Early detection of gastric cancer with esophageal extension by transnasal esophagoscopy.

An 82-year-old man presented to the office complaining of one episode of pill dysphagia and intermittent episodes of a feeling that food was sticking low in his chest.

Flexible laryngoscopy revealed posterior glottic erythema and edema and bilateral pseudosulcus vocalis consistent with laryngopharyngeal reflux. Because of the patient's pill dysphagia, transnasal esophagoscopy (TNE) was performed. A fungating mass near the gastroesophageal junction was detected (figure, A). Analysis of multiple biopsies revealed that the mass was an adenocarcinoma. A secondary mass within the stomach was also noted (figure, B).

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Gastroenterology evaluation included an MRI of the chest and abdomen and endoscopic ultrasound, which revealed local extension and invasion of the pancreas by the tumor. The patient is currently being evaluated for palliative chemotherapy and radiation.

This case is an example of how the ready availability of TNE resulted in much earlier diagnosis of gastric carcinoma with esophageal extension than would otherwise be expected. Although the aggressive local extension of this particular tumor precluded surgical cure, early cancer detection generally improves survival.

Timothy D. Anderson, MD; Steven F. Nezhad, MD

From the Department of Otolaryngology (Dr. Anderson) and the Department of Gastroenterology (Dr. Nezhad), The Lahey Clinic, Burlington, Mass.