A 58-year-old man initially presents to his primary care physician complaining of dysphagia. He states that he has had trouble getting solids down for months, and more recently has started to have issues with liquids as well, though he still manages to maintain his nutrition with protein shakes. He also notes unintentional weight loss of 11.3 kg (25 lb)) in the past year. The patient is referred to a gastroenterologist, who identifies a mass at the proximal third of the esophagus on upper endoscopy.
Biopsy of the lesion is seen below: Which of the following is the most appropriate next step in the management of this patient?
A. CT of the chest, abdomen, and pelvis
B. Esophageal stent placement
C. Initiate neoadjuvant chemotherapy in preparation for surgical resection
D. Palliative radiation therapy to the proximal esophagus
E. Percutaneous gastrostomy placement …show more content…
The management of esophageal cancer depends heavily on staging the condition. Standard staging of esophageal cancer includes CT of the chest, abdomen, and pelvis to look for local extent, nodal spread, and metastatic disease. In addition, PET scanning with 18-fluorodeoxyglucose has been recently incorporated into the staging evaluation of esophageal cancer. This noninvasive test is more sensitive than CT for detecting distant metastases. Recent studies have suggested that PET scanning can detect metastatic disease in 15% of patients who were believed, on the basis of conventional diagnostic techniques, to have localized esophageal cancer. The superimposition of CT and PET scans is even more sensitive in identifying patients with occult
Biopsy of the lesion is seen below: Which of the following is the most appropriate next step in the management of this patient?
A. CT of the chest, abdomen, and pelvis
B. Esophageal stent placement
C. Initiate neoadjuvant chemotherapy in preparation for surgical resection
D. Palliative radiation therapy to the proximal esophagus
E. Percutaneous gastrostomy placement …show more content…
The management of esophageal cancer depends heavily on staging the condition. Standard staging of esophageal cancer includes CT of the chest, abdomen, and pelvis to look for local extent, nodal spread, and metastatic disease. In addition, PET scanning with 18-fluorodeoxyglucose has been recently incorporated into the staging evaluation of esophageal cancer. This noninvasive test is more sensitive than CT for detecting distant metastases. Recent studies have suggested that PET scanning can detect metastatic disease in 15% of patients who were believed, on the basis of conventional diagnostic techniques, to have localized esophageal cancer. The superimposition of CT and PET scans is even more sensitive in identifying patients with occult