A SUCCESSFULLY RESECTED CASE OF CANCER OF THE LOWER ESOPHAGUS WITH MARKEDLY ELEVATED CEA INDICATIVE OF SYNCHROMOUS MULTIPLE BRAIN METASTASES

Abstract

Esophageal cancer commonly metastasizes by the lymphatic circulation and rarely by the bloodstream. Its brain metastasis is exceedingly rare. We experienced a resected case of cancer of the lower esophagus with markedly elevated CEA which indicated synchronous multiple brain metastases. A 69-year-old man was admitted to the hospital because of dysphagia. Upper gastrointestinal series and endscopy revealed a cancer of the lower esophagus. Lymph node involvement in the upper abdominal region was seen, but neither lung nor liver metastasis was present. Subtotal esophagectomy and thoracic anastomosis were performed. After the operation, neurological symptom rapidly progressed and brain CT revealed multiple brain metastases. Probable rapid worsing of brain stem symptom was considered, aggressive resection of the brain tumors with post operative radiotherapy was performed, leading to good result. Considering quality of life of patients, the significance of aggressive resection is emphasized even for advanced esophagus cancer with distant metastases.