Synchronous Esophageal and Laryngeal Squamous Cell Cancers: A Case Report

Abstract

Introduction: It is well recognized that individuals with squamous cell carcinoma (SCC) of the upper aero-digestive tract are at risk for subsequent tumors. Furthermore, careful evaluation for synchronous SCC is a critical aspect of management. We present the unusual case of an individual with three separate primary tumors diagnosed at a single upper endoscopy. Case Presentation: The patient is a 61-year-old male who complained of gradually progressive dysphagia to solids for 3 months. This was accompanied by 30-pound weight loss in the previous 6 months and hoarseness of voice for 2 weeks. He had a 50-pack year cigarette smoking history and 40 years of moderate alcohol consumption. An older sibling had died of SCC of the larynx in his 70s. Examination was notable for cachexia and pulmonary signs of emphysema. Lab studies were unremarkable. EGD was done which showed three different lesions: a laryngeal mass involving the left side of the epiglottis and the supra-glottic larynx, a 2 x 1 cm esophageal mass at 25 cm from incisors, and another distal esophageal fungating mass extending between 30 and 40 cm from the incisors. The stricture caused by the latter lesion was likely the cause of his dysphagia. There was normal esophageal mucosa in between the two esophageal masses. Biopsies were taken from the esophageal masses, and the patient was sent for ENT evaluation of the laryngeal mass. Pathology results confirmed invasive SCC of the larynx and both sites in the esophagus. CAT scan of the chest, abdomen and pelvis was negative for any metastatic disease. The patient was treated with cisplatin and 5-FU as well as radiation therapy for T3N0M0 SCC of the esophagus and larynx. Repeat endoscopy 4 months later showed post-radiation changes, with no tumor detectable on biopsies. Conclusion: Synchronous primary SCC of the esophagus and larynx are very uncommon. As smoking and alcohol consumption are common and synergistic risk factors for aero-digestive tract cancers, physicians should have a high index of suspicion for the possibility of synchronous or metachronous primary cancers of the upper GI and respiratory tract in these patients. This case is unusual in that three separate SCCs presented simultaneously, and highlights the need to screen at-risk mucosa at presentation. Vigilance for subsequent SCC should also be maintained. Early diagnosis of these malignancies can lead to significant benefit in morbidity and mortality with treatment.