CASE O M59 C C Known esophageal cancer

CASE 엄O회 M/59 Ø C. C. : Known esophageal cancer Ø P. Hx. : No known Pul tbc, viral hepatitis, DM, hypertension Alcohol: 2 -3병/day x 30 yrs Smoking: 0. 5갑/day x 30 yrs Ø FHx. : N-C

Present illness 상기 환자는 heavy alcoholics로 1999년 alcoholic liver cirrhosis진단 후 HEP, Esophageal varix bleedings 등으로 타병원 입원치료 도중 시행한 내시경상 Esophageal cancer 소견 보여 본원으로 전 원됨.

Review of Systems Ø ROS : General weakness / Easy fatigue (+/+) Cough / Sputum (-/-), Dyspnea / chest pain (-/-), Abdominal discomfort (-) Indigestion(+) Dysphagia/ Anorexia / Nausea / Vomiting (+/+/+/-) Melena / Hematochezia (-/-) Wt loss (-) Ø P/E : BP 110/70 mm. Hg, PR 69/min RR 21/min, BT 36. 5℃ Chronic ill looking apperance Not pale conjunctivae/ anicteric sclera Clear breathing sound Regular heart beat without murmur Soft and flat abdomen without tenderness Fluid wave/shifting dullness (+/+)

Lababoratory Data Ø Lab. : CBC 5450/11. 9/75, 000 BUN/Cr 6. 2/0. 5 mg/d. L, AST/ALT 30/25 IU/L T. pro/Alb 6. 1/2. 4 g/d. L, T. bili 1. 1 mg/d. L PT/PTT 17. 7/40 sec HBs Ag/Ab (-/+), anti-HCV (-) CEA 2. 58 ng/ml αFP 3. 7 ng/ml

EGD Esophageal cancer in UI 28 cm

Pathology Squamous cell cancer

EUS R/O SM invasion

Abdominal U/S Liver cirrhosis with splenomeagly, Ascites

외부 Abdominal & Chest CT Esophageal varix, Liver cirrhosis, Ascites

Photodynamic Therapy ØPDT after photosensitizer injection (2 days later) ØPhotogem, 2 mg/kg, cylindrical diffuse probe, 630 nm, 150 J/cm 2

F/U EGD after 2 days Ulceration & remnant tissue after PDT

F/U EGD after 1 months No evidence of recurrence

Abdo & Chest CT after 9 months No recurrence or metastasis of esophageal cancer

F/U EGD after 1 years No evidence of recurrence

Photodynamic Therapy (PDT) Injection of photosensitizer Drug selectively retained by cancer cells 24 -72 h Drug sat’d tumor exposed to light Light Source Light activates drug; oxygen excited Cancer cell destroyed!!!

Photodynamic Therapy (PDT) Ø Photosensitizer: Hematoporphyrin 유도체 - Porfimer sodium (photofrin) - 5 -aminolevulnic acid (5 -ALA) - Meta-tetrahydroxyphenychorin (m. THPC) Ø Laser systems & Applicators - Diodide laser - Cylindrical diffuse probe Ø Light dosages : 120~300 J/cm 2 Ø Side effect: Stricture (30%), Photosensitivity