -10kg Anaemia

ADENOCARCINOMA CARDIA SIEWERT II Diagnostics: April 2014 Esophago-gastroscopy: Tumor of the cardia Extension: >39 cm and <46 cm Tumor centre: 42 cm Biopsy: Well-differentiated adenocarcinoma ADENOCARCINOMA CARDIA SIEWERT II

ESOPHAGEAL SCANNER (16/04/14): Tumor staging(1): ESOPHAGEAL SCANNER (16/04/14): Thickening of the lower esophagus and the lesser curvature of the stomach. Locoregional adenopathy: mediastinum and perigastric No liver or lung metastasis c T4 N+ M0, SIEWERT II

Tumor staging(2): PET/CT (18/04/14): Hyper metabolic lesion of the cardia Metastatic lymphadenopathy of lesser curvature

ENDOSCOPIC ULTRASOUND (14/4/14): Tumor staging(3): ENDOSCOPIC ULTRASOUND (14/4/14): Stenosis lesion of cardia. Tumor-infiltrating the cardia, pleura and diaphragmatic pillars. Locoregional adenopathy peri cardial u T4 N +, SIEWERT II GASTROESOPHAGEAL TRANSIT (15/04/14): Large sub-cardial ulceration. The whole stomach is the seat of a parietal malignant infiltration.

Option (s) treatment (s)? Primary surgery Neoadjuvant chemotherapy Neoadjuvant chemoradiotherapy Definitive chemoradiation Palliative treatment

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