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

Once the diagnosis of esophageal cancer is established, the next step is clinical staging because it guides therapeutic management. Staging can be achieved by EUS or PET/CT.[2,5]

EUS is the standard modality for locoregional staging and assessment of mediastinal lymph node involvement. It also allows for fine-needle aspiration biopsy of the lymph node to determine lymph node metastasis. EUS staging may require balloon dilation of the malignant stricture, which should be performed with great caution because the friable mucosa is prone to perforation.[8] PET/CT is used to evaluate distant metastasis (which occurs in 20% of esophageal cancers) and has become an integral part of the pretreatment workup.

The management of esophageal cancers has been highly dynamic over the past decade, with significant therapeutic advancements. The treatment modalities available for esophageal cancer include[2,5,9]:

  • Endoscopic resection (ER)

  • Surgical resection

  • Neoadjuvant therapy

  • Systemic (palliative) treatment

ER is ideal for esophageal cancer limited to the lamina propria and muscularis mucosa of the esophagus. Patients with invasive cancer beyond the submucosa or muscularis mucosa with lymph node involvement are not candidates for ER. Patients who have undergone ER often require close monitoring and prolonged follow-up to assess for recurrence.

Esophagectomy is a curative treatment modality primarily reserved for localized resectable esophageal cancers (stage I and IIA). It is also used alongside neoadjuvant therapy for localized esophageal cancer with regional lymph node spread without metastasis (stage IIB and III).

Chemotherapy and radiation therapy along with surgery (trimodality treatment) provide the greatest survival benefit compared with surgical resection alone. Thus, neoadjuvant therapy with surgery (in patients who are surgical candidates) has become a standard of care for stage IIB and III esophageal cancer. Furthermore, chemotherapy or radiation therapy with or without surgery may be used for stage IVA (metastasized) esophageal cancer.

The main goals of systemic (palliative) treatment are to improve symptoms and quality of life and prolong survival. Systemic treatment may include local interventions (eg, esophageal stents) and radiation therapy with or without chemotherapy. Systemic therapy is the modality of choice for advanced esophageal cancers with extensive distant metastasis.

During his hospital stay, the patient in this case was given a liquid diet and calcium carbonate, which led to the resolution of his chest pain. At the time of discharge, an appointment was scheduled for outpatient evaluation by a surgical oncologist for neoadjuvant chemotherapy with surgery.


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