Primary carcinoma esophagus with unusual synchronous second malignancies: A case series

Multiple primary cancer is no longer a rarity. As life expectancy has increased, more individuals are living long enough to develop not only one but also two or more cancers. Herein, we report on three cases of synchronous malignancies associated with the primary esophagus cancer. All three patients posed a challenge for the treatment. These patients carry a dismal prognosis so early diagnosis of subsequent cancer at a curable stage by regular follow-up is encouraged. The early investigation of new symptoms and signs may help to diagnose, initiate early treatment, and reduce the number of deaths from subsequent primary cancers in patients.

Clinical profile of patients with esophageal carcinoma: A multicentric study from North India

Background: Carcinoma esophagus is the 6th most common cancer in India with an incidence of 5.04% It most commonly affects older age individuals, with incidence peaking in seventh and eighth decades of life. Adenocarcinoma (AC) and Squamous cell carcinoma (SCC) are the two main histological variants. Our aim was to study the risk factors, clinical and epidemiological profile of patients diagnosed with Esophageal Cancer from two tertiary care centres located in North India.Methods:This was a retrospective study carried in departments of gastroenterology of two tertiary care hospitals North India. Data was collected from respective institutes for the previous 1 year i.e. from 1st October 2020 to 30th September 2021. All patients presenting to Gastroenterology OPD or emergency with dysphagia who were diagnosed as having Carcinoma esophagus were included in the study.Results:A total of 106 patients were included in this study. There were 44 females & 66 males. The most common presenting complaint was Dysphagia (48%) followed by Loss of weight (26.4%), Vomiting (in 23.6%) and Odynophagia (22.6%). Involvement of the lower one third of the oesophagus was the most common (37.7%). SCC (Squamous Cell Carcinoma) was the most common type of oesophageal carcinoma in this study, seen approximately in 80% of cases.Conclusion:Our study from North India suggested poor oral hygiene as a strong risk for carcinoma esophagus Males were more commonly affected and SCC was the predominant variant.

A Prospective Study on Concurrent Chemoradiation in Inoperable Carcinomas Esophagus

introduction: Despite many advances in both surgery and radiotherapy, the treatment of esophageal cancer remains a challenge for both surgeons and oncologists. The treatment of choice for patients with carcinoma esophagus is controversial. Recent studies have suggested that combined chemotherapy and radiation therapy may result in improved survival. Aim: The aim of our study was to analyze the role of concurrent chemoradiation in inoperable carcinomas esophagus. Materials and Methods: This single-arm prospective study was conducted in the Department of Radiotherapy, Thanjavur Medical College Hospital from August 2018 to August 2019 to analyze the role of concurrent chemoradiation in inoperable carcinomas esophagus. A total of 26 cases of inoperable cases of carcinoma esophagus were treated with once-weekly cisplatin 30 mg/ m2 along with radiotherapy 60 Gy in 30 fractions in 6 weeks on telecobalt machine. Results: Of 26 patients 16 patients were males, 10 patients were females, 17 patients had age <60 years, 9 patients had age above 61 years, 22 patients had squamous cell carcinoma, 4 patients had adenocarcinoma, 4 patients had lesion in upper part of esophagus, 14 patients had lesion in middle part, 8 patients had lesion in lower part, 4 patients had tumor dimension <5 cm, 22 patients had dimension >5.1 cm, 2 patients had tumor stage T1, 22 patients had T2, 2 patients had T3, 1 patient had Nx, 21 patients had No, 4 patients had N1, 15 patients had mild dysphagia, 8 patients had moderate dysphagia, 3 patients had severe dysphagia1 patients had diarrhea, 1 patient had fatigue, 4 patients had leukopenia, and 1 patient had neutropenia. Conclusion: Combined modality therapy plays a significant role in the treatment of patients with carcinoma esophagus. Concurrent chemoradiation is a superior treatment in inoperable carcinoma esophagus in terms of local control and survival. Hence, concurrent chemoradiation can also be tried in early cases and surgical morbidity survival and quality of life can be improved.

