Metachronous multiple esophageal cancers and a gastric cancer after treatment for hypopharyngeal cancer, report of a case

The patient was a 73-year-old man with moderate drinking and mild smoking habits. During a medical check-up, eleven years after radiation therapy for stage I hypopharyngeal cancer (at the age of 67 years), an iodine-unstained slightly depressed lesion, 30 mm in diameter, was detected by endoscopy in the mid-esophagus (Fig. 1). The biopsy result was squamous cell carcinoma, so endoscopic mucosal resection (EMR) was performed. Histopathological study revealed an 0-IIc type of mucosal cancer without vessel infiltration. Three years after the first EMR (at the age of 70 years), a new iodine-unstained flat lesion, 10 mm in diameter, was detected on the side of the esophagus opposite the EMR scar (Fig. 2). The biopsy result was squamous cell carcinoma and EMR was performed. Histopathological study revealed an 0-IIb type of mucosal cancer without vessel infiltration. Three years after the second EMR (at the age of 73 years), another iodine-unstained slightly depressed lesion, 14 mm in diameter, was detected on the cervical esophagus (Fig. 3). The biopsy result was squamous cell carcinoma and, again, EMR was performed. Histopathological study revealed an 0-IIc type of epithelial cancer without vessel infiltration. At the same time, a slightly elevated whitish lesion, 11 mm in diameter, was detected on the greater curve of the upper gastric body (Fig. 4). The biopsy revealed well-differentiated adenocarcinoma and the lesion was treated with EMR. Histopathological study revealed an 0-IIa type of mucosal cancer without vessel infiltration. This case shows the importance of endoscopic follow-up for patients with head and neck cancers and/or esophageal cancers. Early detection of metachronous cancers enables the patients to recover with excellent prognosis and better quality of life with preservation of organs.