Typical treatment of esophageal cancer cases (a)

By | January 20, 2012

Typical cases of esophageal cancer treatment: Pakistan, aged 56, mainly due to "eating choking feeling 1 year, esophageal cancer after 10 months of nodules found in the neck 3 months, "admitted. Patients 1 year was choking when eating, gradually increased in the digestive tract angiography showed a local hospital lines occupying the upper esophagus, at December 10, 2005 radical surgery of esophageal cancer, postoperative pathology was squamous cell carcinoma, proximal margin visible tumor, postoperative recovery can still, in February underwent a course of radiotherapy, but still feel choked when eating, no significant improvement. Six months after the chest CT (2006. 6.19) found in the anterior wall of the chest soft tissue mass in the stomach, irregular shape, and close to the posterior wall of the trachea, mediastinal lymphadenopathy, double lung markings clear, no abnormal nodules, and no chest plot fluid. Also found that the left anterior neck incision at the nodules and nodules, in the July 5 incision anterior resection of pathological tumor nodule metastasis. B-showed bilateral lymph nodes and left supraclavicular lymph node metastasis, underwent bilateral cervical lymph nodes and left supraclavicular radiotherapy, after radiotherapy the left supraclavicular lymph nodes than before narrowing slightly. But the sense of left shoulder pain in patients with pain radiation to the left upper limb, the pain gradually increased after the night unable to sleep, daily MS Contin to be served from 8 to 10.
Admission examination: the left clavicle and left the neck hit a 6 to 7 lymph nodes, size 1. 0 ~ 1. 5em, quality hardware, not active, the surface is still smooth, part of the lymph node fusion. Radiation hardened skin of the neck, pigmentation. Suprasternal fossa skin bulge, the size of 1.5cm x 2cm, nodules above the depressed ulcer, size 2 em x3em, surface version of the secretions, touch and easy bleeding. On October 30 in the supraclavicular fossa local anesthesia cancerous ulcer treatment and argon implantation of sustained-release chemotherapy drugs, implantation of sustained-release fluoride safety of human 300mg, 20mg and smooth lead into the tumor.
B-(2006.10.14) showed bilateral neck, supraclavicular fossa and left nodules compared with the previous narrow diameter of 0.3 ~ 0.9cm, border clearance. Given after admission bilateral supraclavicular, left neck, left chest wall and left axillary lymph node ultrasound conductivity of local chemotherapy drugs for the uranium and MMC cards, lymph nodes have reduced after treatment. CT guided percutaneous while the release of chemotherapy drugs (5-FU +) 1 anti-self) implanted on the left chest wall tumor. Significantly reduced pain in patients, MS Contin a day just 1 to 3 pieces.
Endoscopic investigations show admission: see esophagus 22cm from the incisors stenosis, wall stiffness, yet smooth, endoscopy can not. 2cm below the glottis, bronchoscopy showed a tumor the following tracheal lumen blocking 1 / 3, left and right bronchus had lesions. Oxygen knife to level the airway tumors. Arterial infusion chemotherapy before 1 after 1 week in patients with swallowing difficulties and perceived pain relief. Then the patient in the dark environment, a stuffed intravenous blood Lin, 450mm, 1 days after photodynamic therapy. Synchronous endoscopic photodynamic therapy of tracheal 3, Endoscopic photodynamic therapy 2 times, after giving fluids, and parenteral nutrition therapy. The original 10 days can be seen repeated endoscopy esophageal lumen stenosis was significantly higher than before widening the surface of a small amount of esophageal tumor necrosis objects than before meals in patients with unobstructed. However, increased cough 15 days of treatment, a small amount of water after the severe coughing, coughing up a small amount of gastric juice, bronchoscopy showed esophageal – tracheal fistula, then use the knife to the surface of the oxygen scavenging necrotic after implantation under X-ray "Y"-shaped tracheal stent, the fistula plug, 2 months after the symptoms were improved and discharged.
Postoperative recurrence of esophageal cancer through the lymphatic channels often transferred to the neck lymph nodes, can be violated by direct infiltration of the trachea and main left and right bronchial. Treatment should be taken within the trachea and esophagus principle of simultaneous treatment with oxygen, a large knife to remove the tumor, as soon as possible to clear the airway and esophagus, the residual tumor to PDT, to effectively prevent tumor recurrence. However, this method could easily lead to a tracheal esophageal fistula. Once the patients had cough and other symptoms, the line as soon as possible bronchoscopy, endoscopy and esophageal imaging and other tests, a clear fistula, stent placement as soon as possible to better the first esophageal stent placement. Such as esophageal stricture can not be placed on "Y"-shaped covered tracheal stent. While local injection of chemotherapy drugs can be taken, um, degree and p53 recombinant adenovirus (Gendicine), etc., to prevent tumor recurrence.
Of superficial transfer of lymph node metastasis and subcutaneous tumor, ultrasound conductivity can be taken to chemotherapy, local injection of radiotherapy and chemotherapy particles so as to prevent the further development of the tumor. In this case a variety of ways, effectively inhibited the metastasis of patients and improve the quality of life of patients and prolong their lives.

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