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This question was answered on Thu 10, Sep 2009 09:40am by Dr. Monica, MD

Clarification about tests and possible esophagus carcinoma diagnosis


    
Asked by aashima bakshi (Male; 59; blood pressure, mild prostrate enlargement; Relevant drugs:cresor for BP ) on Mon 31, Aug 2009 10:50pm

Dear Dr., Greetings! My father has undergone CT chest and the report reveals: 1. multiple discrete homogenous enlarged pretracheal & paratracheal lymphnodes are seen. largest measuring 24x12mm 2. there is short segment asymmetric mural thickening involving the mid esophagus over a segment of 2.8cm. maximum mural thickness measures 11mm. fat planes with surrounding structures is preserved. 3. rest all organs ans systems are fine. but the radiologist says that the impression of carcinoma esophagus. Earlier to this, his barium x-ray revealed irregular filling defect and endoscopy revealed mild ulceration, but not from inside the esophagus. So the doctors did not go for biopsy at that time. Symptoms: he doesn’t have any other symptoms except that when he eats,he feels the food passes through esophagus while touching its lining. No pain. No appetite or weight loss. Request you to please clarify, 1. Does this indicate esophageal carcinoma? 2. If yes, what possible stage we can predict before confirmatory tests? 3. Is there a possibility of Benign tumor? 4. Can this be only because of infection (possibly bacterial infection)? 5. What can be the possible confirmation tests apart from biopsy? 6. Any possibility of complete removal and no reoccurrence? plz suggest your opinion and further course of action. sincere regards,

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Answer by Dr. Monica, MD  on Thu 10, Sep 2009 09:40am:

Hi, The clinical symptoms and CT scan findings suggest a strong possibility of esophageal cancer. Biopsy is needed for confirmation of the diagnosis. Other tests would be needed to stage the disease and to know the extent and spread. Benign tumors are unlikely to be associated with enlarged lymph nodes. Bacterial infection also seems unlikely. The enlarged lymph nodes would suggest an advanced stage however it is difficult to confirm the stage without additional investigations. Once the extent of the disease is known, the possibility of surgery can be assessed. Radiation therapy with chemotherapy is another option for treatment. There is a possibility of recurrence even after complete removal/chemoradiation so regular follow up is important. Further course of action would be to first undergo an endoscopy and biopsy to confirm the diagnosis followed by additional investigations to determine disease extent. Following this treatment options can be discussed. All the best

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