Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

A Story of a Hero and Two Villains: “Kill Two Birds With One Stone!” FREE TO VIEW

Faizan Malik, MBBS; Reuben Azad, MBBS; Imran Jafri, MBBS; Irfan Ahsan, MBBS; Naveed Ali, MBBS
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Abington Jefferson Health, Abington, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):747A. doi:10.1016/j.chest.2016.08.842
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Cancer recurrence represents treatment failure, the development of new primary tumors is suggestive of persistent exposure to etiological risk factors. The detection of synchronous cancers stresses the importance of recognizing and eradicating the environmental risk factors like smoking and drinking. Field cancerization effect, suggests that carcinogenic exposure or genetic factors affect tissues or organs, potentiating many cells in the same area to become transformed.

CASE PRESENTATION: 61 year old male with medical history of esophageal reflux and 45 pack year smoking was admitted to the hospital with significant dysphagia. Vitals were all within normal limits. Physical examination was significant for absent lymphadenopathy, regular cardiac rate and rhythm, and intact neurological exam. Significant labs were hemoglobin of 11g, MCV of 74.9 and platelets of 424,000. Endoscopy showed extrinsic compression of proximal esophagus and biopsy showed esophageal squamous cell cancer. Staging computerized tomography showed three bilateral pulmonary nodules and mediastinal lymphadenopathy. EBUS of left Para tracheal lymph node showed squamous cell cancer which was CK56 positive, p63 positive, and TTF-1 negative. Esophageal cancer was staged as TxN1M0 (stage 3). Biopsy of the 1.9cm pleural based right upper lobe pulmonary nodule revealed adenocarcinoma which was TTF-1 positive. This was staged as T1a, Nx, Mx at diagnosis. Other solid lung nodules were sub-centimeter but FDG avid on PET scan. Lung carcinomas were treated as was treated as unknown stage because other nodules were not biopsied. Magnetic resonance imaging brain was negative for any metastatic disease. Molecular analysis was negative for EGFR, RAS, BRAF, ALK, MET, RET or ERBB2 mutations. He was initiated on concurrent chemo radiotherapy with carboplatin and paclitaxel to treat both esophageal and lung cancers.

DISCUSSION: Multiple primary cancers (MPC) like lung cancer synchronous with esophageal cancer is an uncommon occurrence and is being recognized more in literature due to better diagnostic and surveillance techniques. In our case, smoking was the biggest risk factor. Diagnosis and treatment for multiple cancers remains a diagnostic and therapeutic challenge and it should involve a multidisciplinary approach including medical oncology, surgical oncology, radiation oncologist, pulmonology and gastroenterology. There should be a low threshold of referring these patients to cancer centers for second opinions. The treamtment guidelines have not been established yet.

CONCLUSIONS: 1) Patient showed synchronous dual cancer with lung adenocarcinoma and esophageal squamous cell cancer. 2)Treatment approach was different than it would be for either cancers existing alone.

Reference #1: Chuang SC1, Hashibe M, Scelo Get al, Risk of second primary cancer among esophageal cancer patients, Cancer Epidemiol Biomarkers Prev. 2008 Jun;17(6):1543-9. doi: 10.1158/1055-9965.EPI-07-2876.

DISCLOSURE: The following authors have nothing to disclose: Faizan Malik, Reuben Azad, Imran Jafri, Irfan Ahsan, Naveed Ali

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