AN UNUSUAL CASE OF SQUAMOUS CELL ESOPHAGEAL CARCINOMA IN A 34 YEAR OLD MALE

Abstract

The majority of esophageal cancers are squamous cell or adenocarcinomas. Although the incidence of squamous cell carcinoma (SCC) is decreasing in the United States, the incidence of adenocarcinoma is rising dramatically. The prognosis for both types of cancer is poor. We present an unusual case of a 34-year-old male who presented with squamous cell carcinoma of esophagus. He presented with history of jaundice, intermittent diffuse abdominal pain and a 25 lb weight loss. He also had nausea, vomiting and two episodes of hematemesis. The patient was diagnosed with SCC of esophagus two years prior to this visit (stage T3NOMO). He was treated with subtotal esophagectomy after chemotherapy and radiation. Physical exam was within normal limits. Lab abnormalities include a total bilirubin of 10.3 mg/dl (direct bilirubin 6.6 mg/dl and indirect bilirubin 3.7 G/dl), alkaline phosphatase 603 U/L, AST 218 U/L, ALT 333 U/L. CEA was elevated at 128.4 ng/ml and CA 19–9 was elevated at 97 U/ml. CT scan of abdomen showed extensive retroperitoneal and mesenteric adenopathy. Biopsy of retroperitoneal mass was positive for squamous cell carcinoma. The most common risk factors for SCC are alcohol intake, cigarette smoking and ethnicity (African American). In patients with local esophageal cancer diagnosed at early stage, surgery along with adjuvant chemotherapy and radiation therapy may have curative potential. Esophageal cancer is more amenable to therapy in early stage. Screening for esophageal carcinoma has not been well studied. Screening studies have shown promise in high prevalence areas like China and Japan. In one mass screening program conducted in 11,564 asymptomatic patients over the age of 30, stage I carcinoma was found in 96% of cancers detected. Early detection of esophageal carcinoma by balloon cytology and endoscopic mucosal staining has shown some positive results. The question of whether our patient would have benefited from such screening procedures is uncertain. Being African-American, a smoker and an alcoholic puts a patient at higher risk category. Though a population-wide screening program is not feasible and not recommended due to low incidence of the disease, physicians should be alert for warning signs in high risk populations. Cost effective screening procedures should be further explored.