Pachella Laura A, Knippel Susan
Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Adv Pract Oncol. 2016 Nov-Dec;7(7):741-747. Epub 2016 Nov 1.
KD is a 67-year-old man with a medical history of hypertension, asthma, and a 20-pack/year smoking history who developed progressive dysphagia 8 months ago. Upon consultation with his primary care provider, he underwent an esophagogastroduodenoscopy (EGD) for evaluation. A friable mass was visualized at the gastroesophageal junction, and biopsies confirmed adenocarcinoma of the esophagus. KD completed a staging evaluation with positron-emission tomography/computed tomography (PET/CT), which did not reveal distant metastatic disease. He also had an endoscopic ultrasound (EUS), which showed the tumor invading the muscularis propria and did not identify any enlarged regional lymph nodes (stage T3N0 disease). KD was referred to a medical oncologist and a radiation oncologist; he underwent concurrent chemoradiation therapy with docetaxel and fluorouracil and radiation therapy (50.4 Gy). KD was referred to thoracic surgery following restaging with PET/CT and EGD; there was no evidence of distant metastatic disease, and pathology findings revealed residual adenocarcinoma in one of the four esophageal biopsies. KD underwent Ivor Lewis esophagectomy and had a jejunostomy tube placed for nutritional requirements for 10 weeks as he adjusted to oral nutrition. Surgical pathology findings revealed residual adenocarcinoma with treatment effect; no malignancy was detected in the sampled regional lymph nodes. Four months later, KD presents with complaints of frequent postprandial diarrhea and reflux. He says he has been trying to lie down after meals due to palpitations and flushing. He is anxious about these symptoms and fearful about his long-term prognosis adjusting to the side effects of esophagectomy and would like to discuss lifestyle modifications.
KD是一名67岁男性，有高血压、哮喘病史，吸烟史20包/年，8个月前出现进行性吞咽困难。在咨询其初级保健提供者后，他接受了食管胃十二指肠镜检查（EGD）以进行评估。在胃食管交界处可见一个易碎肿物，活检证实为食管癌。KD完成了正电子发射断层扫描/计算机断层扫描（PET/CT）分期评估，未发现远处转移疾病。他还进行了内镜超声检查（EUS），显示肿瘤侵犯固有肌层，未发现任何区域淋巴结肿大（T3N0期疾病）。KD被转诊至医学肿瘤学家和放射肿瘤学家处；他接受了多西他赛和氟尿嘧啶同步放化疗及放射治疗（50.4 Gy）。在用PET/CT和EGD重新分期后，KD被转诊至胸外科；没有远处转移疾病的证据，病理结果显示在四次食管活检中的一次发现残留腺癌。KD接受了Ivor Lewis食管切除术，并放置了空肠造口管，以便在他适应口服营养的10周内满足营养需求。手术病理结果显示残留腺癌有治疗效果；在取样的区域淋巴结中未检测到恶性肿瘤。四个月后，KD出现餐后频繁腹泻和反流的症状。他说由于心悸和脸红，他饭后一直试图躺下。他对这些症状感到焦虑，并且担心适应食管切除术后的副作用对其长期预后的影响，希望讨论生活方式的改变。
