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ESOPHAGEAL CANCER
INITIAL STAGING
61-year-old male, referred by a radiation oncologist for evaluation of diagnosed esophageal cancer.
Patient History
- The patient was presented to the radiation oncologist for treatment for esophageal cancer.
- Prior to treating this cancer the radiation oncologist ordered a CAT scan of the chest, abdomen, and pelvis.
Diagnosis
- A biopsy proved esophageal cancer.
- A CT also confirmed the esophageal mass, but did not show any sign of metastatic disease.
- The CT results showed a gastroesophogeal soft tissue mass with associated mediastinal and upper abdominal adenopathy.
- In the CT impression it was recommended by the reading radiologist to have a PET scan to further characterize their findings.
Treatment Planning
- At this time treatment planning would be surgery, but they will not proceed with surgery until they receive the PET finding.
Clinical Question
Is this patient a surgical candidate? |
In order to answer this question, a whole body PET scan was ordered by the radiation oncologist.
The images were reviewed in 3-D rotating images from the base of the brain to the base of the pelvis, as well as multi-planar tomoographic images.
Impression
- Primary esophageal neoplasm with adjacent metastatic adenophathy and intrathoracic metastatic adenopathy in the pretracheal retrocaval space.
- A moderate focus of increased emission in the right sacral wing, consistent with osseous metastatic disease.
PET Staging
- The PET study delineates an area of intensely increased metabolic activity in the sacral wing that was not apparent on the CT.
- The PET scan helped the physician upstage the patient; therefore, they are not a surgical candidate at this time.
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Treatment
- With the correlation of the CT and the PET scan the patient underwent radiation therapy to the sacrum and esophagus followed by chemotherapy.
- This patient will be continually followed with CT and PET scan to determine the efficiency of the radiation therapy and chemotherapy.
- The patient will most likely not be a surgical candidate.
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Figure 1 - Saggital slice showing sacral met.
Figure 2 - Coronal slice showing sacral met.
Figure 3 - Coronal slice showing esophageal neoplasm and metastatic adenopathy in the pretracheal retrocaval space.
PET images were obtained one hour following intravenous administration of 10.5 mCi of F18-FDG into the right arm. |
