Synchronous esophageal and gastric cancers

Abstract

A 67-year-old man presented with progressive dysphagia and weight loss since 3 months. Barium meal study showed suspicious irregularities both in mid-thoracic portion of esophagus and proximal part of stomach. Endoscopic ex-amination revealed severe stricture in thoracic esophagus. Passage of endoscope through esophageal tumor was not possible. Surgical exploration revealed the large mid-tho-racic esophageal cancer and proximal gastric tumor, about 12 cm apart. He underwent trans-thoracic esophagectomy, proximal gastrectomy and gastric pull-up successfully. His-topathologic examination showed synchronous esophageal and gastric sequamous cell carcinoma with intervening normal mucosa.The diagnosed multiple cancer cases have recently been increasing in number. The frequency of synchronous esophageal and gastric carcinomas is increasing due to de-velopment of more sophisticated invasive and non-invasive diagnostic tools and an increase in the number of elderly patients [1]. Esophageal and gastric cancers share some risk factors; including diet, low socioeconomic status, age, alco-hol and tobacco use, and nitrites.The possibility of multiple primary cancers should be kept in mind during the preoperative examination. In case of esophageal cancer with severe stricture, when endoscope cannot be passed through the esophagus, the stomach should be carefully examined in a barium meal study. Intraopera-tive gastric observation should be done when the upper gas-trointestinal series reveal certain gastric abnormalities [1].