Esophageal Cancer in Young Patients: Diagnostic Challenges, Management and Survivorship

4 May 2022 16:00 17:30
Melbourne – Bomet
Matthew Read  Host
Russell E White Host

Case 1: Gastroesophageal Junction Cancer in a Young Adult

Patient Profile & Clinical Presentation

  • Patient: 23-year-old man, originally from East Africa

  • Presentation: Recently presented to St Vincent’s Hospital in Melbourne with a four-month history of chest tightness, progressive dysphagia and headache.

  • Endoscopy: Revealed a cancer at the gastroesophageal junction (GEJ).

  • Staging: Subsequent staging excluded metastatic disease.

Figures

Figure 1. Endoscopic Images

Endoscopic images detailing the GEJ from above.

Figure 2. Endoscopic Images

Endoscopic images detailing the GEJ from below.

Figure 3. FDG PET

FDG PET avid lesion at the GEJ.

Case 2: Esophageal Adenocarcinoma in an Adolescent Patient

Patient Profile & Clinical Presentation

  • Patient: 16-year-old male

  • Clinical Presentation: Eight-month history of progressive dysphagia, anorexia, and weight loss.

  • Diagnostic Delay: Despite multiple visits to health facilities and being treated for a range of different ailments, no endoscopy was performed until seven months later.

  • Risk Factors: No associated risk factors, no history of smoking and no alcohol intake.

  • Family History: No significant family history of cancer.

Diagnosis & Initial Treatment

  • Histology: Moderately differentiated adenocarcinoma.

  • Neoadjuvant Treatment: Received neoadjuvant chemotherapy with a complete clinical response.

  • Surgical Decision: In view of limited access to an ongoing surveillance program, a three-stage esophagectomy was performed.

Postoperative Course

  • Recovery: Following surgery, the patient made a good recovery.

  • Anastomotic Complication: Developed an anastomotic stricture which required serial dilatation.

  • Bowel Complication: Required treatment for a bowel obstruction secondary to a band adhesion.

  • Psychological Health: Developed suicidal ideation in association with a major depressive illness and is currently receiving psychotherapy (12 sessions to date).

Discussion Points

  1. Diagnosis and management: What challenges exist in the diagnosis & management of esophageal cancer in the younger patient?

  2. Care, quality of life and survivorship: How can care be balanced with quality of life and survivorship, and how should the best approach be tailored?

  3. Younger versus older patients: How do cancers between a younger patient and an older patient compare? Are they different entities and should we be more aggressive with our management?

  4. Resource-limited environments: Management of esophageal cancer in a resource limited environment.

  5. OESO Pilot Centers: Highlighting the significance of the first fellowship between OESO Pilot Centers.

Additional Presentations

  • Surgery for Cancer of the GEJ. How I Do It: Dr. Yong Li, Thoracic Surgeon of the Beijing National Cancer Center, China.

  • Clinicopathological Features of GEJ Cancer of the Younger Patient: Assoc Prof Qin Huang, Harvard Medical School / Brigham and Women’s Hospital, Boston.

Panel for Discussion

Michael Mwachiro (Program Director, Tenwek) | Dr Guifang Xu, GI Gastroenterologist of Nanjing Drum Tower Hospital, China | Dr Lei Wang, GI Gastroenterologist of Nanjing Drum Tower Hospital, China | Dr Yong Li, Thoracic Surgeon of the Beijing National Cancer Center, China | Assoc Prof Qin Huang, Harvard Medical School, Boston