Making It Stick: Management of Gastroesophageal Junction Adenocarcinoma with Poorly-Cohesive Cells (PCC)

Excerpt

A 61-year-old man was seen in the gastroenterology outpatient clinic due to recurrent heartburn. Five years prior, he had experienced gastroesophageal acid reflux symptoms that were treated with proton pump inhibitors for 4 months. Since that first episode, he had neither clinical follow-up nor endoscopic evaluation. At presentation, he described moderate dysphagia but he had not lost weight, weighing 94 kg. Upper gastrointestinal endoscopy demonstrated an esophageal tumor, extending 35–42 cm from the incisors from the distal esophagus, without stenosis, to the lesser curvature of the stomach. Mucosal biopsies demonstrated adenocarcinoma with poorly cohesive cells (PCC), conferring a poor prognosis. Preoperative evaluation, included a thoraco-abdominal CT scan (Fig. 1) and a PET scan (Fig. 2) concluded that the patient had a large gastroesophageal junctional tumor classified as Siewert I-II-III extending from the lower esophagus to the lesser curvature of the stomach (Fig. 3). A pretherapeutic laparoscopy did not show any peritoneal metastases. Perioperative chemotherapy was given according to the FLOT regimen: fluorouracil, leucovorin, oxaliplatin, and docetaxel [1]. The patient did not experience any toxicity. A re-evaluation by CT scan performed 2 weeks after the end of the chemotherapy demonstrated tumor stability without progression.

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