A Case of Superficial Esophageal Cancer Causing Intestinal Obstruction due to Small Bowel Metastasis One Year after Successful Curative Radiation Therapy

Abstract

An 89-year-old man was found to have a 0-IIc lesion at the thoracic esophagus by an esophagogastroduodenoscopy in a medical checkup, and it was diagnosed as moderately differentiated squamous cell carcinoma by a biopsy. Considering his great age of 89, we performed curative radiation therapy (60 Gy) for squamous cell carcinoma (T1bN0M0 : Stage I) of the thoracic esophagus. Thereafter no recurrence had been detected by follow-up endoscopies until one year had elapsed after the completion of the irradiation, when abdominal pain occurred. He was diagnosed with intestinal obstruction caused by a tumorous lesion of the small intestine by CT and underwent emergency operation. The tumorous lesion was present in the ileum, a proximal small bowel to the lesion had dilated, and a nodular lesion was also identified in the ileum distal to the lesion. We thus performed enterectomy including the lesions. Histopathologically the both tumorous and nodular lesions were squamous cell carcinoma and appeared to be small bowel metastasis of esophageal squamous cell carcinoma.

This case was of superficial esophageal cancer successfully treated by curative irradiation, with subsequent small bowel metastasis causing intestinal obstruction. In performing radiation therapy particularly done without adjuvant chemotherapy, it is important to follow-up the patient by keeping a possibility of other organ metastasis as well as recurrence at the primary site in mind, even if he or she has superficial esophageal cancer.