A cancer patient's swallowing trouble revealed a hole forming between esophagus and airway.

Years after a stem cell transplant, patients can develop dangerous second cancers. Doctors described a 33-year-old man who had received a transplant, chemotherapy, and radiation approximately 8 years earlier. His recovery was complicated by chronic graft-versus-host diseasegraft-versus-host diseaseA condition where donated immune cells attack the recipient's body, causing symptoms like skin rashes or eye irritation., where donor cells attack the patient's skin and eyes. He later suffered six months of swallowing difficulty and weight loss. Doctors ran an endoscopy, using a camera to look inside his food pipe, and discovered esophageal squamous cell carcinoma, a type of cancer. He received six cycles of chemotherapy. Imaging showed how this tumor grew and damaged tissue. A chest scan revealed a mid-esophageal mass of approximately 70-mm. A barium swallowbarium swallowAn X-ray test where the patient drinks a chalky liquid that coats the esophagus to show its shape and any leaks. test, which tracks swallowed dye, showed an irregular narrow passage and approximately 2.5 cm of dye leaking toward his left airway. This suggested a suspected bronchoesophageal fistulafistulaAn abnormal connection between two body parts, like between the esophagus and the airway., an abnormal tunnel connecting the food pipe to the airway. Before surgery, the patient died from cardiopulmonary arrest.

Why it matters

People who survive bone marrow transplants can develop new cancers years later, and symptoms like trouble swallowing can be mistaken for a benign complication of the transplant itself. This case shows how imaging tests can catch a dangerous complication—a fistula—that changes treatment decisions. It reminds doctors to consider cancer when transplant survivors report new swallowing problems.

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