Case 280 Enunciado A 84-year-old male patient sought care for right cervical pain started 4 months ago associated with odynophagia. He progressively developed dysphagia for solid foods 2 months ago, and later for liquids as well. It has been reported a weight loss of 20 kg in the last 4 months. He is a long-time smoker and a former alcoholist. On the physical examination: pale color mucosa, cervical and supraclavicular lymph nodes enlarged on the right side, without phlogistic signs. Upper digestive endoscopy revealed an infiltrative and ulcerated lesion 20 cm from the upper dental arch. Computed tomography (CT) of the thorax and abdomen were also requested: Image 1: Chest CT, axial sections, without intravenous injection of iodinated contrast medium. Image 2: Chest CT, axial sections, supracarinal (A) and infracarinal (B) levels, after intravenous injection of iodinated contrast medium, arterial phase. Image 3: Chest CT, coronal and sagittal reconstructions, carinal level, before (A) and after (B) intravenous injection of iodinated contrast medium Question:Considering the images, the EDA and the clinical history, indicate the alternative that presents the predominant tumor location and the most important risk factor(s) associated with this type of tumor: Cervical esophageal tumor and Helicobacter pylori infection Upper thoracic esophageal tumor and smoking and alcoholism Middle thoracic esophageal tumor and gastroesophageal reflux disease A conclusion could not be drawn from the data provided Questão de Prova (Hospital Residency - Hospital Universitário Antônio Pedro / UFF - 2014) The best method for the staging of esophageal squamous cell carcinoma in the preoperative period, in relation to item T of the TNM classification, is: Esophagogram Chest computed tomography Bronchoscopy Ecoendoscopy Esophageal endoscopy biopsy and histopathological study Time is Up! Time's up
