Surgery for Esophageal Adenocarcinoma: Three field open McKeown procedure has a role in assessment and treatment of extensive locally advanced esophageal adenocarcinoma with a favorable clinical and pathological outcome.

Esophageal adenocarcinoma has seen an increased incidence due to gastroesophageal reflux disease , smoking and obesity. There are no established guidelines for screening of esophageal cancer and many patients present late in their disease process. Most early stage adenocarcinoma of the esophagus is treated with neoadjuvant chemotherapy and radiation follow by surgical resection in suitable operative candidates. We describe a case of locally advanced esophageal cancer, where the patient had a relatively insignificant response to neoadjuvant chemotherapy and radiation, who was then treated by open direct resection of the esophagus and proximal stomach (three field McKeown approach) with lymphadenectomy. The patient did well after surgery apart from pneumonia and increased secretions that required tracheostomy. There were no surgical complications such as anstomotic leak or chylothorax. Pathology showed T2N0 disease. Locally advanced esophageal cancer in the mediastinum occasionally requires an open direct approach for direct assessment of resectability and full mobilization of the esophagus and subsequent complete cancer free surgical outcome. We felt that this was a necessary procedure under these circumstances due to the large mass effect of the tumor, and a preoperative staging of T2N3. The mainstay of esophageal resection continues to be minimally invasive procedures for early stage esophageal malignancy where assessment of resectability and direct mobilization from the mediastinum are typically not an issue

Small Cell Carcinoma of Prostate: A Case Report of a Patient With Concomitant Transitional Cell Cancer of the Bladder

Small cell carcinomas (SCCs) are aggressive neoplasms commonly associated with a pulmonary origin. However, albeit rare, extrapulmonary SCC can occur in a variety of sites with an incidence in North America approximated to be 0.1% to 0.4%. Among these sites, approximately 10% of extrapulmonary SCC cases occur in the prostate and are associated with a poor mortality with a median survival of 10 months. Because of the rarity of the prostatic SCC, there is no formal treatment protocol. In this case report, we present a patient who was diagnosed with SCC in the prostate as primary origin. Adjuvant concurrent chemoradiotherapy was started, which he is tolerating so far. While the management of metastatic disease is well documented with the use of chemotherapy, specific data on nonmetastatic disease is lacking. As some studies suggest, a combined surgical and chemotherapeutic approach is helpful in localized disease. In our case, this approach has led to a good clinical outcome in a disease that does not usually allow such results

Surgery for Esophageal Adenocarcinoma: Three field open McKeown procedure has a role in assessment and treatment of extensive locally advanced esophageal adenocarcinoma with a favorable clinical and pathological outcome

Esophageal adenocarcinoma has seen an increased incidence due to gastroesophageal reflux disease , smoking and obesity. There are no established guidelines for screening of esophageal cancer and many patients present late in their disease process. Most early stage adenocarcinoma of the esophagus is treated with neoadjuvant chemotherapy and radiation follow by surgical resection in suitable operative candidates. We describe a case of locally advanced esophageal cancer, where the patient had a relatively insignificant response to neoadjuvant chemotherapy and radiation, who was then treated by open direct resection of the esophagus and proximal stomach (three field McKeown approach) with lymphadenectomy. The patient did well after surgery apart from pneumonia and increased secretions that required tracheostomy. There were no surgical complications such as anstomotic leak or chylothorax. Pathology showed T2N0 disease. Locally advanced esophageal cancer in the mediastinum occasionally requires an open direct approach for direct assessment of resectability and full mobilization of the esophagus and subsequent complete cancer free surgical outcome. We felt that this was a necessary procedure under these circumstances due to the large mass effect of the tumor, and a preoperative staging of T2N3. The mainstay of esophageal resection continues to be minimally invasive procedures for early stage esophageal malignancy where assessment of resectability and direct mobilization from the mediastinum are typically not an issue

Gemcitabine-induced skin necrosis

Since its emergence as a chemotherapy agent, gemcitabine has been associated with cutaneous adverse reactions. Rash is reported to be the most common cutaneous adverse effect. Other reported cutaneous reactions in the literature include bullous dermatosis, pseudocellulitis, subacute cutaneous lupus alopecia, and palmar–plantar erythrodysesthesia. Skin necrosis is a very rare adverse effect of this otherwise well-tolerated chemotherapeutic agent. In searching the literature, only one other case has been reported. In our report, we present a 74-year-old male with adenocarcinoma of the pancreas, status-post pancreaticoduodenectomy (Whipple procedure), who developed a rare case of skin necrosis of the lower leg 2 weeks after completing six cycles of monotherapy gemcitabine treatment

Ischemic Colitis Associated with Paclitaxel and Carboplatin Combination

A 62-year-old white female with a history of early-stage triple-negative breast cancer on a combination of carboplatin and paclitaxel in the adjuvant setting presented with lower gastrointestinal bleeding. She tolerated 4 cycles of dose-dense adriamycin/cyclophosphamide with no major symptoms. After 6 cycles of weekly paclitaxel in combination with carboplatin every 3 weeks, she presented with diarrhea and lower gastrointestinal bleeding. Colonosopic examination showed erythema and inflammation in the splenic flexure, descending colon, and sigmoid colon consistent with ischemic colitis. Pathology favored the same diagnosis. She was treated conservatively with intravenous fluids and bowel rest. Chemotherapy was held for 2 weeks and resumed after recovery without carboplatin. She was able to tolerate the remaining 6 cycles of paclitaxel with no recurrence of her symptoms