Esophageal squamous cell carcinoma co-existing with achalasia: report of two cases

Esophageal achalasia is a primary motility disorder of the esophagus. Although various treatments can relieve the symptoms, esophageal cancer arising in patients with achalasia is the most important problem for long-term survivors. We encountered 2 cases of esophageal squamous cell carcinoma co-existing with achalasia that had been diagnosed 27 and 30 years earlier, respectively. Neither patient had been aware of dysphagia due to dilatation of the esophagus. Both patients underwent esophagectomy via right thoracotomy. Although esophagectomy with radical lymphadenectomy was performed successfully in one case of submucosal cancer, the primary tumor in the other case was more invasive and aggressive than indicated by the preoperative clinical diagnosis, and could not be completely resected. Regular endoscopic examination should be scheduled for long-term survivors of achalasia in order to detect esophageal cancer early and evaluate any changes in the esophagus carefully.