Thank you very much for this case scenerio:
1. The clinical scenerio above is likely advanced esophageal carcinoma with metastasis (as indicated by Virchow's node). Differential diagnosis include Gastric cancer- adenocarcinoma and oesophago-gastric junction tumour. An upper GI endoscopy and biopsy is the goal standadrd and would reveal the diagnosis, while a contrast CT scan of chest/abdomen and pelvis would help assess extent of locoregional or distant spread. In low resource setting, if endoscopy is not available or delayed, then patient can have a barium meal and follow through to delineate the tumour and assess extent of obstruction, while high resolution assess spread of tumour.
2. The likely histology is squamous cell carcinoma based of clinical history and risk factors. However, at the GEJ tumours, the risk factors would include gastro-oesophageal reflux disease, Barrett oesophagus, obesity and H.pylori infection
3. The presence of supraclavicular lymph nodes indicates it is a Stage IV disease. The best imaging to assess T,N,M stage is endoscopic ultrasound scan, while CT scan is used as a complimentary imaging modality to assess invasion of tumour into adjacent soft tissue structures.
4. The best treatment combination and sequencing is distress chemotherapy, followed by concurrent chemo-radiation, then adjuvant chemotherapy. The lack of assess to radiotherapy facility may influence the choice of treatment combination to neo adjuvant chemotherapy with resection surgery and stenting.
5. The immediate intervention is to pass a gastrectomy feeding tube which would be in place until the obstructed is removed by treatment. High calorie and balanced diet would be fed to patient with the consultation of nutritionist. If lesion is unresolvable, then the goal of treatment is to reduce tumour burden, relief symptoms of obstruction and pain and improve quality of life of the patient.
So what is the prognosis of the patient described in this scenerio and what factors would influence the prognosis?