KHANI.M,MD MEDICAL ONCOLOGIST&HEMATOLOGIST ISFAHAN BLOOD&CANCER INSTITUE

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 PHE:cachexia,temporal muscle wasting,no lap LAB:hb=10,plt=180,000,serum alb=2.5

Endoscopy result A 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 available Thoracic 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? PET PET/CT Pelvic &cervical ct?

Pathology report Poorly differentiated adenocarcinoma Tumor invades muscularis propria

Clinical staging T2,N1,M0 Stage IIb

Next step? Surgery Radiation Chemoradiation then surgery Definitive chemoradiation Chemo then chemorad then surgery +- chemo

This patient recived 2course ECF then chemoradiation then surgery

SURGERY TRANSHIATAL

Post surgery pathology report Poorly differentiated adenocarcinoma All margin free Tumor invades adventitia 4 out of 4 lymph node free of tumor T3N0/1M0 at least IIA

NEXT? 2 more ECF Follow up

Thank You

CASE NO:2 A 60 y/o male PMH: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 vomiting PHE:several deformity of face due to flap with dirty wound,cervical lap 2*3 cm,hoarsness

ENDOSCOPY RESULT A MASS LESION LOCATED IN 25 CM OF INCISURA TEETH CAUSE NEAR COMPLETE OBSTRUCTION OF LUMEN,MULTIPLE BIOPSY WAS TAKEN

PATHOLOGY REPORT SQUAMOUS CELL CARCINOMA

NEXT STEP? CERVICAL,THORACIC CT SCAN ABDOMINOPELVIC CT? BRONCHOSCOPY LAPAROSCOPY? PET OR PET/CT? EUS

RESULTS MASS LESION IN THORACIC ESOPHAGUS,DIMINISH FAT STRIP BETWEEN TRACHEA&ESOPHAGUS WITH MULTIPLE MEDIASTINAL LAP NORMAL ABDOMINOPELVIC CT BRONCHOSCOPY:NORMAL,NEGATIVE BIOPSY OF SUSPICIOUS AREA

T3/T4,N1,M0 STAGE III

NEXT STEP? SURGERY DEFINITIVE CRT CX -> CRT-> CX ->+-SURGERY CX-> CRT > SURGERY

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

AFTER 5 WEEK CONTINUE DYSPHAGIA ENDOSCOPY:DECREASED STENOSIS BUT PERSISTANT MASS THORACIC CT:NO OBVIOUS CHANGES COMPARE TO PREVIOUS CT,NO OBVIOUS OTHER ORGAN ADHESION

PET BIOPSY

RADIATION SURGERY CX