Esophageal cancer is one of the deadliest known cancers worldwide, and its incidence in the US is increasing over time. As per the Surveillance, Epidemiology, and End Results (SEER) data, it contributes to about 2.5% of all cancer deaths. Patients with esophageal cancer often present with an advanced stage disease where the prognosis is not very favorable. The typical symptoms at diagnosis are dysphagia and or odynophagia. Patients with adenocarcinoma may have previous or continued symptoms of gastro-esophageal reflux disease. By the time these symptoms occur, the disease is usually advanced, thus explaining the limited success in improving prognosis and overall survival. One of the reasons for early spread and late diagnosis is the fact that unlike most other gastrointestinal conduits, it lacks the serosa, and hence its high potential to spread relatively sooner. Another factor that negatively affects prognosis is the proximity of the esophagus to the vital structures like the airway and major vessels, and therefore the tendency of the cancer to directly invade them. The vitality of these structures is also a surgeon’s major concern, and this sometimes jeopardizes the surgical approach and intervention while treating this cancer. The alarm symptoms in most cases precede the manifestations of advanced metastatic disease. Depending upon the location of the disease at different metastatic sites (usually lung and liver), in addition to the characteristic symptoms, this cancer may accordingly present with additional signs and symptoms. Whereas most patients present with typical symptoms such as dysphagia, weight loss and abdominal pain we herein report a patient whose primary presentation was left hemiparesis due to metastatic esophageal cancer to his brain. He did not report classical esophageal cancer symptoms prior to this neurologic presentation.
Roux-en-Y loop for gastro-esophageal reflux after esophagectomy with gastric pull-up for esophageal cancer
