Ninja Nerds!

In this episode of the Ninja Nerd Podcast, Zach and Rob discuss two high-yield, board-relevant cases highlighting the diagnosis, staging, and treatment of esophageal adenocarcinoma and intestinal-type gastric adenocarcinoma.

We begin with a 56-year-old man presenting with progressive dysphagia and unintentional weight loss. Zach breaks down the concern for distal esophageal adenocarcinoma in the long-standing GERD and Barrett's esophagus setting. We walk through the stepwise diagnostic process—starting with barium swallow, followed by EGD with biopsy, and endoscopic ultrasound (EUS) and CT chest/abdomen/pelvis for staging. Based on a staging result of T2 N1 M0, we discuss the standard approach of neoadjuvant chemoradiation followed by transthoracic esophagectomy, with comparisons to management of early mucosal disease and metastatic presentations.

Next, we pivot to a 63-year-old woman with chronic Helicobacter pylori gastritis, now presenting with early satiety, epigastric discomfort, and melena. The focus shifts to intestinal-type gastric adenocarcinoma, classically found along the lesser curvature. We review the appropriate use of EGD with biopsy as the first test in alarm dyspepsia, followed by CT imaging and EUS to assess depth and nodal involvement. With a staging result of T1b N0, we emphasize the role of subtotal (distal) gastrectomy with D2 lymph node dissection, and outline when perioperative chemotherapy or palliation (e.g., GOO stents, systemic chemo, trastuzumab for HER2⁺ tumors) becomes necessary.

Finally, we conclude with a rapid comparison of the two cases, highlighting shared themes: the importance of depth of invasion, nodal status, and the shift from endoscopic resection to surgical and systemic therapies based on stage.

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