Edible Marijuana Use, Chest Pain, and Cough in a 53-Year-Old

Dushyant Singh Dahiya, MD; Farah Wani, MD; Asim Kichloo, MD


December 07, 2021


This patient presented with acute nonspecific chest pain that started after eating; a chronic, dry, nagging cough (from GERD); fevers; night sweats; a history of difficulty in swallowing solid foods; supraclavicular lymphadenopathy; and anemia. His clinical presentation suggests esophageal obstruction, probably resulting from esophageal adenocarcinoma. He does not report weight loss, most likely because he uses marijuana edibles to stimulate his appetite.

In the ED, the CTA scan of the chest was negative for pulmonary embolism, and the patient was admitted to the hospital for further evaluation. A gastroenterology consultation was eventually obtained, and the patient underwent upper endoscopy with biopsy and histologic analysis, which revealed esophageal adenocarcinoma. Endoscopic ultrasonography (EUS) and integrated fluorodeoxyglucose-PET (FDG-PET)/CT was ordered for tumor staging. He was found to have stage III esophageal adenocarcinoma.

Esophageal cancer is a highly aggressive and lethal cancer that leads to significant morbidity and mortality across the globe.[1] It can be divided into two distinct subtypes on the basis of histopathology: squamous cell carcinoma (SCC) and adenocarcinoma.[2,3]

SCC is the most common subtype worldwide, with high prevalence rates particularly in developing countries. It typically involves the middle and the lower esophagus. Major risk factors implicated in the development of esophageal SCC include alcohol consumption and smoking.

Adenocarcinoma is the most common subtype in developed (Western) countries, such as the United States, the United Kingdom, France, and Australia. It usually involves the distal esophagus at the gastroesophageal junction. Esophageal adenocarcinoma is closely linked to obesity and GERD, which can progress to Barrett esophagus (intestinal metaplasia of the gastroesophageal junction) and lead to adenocarcinoma.

From 2014 to 2018, esophageal cancer accounted for 1% of all new cancer cases in the US, and the incidence rate was 4.2 per 100,000 men and women per year. The 5-year relative survival rate was 19.9% (2011-2017). The mortality rate was 3.9 per 100,000 men and women per year.[4]


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