Synchronous gastric and colonic cancer – A case report

Bratislav Trifunović; Branimir Nešković; Mihailo Bezmarević; Jovan Kršić; Milić Veljović; Dejan Zeljković

doi:10.2298/6361

Bratislav Trifunović Clinic of General Surgery Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Branimir Nešković Clinic of General Surgery Military Medical Academy, Belgrade, Serbia
Mihailo Bezmarević Clinic of General Surgery Military Medical Academy, Belgrade, Serbia
Jovan Kršić Clinic of General Surgery Military Medical Academy, Belgrade, Serbia
Milić Veljović Clinic of Anesthesiology and Critical Care, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Dejan Zeljković Clinic of General Surgery Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/6361

Keywords: neoplasms, multiple primary, stomach neoplasms, colonic neoplasms, diagnostic techniques and procedures, histology, digestive system surgical procedures,

Abstract

Introduction. Synchronous gastric and colorectal cancer is present in 4% of cases, commonly as additional finding. This is the case of invasive, synchronous gastric and sigmoid colon cancer. Case report. A 63-years-old male patient admitted to our institution complaining on pains in epigastrium, vomiting, rapid weight loss and occasional constipation. Using the method of esophagogastroduodenoscopy (EGD) the presence of ulcero-infiltrative tumor of gastric fundus was verified, and colonoscopy revealed stenosing tumor of sigmoid colon. Undergoing a multislice computed tomography (MSCT) of the thorax and the abdomen the changes on the patient’s right lung appeared, while video-assisted thoracoscopy (VATS) and biopsy of the right lung excluded malignant dissemination. A total gastrectomy with omentectomy, splenectomy, D2 lymphadenectomy and typical left hemicolectomy were also performed. Histopathological examination verified invasive, diffuse gastric adenocarcinoma and invasive, tubular colon adenocarcinoma. The patient underwent systemic postoperative chemotherapy. Two years after the surgical procedure, the patient is alive, with no signs of recidivism. Conclusion. In patients with symptomatology which does not correspond to primary malignancy, just like in the presented case, additional diagnostics is required. Combined resection is adequate surgical procedure for synchronous gastric and colonic cancer.

References

Koide N, Adachi W, Koike S, Watanabe H, Yazawa S, Amano J. Synchronous gastric tumors associated with esophageal cancer. Am J Gastroenterol 1998; 93(5): 758−62.

Chang YT, Tsai CI, Yang TH, Shih CW, Wu MS, Lin JT. Syn-chronous triple cancers at middle and lower esophagus and stomach with different histological features and genetic altera-tions. J Gastroenterol Hepatol 2002; 17(6): 724−7.

Onoue S, Katoh T, Chigira H, Matsuo K, Suzuki M, Shibata Y, et al. Synchronous multiple primary cancers of the stomach and duodenum in aged patients: report of two cases. Surg Today 2000; 30(8): 735−8.

Dinis-Ribeiro M, Lomba-Viana H, Silva R, Moreira-Dias L, Lomba-Viana R. Associated primary tumors in patients with gastric cancer. J Clin Gastroenterol 2002; 34(5): 533−5.

Tamura M, Shinagawa M, Funaki Y. Synchronous triple early cancers occurring in the stomach, colon and gallbladder. Asian J Surg 2003; 26(1): 46−8; discussion 49.

Sato K, Maekawa T, Yabuki K, Tamasaki Y, Maekawa H, Kudo K, et al. A case of triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas. J Gastroenterol 2003; 38(1): 97−100.

Laurén P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand 1965; 64: 31−49.

Watanabe S, Kodama T, Shimosato Y, Arimoto H, Sugimura T, Suemasu K, et al. Multiple primary cancers in 5,456 autopsy cas-es in the National Cancer Center of Japan. J Natl Cancer Inst 1984; 72(5): 1021−7.

Warren S, Gates O. Multiple primary malignant tumors: a survey of the literature and statistical study. Am J Cancer 1932; 16: 1385–414.

Lee JH, Bae JS, Ryu KW, Lee JS, Park SR, Kim CG, et al. Gastric cancer patients at high-risk of having synchronous cancer. World J Gastroenterol 2006; 12(16): 2588−92.

Saito S, Hosoya Y, Togashi K, Kurashina K, Haruta H, Hyodo M, et al. Prevalence of synchronous colorectal neoplasms detected by colonoscopy in patients with gastric cancer. Surg Today 2008; 38(1): 20–5.

Šipetić Grujičić S, Krivokapić Z. Epidemiological and etiological characteristics of colon and rectal cancer. In: Krivokapić Z, editor. Rectal cancer. Belgrade: Zavod za udžbenike; 2012. p. 37−55. (Serbian)

Nakajima T. Gastric cancer treatment guidelines in Japan. Gas-tric Cancer 2002; 5(1): 1−5.

Maruyama K, Okabayashi K, Kinoshita T. Progress ingastric cancer surgery in Japan and its limits of radicality. World J Surg 1987; 11(4): 418–25.

Eom BW, Lee HJ, Yoo MW, Cho JJ, Kim WH, Yang HK, et al. Synchronous and metachronous cancers in patients with gas-tric cancer. J Surg Oncol 2008; 98(2): 106−10.

Kim JP, Park JG. Results of treatment of stomach cancer. J Korean Med Assoc 1983; 26: 637–42.

Ikeda Y, Saku M, Kawanaka H, Nonaka M, Yoshida K. Features of second primary cancer in patients with gastric cancer. On-cology 2003; 65(2): 113−7.

Lei Z, Zhao H, Liang D. Clinical analysis of 13 cases of syn-chronous gastricand colorectal cancer. Chinese German J Clin Oncol 2007; 6(4): P331–3.

Mylonakis E, Κlimis A, Vlachos G, Glynatsis M. Glynatsis. Syn-chronous Colon and Advanced Gastric Cancer. Hellenic J Surg 2012; 84: 5.

Ohtani H, Yashiro M, Onoda N, Nishioka N, Kato Y, Yamamoto S, et al. Synchronous multiple primary gastrointestinal cancer ex-hibits frequent microsatellite instability. Int J Cancer 2000; 86(5): 678−83.

Ikeguchi M, Ohfuji S, Oka A, Tsujitani S, Maeda M, Kaibara N. Synchronous and metachronous primary malignancies in or-gans other than the stomach in patients with early gastric can-cer. Hepatogastroenterology 1995; 42(5): 672−6.

Kaibara N, Maeta M, Ikeguchi M. Patients with multiple primary gastric cancers tend to develop second primaries in organs other than the stomach. Surg Today 1993; 23(2): 186−8.