Description
A 54-year-old man presenting with dysphagia, weight loss, epigastric pain and cervical lymphadenopathy was referred directly to endoscopy. The medical history included hypertension and hypercholesterolaemia. Blood tests showed normal bilirubin, aspartate transaminase (AST) 490 iu/L, -glutamyl transferase (GGT) 535 iu/L, alkaline phosphatase (ALP) 829 iu/L and prothrombin time (PT) 13 s.
Gastroscopy showed a lower oesophageal lesion (figure 1) with biopsies showing high-grade dysplasia. A CT scan showed lower oesophageal wall thickening and multiple lymphadenopathy in the chest/abdomen but no liver metastases (figure 2). The local multidisciplinary team meeting outcome was for repeat oesophageal biopsies and supraclavicular lymph node biopsy to exclude a lymphoma.
Figure 1
Endoscopic picture of oesophageal tumour.
Figure 2
CT scan showing oesophageal cancer (red arrow) but no obvious liver lesions.
The patient thereafter clinically deteriorated over a 4-week period, developing jaundice. On...
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