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Esophageal Cancer Asymptomatic Metastatic Esophageal Cancer Presenting Like Stroke—A Case Report Lilit Karapetyan, 1 Gurvinder S Bali, 2 Mark Cohen 3 and Michael K Gibson 1 1. Department of Hematology/Oncology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, US; 2. Sinai-Grace Hospital, Detroit Medical Center, Department of Internal Medicine, Detroit, Michigan, US; 3. Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, US Abstract 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. Keywords Esophageal cancer, asymptomatic, brain metastasis Disclosure: Lilit Karapetyan, Gurvinder S Bali, Mark Cohen, and Michael K Gibson have nothing to declare in relation to this article. No funding was received in the publication of this article. Compliance with Ethics Guidelines: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in this case study. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: February 10, 2016 Accepted: March 22, 2016 Citation: Oncology & Hematology Review, 2016;12(1):38–40 Correspondence: Lilit Karapetyan, 11100 Euclid Avenue, Lakeside Building 1200, Cleveland, OH, US 44106. E: Lilit.Karapetyan@uhhospitals.org Esophageal cancer is one of the deadliest cancers, and its incidence is on the rise worldwide. 1 In the United States, an estimated 16,980 cases of esophageal cancer were diagnosed in 2015 and 15,590 deaths are expected from the disease. With the latest advances in multimodality approaches, the five-year survival rate has risen only to a mere 17.9%. 2 Two main types of esophageal cancers are commonly known, i.e., squamous cell carcinoma and adenocarcinoma, and these may have some similar and some different risk factors. Squamous cell type is the most common subtype worldwide, but in the US its incidence is declining whereas adenocarcinoma is now the most common type. 1 The rising rate of adenocarcinoma in the US is thought to be due to corresponding high incidence of Barrett's esophagus. 3 38 Various risk factors are associated with esophageal cancer, including smoking, alcohol, socioeconomic status, and caustic injury, history of thoracic radiation, demographic features, obesity, and gastroesophageal reflux disease (GERD). 4–9 The characteristic presenting symptoms of esophageal cancer are mainly dysphagia and/or odynophagia. Other symptoms may include, but are not limited to, chest or upper abdominal pain/discomfort, regurgitation, weight loss, loss of appetite, hematemesis, dyspepsia, hoarseness, chronic cough, vomiting, and cervical lymphadenopathy. 10 Patients with a history of GERD may be found to have Barrett's esophagus on routine follow-up, which further needs follow-up because of high risk for the developing TOUCH ME D ICA L ME D IA