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 22 March 2018

Advanced search - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder


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GastroenterologyStomach & duodenum

Malignant diseases

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Carcinoma of the cardia.

An 85-year-old man with a short history of dysphagia. Endoscopy revealed a polypoidal lesion occluding most of the lumen of the lower esophagus. Biospied and shown to be an adenocarcinoma. The CT scan suggested that the proximal one-third of the stomach was infiltrated with tumor.

Underwent chemoradiotherapy with one cycle of cis-platinum and 5-FU and 34 Gy of radiotherapy. He had a rapid resolution of his symptoms and the endoscopy photograph taken two weeks after completion of the radiotherapy shows 90% disappearance of the tumor.

Comment: Traditionally adenocarcinoma of the upper digestive tract has not been considered to respond satisfactorily to radiotherapy. However, there are a number of studies which report positive results of neo-adjuvant chemoradiotherapy (in combination with esophagectomy). Both adeno and squamous cell tumors do respond to the combined therapy and it is possible that downstaging the disease may lead to improved survival (Bessell JR, Devitt PG, Gill PG, Goyal S, Jamieson GG. Prolonged survival following resection of esophageal SCC downstaged by prior chemoradiotherapy. Aust N Z J Surg 1996: 66: 214-17).
Peter Devitt, Adelaide, Australia

Carcinoma of the cardia.

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