食道と膀胱に発生した同時性重複癌の2例

Abstract

An 82-year-old man was seen with the complaints of gross hematuria and dysphagia in September 1979. An invasive bladder tumor was found and TUR-Bt (Transitional cell carcinoma, G2, pT3NXMO ) was performed. Fluoroscopic examination revealed a large esophageal cancer (Undifferentiated squamous cell carcinoma, T2NXMO ) and irradiation was performed (Linac 4, 600 rads). The patient's condition aggravated rapidly and he died in February 1980. A 76-year-old man irradiated for an esophageal cancer (Linac 6, 540 rads) (undifferentiated squamous cell carcinoma, T1NXMO ) in March 1981. Eleven months later, bladder cancer was found and treated with TUR-Bt (Transitional cell carcinoma, G2, PTlmNXMO ) followed by intravesical instillation of carboquone and adriamycin. The patient was alive 1 year and 9 months after the diagnosis of the esophageal cancer. Sixteen cases of double cancer of the esophagus and urinary bladder were found in the Japanese literature. Eighteen cases including the above 2 cases were males and their ages ranged from 51 to 82 years. Sixteen bladder cancers were transitional cell carcinoma and 15 esophagus cancers were squamous cell carcinoma. Of 9 cases whose clinical course were described in detail, 3 were synchronous and 6 were metachronous. Radical surgery was performed for one or both of the two cancers in 5 cases, 4 of which were metachronous. Indication of surgery for the metachronous second cancer does not differ significantly from sporadic cancer when the first cancer has been managed successfully. However, the treatment for the synchronous double cancer of this type of combination is often forced to be restricted, since the prognosis of esophageal cancer is poor and surgical risk may be increased by two radical surgeries in such elderly patients.