Retrospective Analysis of Risk Factors in Cases of Biopsy Proven Carcinoma Esophagus in an Urban Indian Population

Aims and Objectives: Carcinoma (Ca) esophagus is a life-threatening malignancy in Indian scenario, due to late-stagepresentation and limited treatment options. Rampant tobacco and alcohol use have seen a rise in the incidence of squamous cellCa esophagus. Accurate identification and description of risk factors are critical to the implementation of preventive measures.The data in this regard are lacking in our country.Materials and Methods: This was a retrospective study conducted at a tertiary care center in Southern India. 103 patients withbiopsy-proven esophageal Ca presenting over a period of 22 months were studied. The data regarding smoking and alcoholconsumption, history of gastroesophageal reflux disease (GERD), Helicobacter pylori infections as assessed by rapid ureasetest during endoscopy and documentation suggestive of tylosis were collected by means of a questionnaire and analysis ofexisting medical documents. No therapeutic or diagnostic interventions were made based on the data collected.Results: Smokers were more likely to develop squamous cell Ca (82.1%, P = 0.04, Z = 1.74) as well as adenocarcinoma (41%,P = 0.01, Z = 5.18). Alcohol consumption was more likely to develop both squamous cell Ca (39%, P = 0.01, Z = 1.73) andadenocarcinoma. Smoking, GERD, and H. pylori infection had a significantly higher association with adenocarcinoma than withthe squamous cell Ca while alcohol use and caustic injury had a higher association with squamous cell Ca.Conclusion: A systematic analysis of risk factors shows that smoking and alcohol are strongly associated with bothhistopathological subtypes of this malignancy. Other risk factors were H. pylori infection, GERD, caustic injury, and tylosis.

Radiation Schedules for Palliation in Carcinoma Esophagus.

This study was undertaken to compare the three different radiation schedules for their efficacy in symptom relief, dysphagia free survival and radiation morbidity (if any), in carcinoma oesophagus. A total of 116 inoperable patients were prospectively randomized to three different arms of radiation. Arm-A received external beam radiation (EBRT) to a dose of 30Gy/10 #/2 weeks along with two sessions of intraluminal brachytherapy (ILBT), 600cGy each, one week apart, after a gap of two weeks from EBRT. Arm-B received only EBRT to a dose of 30Gy/10 #/2 weeks. Arm-C received EBRT to a dose of 20Gy/5#/1week without brachytherapy. The age of the patients ranged from 30 - 70 years. Improvement in dysphagia was seen in 76% of patients in Arm-A, 56% in Arm-B & 54% in Arm-C at 1 month. The dysphagia progression free survival was 10.6+0.6 months in Arm-A, 9.8+0.8 months in Arm-B and 9.9+0.6 months in Arm-C respectively. Grade 1 & 2 acute radiation toxicity was seen in 50% of patients in Arm-A, 55% patients in Arm-B & 30% patients in Arm-C. It is concluded that all the three radiation schedules achieved good palliation with similar dysphagia free survival.

Role of Combined Approach with Radiotherapy and Metallic Stent in Palliation of Advanced Cases of Carcinoma Esophagus -APilot Study

Carcinoma esophagus presents with dysphagia and in 60% of patients, the aim of treatment is palliation. ThIs study was done to evaluate the feasibility and role of planned combined approach using radiotherapy with metallic stent in palliation of malignant dysphagia. Ten patients with histologically proven, locoregionally advanced esophageal carcinoma were selected. All patients underwent external radiotherapy followed by brachytherapy. The self-expanding metallic stent was placed under combined endoscopic and fluoroscopic guidance. A predetermined questionnaire to assess dysphagia, pain, reflux symptoms and quality of life was administered before the procedure, and thereafter at monthly intervals until death or last follow-up. 10/10 patients had grade III dysphagia at presentation. 4/10 patients underwent stent placement prior to any radiotherapy (group A), 4/1 0 patients had stent placement after external radiotherapy (group 8) and 2/1 0 had stent after completion of brachytherapy (group C). There was no difficulty in placing the stent despite the post-radiotherapy ulcerations and stricture in all the patients in group 8 and C. 8/8 patients in groups A and 8 had no difficulty in placing esophageal bougie for brachytherapy. The mean follow-up after stent placement was 9 months (4-24 months). There was complete disappearance of dysphagia in 4/4 patients in group A, 2/4 patients in group Band 0/2 patients in group C. The rest of patients had significant improvement in dysphagia score by atJeast two grades. For dysphagia grade. the mean progression free interval was recorded as 5 months for group A, 3 months for group Band 2 months for group C. Combining radiotherapy and metallic stent is a safe, simple and effective means to palliate malignant dysphagia. This raises an issue whether all patients with advanced carcinoma esophagus should preferably be pre planned for stent placement followed by radiotherapy for best results.