Case presentation (1)

Gastric cancer

Asist. Univ. Dr. Ana-Maria Ghiuchici

Department of Gastroenterology and Hepatology, “Victor Babeş”
University of Medicine and Pharmacy Timisoara, Romania
Medical History

N.A., 62 years old, female pacient,

AHC: family history of colonic cancer (father)
APP: essential hypertension under treatment,
inactive fibrotic pulmonary tuberculosis
lesions
 The pacient cames in the gastroenterology
ambulatory complaining of :

• Asthenia
• Fatigue
• Loss of appetite
• Weight loss- 7 kg in 2 months
Clinical exam:
o skin pallor
o upper abdominal pain
o regular bowels

Laboratory exam:
o Mild hypochromic, microcytic anemia Hb= 9,7
g/dl
o Blood smear: microcytosis, hypochoromia
marcata
o Ag HBS, Ac antiHCV- negative
o Negative tumoral markers (CEA, CA19-9, AFP)
 Abdominal ultrasound

• Thickened gastric wall

• Heterogeneous hepatic
structure because of the
multiple hyperechoic
lesions

• Mild ascites
 CEUS- contrast enhanced ultrasound
The liver lesions showed
homogeneous
hyperenhancement during
the arterial phase and
complete wash out starting
from the portal phase.

Conclusion:
Hypervascular liver
metastasis
Next step : The pacient was admitted in the
gastroenterology department for endoscopic
evaluation.
Gastroscopy
- Protruding mass on both lesser and
greater curvature of the stomach,
friable.

- we took multiple biopsies

Thoracic, abdominal and pelvis computed
tomographic scans with contrast

- Inactive fibrotic pulmonary tuberculosis lesions

- Multiple liver metastasis
- Tumoral gastric mass
- Perigastric, periaortic and interaortocaval lymph
nodes of 1.5 cm
- No other secondary lesions
Histology
• Moderately differentiated tubulopapillary
adenocarcinoma G2
 Diagnostics:
• Stage IV gastric tumor (T3N2M1)
• Metastatic liver and ganglionary lesions
• Carcinomatous ascites
• Mild hypochromic, microcytic anemia
• Grade II essential hipertension
Treatment
• In the oncology department
• Palliative Chemotherapy
Prognostic
Considering the late phase of the disease and
the limited treatment possibilities this pacient
have, the survival rate is 3-6 months.
Therapeutic possibilities for gastric
cancer
• Endoscopic procedures
– Endoscopic mucosectomy for the early gastric cancer (endoscopic
mucosal resection - EMR)
– Only in T1 stage with the invasion of the mucosa
• Surgical therapy- the best treatment option for gastric cancer, being the
only therapy that offers a potential cure.
• Total/subtotal gastrectomy
• Medical therapy- chemotherapy
– neoadjuvant
– adjuvant
– palliative
Palliative treatment
– In 20 to 30% of the cases, we diagnosed the gastric cancer in a late
stage (IV)
– Palliative treatment is designed to relieve symptoms and improve the
quality of life.
Can be :
– Endoscopic (endoscopic dilation +/- metallic stents)
– Chemotherapy
• In advanced cancer (metastatic one)
• Survival rate between 3 to 6 months
• Combined cytostatic chemotherapy – superior efficiency
(cisplatinum, 5- fluorouracil, etc.)
Discussions
• The prognostic and treatment of gastric cancer
depend on the TNM stage, histology and the age
of the patient.
• Early detection allows more treatment options.
• Follow-up is based on the case history, clinical
examination, blood tests, including tumor marker
assays, imaging and endoscopy.
Thank you!