Malignant tracheoesophageal fistula in two siblings. A coincidence?

The incidence of carcinoma of the esophagus is 1:10,000 for males. Esophageal carcinoma occurs less frequently in females. Tracheoesophageal fistula may occur as a complication of esophageal cancer. In this report, a brother and sister are presented who, although six years different in age, developed malignant tracheoesophageal fistulas within one month of each other. The probability of this occurring coincidentally is less than one in five hundred million. Each sibling had a different form of palliation with markedly different results. The first patient was treated with a Celestin tube which never provided good palliation. He suffered a rapid and miserable decline and death. The second patient was treated with substernal esophageal bypass using the stomach and exclusion of the thoracic esophagus. She has since undergone irradiation to the area of the fistula. She remains alive and well, physically active and eating a regular diet 23 months after surgery.