# The Uncharted Territories of Esophageal Cancer with Cardiac and Skeletal Muscle Metastasis: A Case Report and Literature Review

## TL;DR

A rare case of esophageal cancer with unusual spread to heart and muscle tissues is reported, highlighting the potential of ctDNA for early detection and the need for better screening.

## Contribution

This case report presents a rare instance of esophageal cancer with cardiac and skeletal muscle metastasis and emphasizes the role of ctDNA in monitoring recurrence.

## Key findings

- The patient had P53-positive esophageal cancer with metastasis to cardiac and skeletal muscles.
- Multimodal therapy, including immunotherapy, contributed to prolonged survival despite poor prognosis.
- ctDNA remained positive even with negative scans, indicating its potential as a recurrence predictor.

## Abstract

Background: Esophageal cancer (EC) comprises 1% of all diagnosed cancers in the USA. It is more common in other parts of the world. If there is distant metastasis, the relative survival rate is 6%. There are no standardized screening methods for EC. Case Presentation: We reported a four-year case of esophageal cancer, a P53-positive mutation with atypical distant metastasis to the cardiac and skeletal muscles. The patient was managed with multimodal therapy, including immunotherapy, which could have been a factor in prolonged survival. Conclusions: Distant metastases are typically seen postmortem, and with prolonged survival, we are able to find such unique metastases antemortem. Despite a history of negative scans, the patient’s ctDNA (circulating tumor DNA) remained positive, which was a better predictor of recurrence in this case. Future research is required to establish cost-effective screening methods and standardized treatments.