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A 62 year old Caucasian male who started experiencing symptoms including painful swallowing, heart burn, and cough.

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Kristen Bolek
Clint McCarty
Anthony Lujan
Kenneth Cates
Yazmin Puentes
Nicole Alvillar

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CT reveals the mass has spread to patient's lymph nodes and liver

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Future Patients with Esophageal Cancer and their prognosis:

treatment completed - revisit for check up
- either for signs of cancer still there
- treatment side effects
- any questions or problems
- doctor visit every 3-6 months for first 2 years, changes to 6-12 months every 3 years and then once a year after that.

- side effects may last a few days/ weeks or longer
- may not show up until years later
- trouble swallowing
- leads to weight loss or weakness due to lack of nutrition
- certain surgeries can affect eating habits
- may have problems with esophageal stricture (narrowing of esophagus); possibly placing stent
-feeling like you don't want to eat anything/ don't feel like eating
- dumping syndrome - stomach passes food too quickly; causes diarrhea, sweating and flushing after eating.
- chest pain

lowering risk
- staying active
- eating a certain type of diet
- taking nutritional supplement
- decrease smoking and drinking alcohol; helpful to stop to increase appetite and with tolerating chemo therapy and radiation.

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Chemotherapy was unsuccessful in treating Charles' condition. Charles makes his final arrangements to see that his his affairs are settled and his family provided for. At first he does his best to maintain a brave face for his family and friends, but inside he is terrified of dying. As he weakens more and more his fears subside. Fortunately he has reached the point where he is just too exhausted to be afraid and is beginning to look forward to it all just being over. He has been put on hospice care and is made as comfortable as possible. 5 weeks after getting on hospice, Charles passes away peacefully in his sleep. The journey is completed.

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Charles will be given a palliative dose prescription. This is in hopes to relieve the dysphagia that has been occuring. Charles will be receiving a dose of 20 Gy in 5 fractions. He will lay on the table head first, supine every day for treatment. We will take a daily image to ensure everything lines up correctly. It is critical that Charles lays as straight and still as possible.

Field design and critical structures:
Esophageal cancer spreads longitudinally with a skin lesions up to 5 cm from the primary lesion.
The clinical treatment volume includes the regional lymphatics and encompasses the primary tumor with a 3 cm to 4 cm margin above and below the gross tumor volume and a 1 cm radical margin.
- IMRT fields
- VMAT

Side effects:
After two weeks of radiation, Charles may experience esophagitis. Many patients report substernal pain during swallowing and the sensation of food sticking to the esophagus.

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Doctor talks to Charles about his newly diagnosis of esophageal cancer & orders a CT scan.....

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Doctor talks to Charles about his newly diagnosis of esophageal cancer & orders a CT scan.....

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With esophageal cancer, there are different approaches to go about treating it.  Surgery would be the first, optimal choice, but is most effective when the tumor is localized to the area of origin.  Unfortunately for our patient, it seems that the cancer has already begun to metastasize and spread to other parts of his body.  This automatically makes this a stage IV cancer.  This also means  chemotherapy will be one of our most likely options for the patient.  Using cytotoxic drugs in chemotherapy is a systemic approach.  This means the cancer cells will be destroyed throughout the body, no matter the location.  This of course comes with side effects the most prevalent being fatigue.  Another important thing will be radiation therapy.  Using external beam radiation therapy can be curative or palliative (easing the symptoms).  Our patient is suffering from many symptoms so i highly recommend radiation therapy as a palliative treatment.

As mentioned previously, this is stave IV cancer.  Specifically T2N1M1.  The T describes the tumor size, which is between 3-5 cm.  N means lymph node involvement, which in this case means 4-9 lymph nodes involved.  M, objectively the most important is for metastases, or spread to other parts of the body.  This is what will automatically make it a stage IV.

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Although Charles had feeling things were not good, his worst fears are realized. Having done some independent research online Charles knows his chances for survival are slim at best, but he is determined to fight as best he can. More troubling to Charles is having to tell his family and friends. He enjoys a very close relationship to these people and he knows how much they care for him and how heart-breaking the news will be for them. At this point the fear of dying has not crossed his mind. That part has yet to sink into his thoughts. As he dreads telling everyone he starts to feel anger at himself for all the years of smoking which undoubtedly has been the greatest contributing factor to his illness.
Charles breaks the news to his wife who struggles at first not to cry but she just can't help it. Her tears brings Charles to tears as well. Not for himself, but for her. After the crying subsides Charles steels himself as there are more loved ones to tell and many, many more tears to shed.

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In the lab, the pathologist analyzes the biopsy...

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In the lab, the pathologist analyzes the biopsy...

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An endoscopic biopsy confirmed the diagnosis of invasive adenocarcinoma of the esophagus. This type of cancer originates in the glandular cells of the lower esophagus and most commonly metastases to the lymph nodes, lung, liver, bones, adrenal glands, and brain.

Report sent to back to the physician indicates:

Invasive cancer cells have grown beyond the mucosa (the inner lining of the esophagus). This means that it is a true cancer and not a pre-cancer.

Indicates poorly differentiated cells which means that the cancer is high-grade and can grow and spread quickly.

Barrett's syndrome not indicated on this report, but is a risk factor for this type of cancer as Barrett's cell dysplasia is considered pre-cancerous.

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EGB(Esophagogastroduodenoscopy) is performed.

EGD results with discovery of large mass

Biopsy collected and sent to lab for testing

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Charles returns several weeks later with increasing severity of original symptoms with the addition of regurgitation of food and liquids. 

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He is starting to worry.

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1st Diagnostic Imaging Study                      Modified Barium Swallow

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1st Diagnostic Imaging Study                      Modified Barium Swallow

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Modified Barium Swallow is conducted to observe function of the esophagus and at what location reflux occurs.

Results of MBS inconclusive, mild reflux observed. Results sent to physician. (patient prescribed medication to treat acid reflux.)

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Charles visits his doctor who orders a diagnostic imaging study to visualize his swallowing function more closely. 

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Charles visits his doctor who orders a diagnostic imaging study to visualize his swallowing function more closely. 