Synchronous Gastric and Colon Carcinomas: A Case Report and
Review of Literature
Ayın Vakada Eș zamanlı Görülen Mide ve Kolon Kanseri: Olgu Sunumu ve Literatür Derlemesi
Gül Bora, Bilgehan Çağdaș Sonbahar, Gökhan. Kabaçam, Necdet Özalp
Dept. of Surgery and Gastroenterology; Medicalpark Ankara Hospital,
Ankara, Turkey Bilindiği üzere senkron mide ve kolon kanseri nadir görülen bir durumdur. Biz burada senkron iki tümörün
formu olan mide ve kolon adenokanseri vakasını bildiriyoruz. 74 yașında kadın hasta kliniğimize epigastrik ağrı ve yanma șikayetiyle bașvurdu. Hastaya gastroskopi yaptık ve midede malign kitle gördük. Șikayeti olmamasına rağmen hastaya kolonoskopi yaptık ve sağ kolonda malign kitle ve polip saptadık. Yașlı hastalarda gastrointestinal traktusta bașka bir senkron tümör olabileceğini unutmamak gerektiğini öneriyoruz.
Anahtar Sözcükler: Senkron Tümör, Gastrik Karsinom, Kolon Karsinomu
As is known synchronous gastric and colon cancer is rare. Here we report the synchronous two malignancies in form of gastric adenocarcinoma and colon adenocarcinomas. A 74 year old female patient was admitted to our department with epigastric pain and heartburn. We performed gastroscopy and saw gastric malignant mass. Despite the lack of patient complaints we did colonoscopy and detected malignant synchronous mass and colonic polip in right colon. We suggest, not to forget in older patient there will be another synchronous malignancies at other gastrointestinal tractus.
Key Words: Synchronous Tumor, Gastric Carcinoma, Colon Carcinoma
The first description of the term “multiple primary neoplasm” by Billroth in 1889 is defined as the development of more than one neoplasm in a patient (1). But multiple primary neoplasia were not taken seriously, until the study of 1,259 case reports by Warren and Gates in 1932 (2).
Worldwide, gastric cancer is the fourth most common cancer in population(3,4). In Turkey, gastric cancer is the fifth most common cancer with an incidence of 10 per 100 000 (5). There are two kinds of second primary malignancies; synchronous and metachronous. Synchronous tumors mean that which occurs at the same time or in first six months, when diagnosis first malignancies, while metachronous cancers were defined as those occurring more than 6 months later (6). The simultaneous occurrence of malignancies in two or more digestive organs, on the contrary, is very unusual. The combination of organs reported to be synchronously involved are the esophagus and
stomach, the stomach and duedonum, the stomach and colon, the stomach, colon and gallblader, the gallblader, commone bile duct and pancreas (7-11). However, both gastric and colon malignancies, together or associated with other digestive tract tumors, are frequently at an early stage (7-10). The case reported here synchronous
gastric and colon cancers.
Case Report
A 74 year old female was initially admit-ted our department for epigastric pain, burning in the chest and weight loss. Physical examination revealed epigastric tenderness. Blood test re-sults: WBC:5.31, Hgb:5, Plt:418, Ca125: 13.56, Ca15.3: 15.9, Ca19.9: 28.76, CEA:5.96. Abdominal CT scan revealed extending wall thickening in the greater curvature of the gastric antrum (Figure 1A,1B). The patient underwent an upper gastrointestinal endoscopy and detected gastric ma-lignancie (Figure 2). Then our
gastro-Ankara Üniversitesi Tıp Fakültesi Mecmuası 2016, 69 (2)
DOI: 10.1501/Tıpfak_000000932
DAHİLİ TIP BİLİMLERİ/ MEDICAL SCIENCES
Olgu Sunumu / Case Report
Received : April 19, 2016 Accepted: Aug 16, 2016 Corresponding author:
Op. Dr. Bilgehan Çağdaș Sonbahar E-mail: bilgehansonbahar@yahoo.com Phone: 444 44 84
GSM: 0 542 576 50 44
Ankara Üniversitesi Tıp Fakültesi Mecmuası 2016, 69 (2)
Synchronous Gastric And Colon Carcinomas: A Case Report And Review Of Literature
130
A) B)
Figure 1: Photograph of abdominal computer tomography, shows the gastric Wall thickness.(A,B)
Figure 2: Photograph of endoscopy, shows 8x7cm ulcerovegetan mass in antrum.
Figure 3: Photograph of endoscopy, show the 5x6cm mass, orginating ileocecal valve and clogging %75 to calcum lumen.
enterology clinic performed lower gastrointestinal endoscopy before forwarding the patient surgery clinic and detected synchronous right colon carcinoma (Figure 3).
Discusion
The incidence of gastric cancer with a synchronous second primary cancer varies from 2.0% to 10.9% (12-15). Ha et all (6) found this rate as %1 Lawnic-zak et al (13) find as %6,7. Especially of late years there has been an increase in the rate of detection of synchronous second primary cancers because of improvement on screening techniques. Colorectal cancer is the most frequent seen cancer synchronously in patients with gastric cancer (12-19). Smilarly the most frequently cancer is gastric cancer in with kolorectal cancer patients too. Also, gastric cancer is the most com-mon extracolonic cancer associated with hereditary nonpoliposis colorectal cancer syndrome (HNPCC) (20). Fa-milial gastric cancer is associated with the presence of a synchronous colorec-tal cancer. It is dificult to explain which mechanism is responsible. But there are suspicous that can be cause of mismatch repair gene defect (21-22). Although, Molinero et al (23) observed a family history as %56 in gastric can-cer patients.
As is konwn age is a predominant risk factor for malignancies. Common point of researchs is patients who ha-ve secondary malignancy synchro-nous or metacrohsynchro-nously are older. Especially older than 57 years. Like wise, males have higher risk from females for secondary malignancies. Lee et al’s (12) investigation; they ha-ve found a rate of synchronous tu-mors as %3.4 and pointed out that older patient had risk especially. Ike-da et al (14) found that patients with a second tumor tended more frequ-ently to be males and elderly than those without a second tumor. Eom et al. (24) indicated that the mean age of patients and the proportion who had early gastric carcinom were both higher in patients with a second can-cer than in those without. Both
stu-dies were conducted in Asia and were carried out in larger groups.
Prognosis of gastric cancer is not as good as expected. But if there is an early gastric cancer, prognosis can be well. So presence of secondary primary cancer will affect prognosis too (15,25). Skoropad Vlu et al. (26) investigated 1255 patient with gastric cancer. They found second tumors in only 99 patient. They underlied that treatments weren’t contradicated at presence of second tumors. Lots of investigaiton showed that patients who have secondry malignancies had
early degree or well differantiated tumors (26-28).
So we must think all the details about patient. İf someone applies to us with gastric cancer, or we diagnose; we should bring to mind posibilities of synchronous tumors also kolorectal cancer. İf there are complaients about kolorectal carsinom like bleeding, obstruction, it is easy deciding to making colonoscopy. But kolorectal complaints may not be ocur every time. So if the patient is older than 50 years, male, has familiy history, precense of a histroy of radioterapy/
Journal Of Ankara University Faculty of Medicine 2016, 69 (2)
Gül Bora, Bilgehan Çağdaș Sonbahar , Gökhan. Kabaçam, Necdet Özalp 131
chemoterapy; we should make perioperative screenening like pet/ct or colonoscopy. This relatively high rate indicates that it would be highly significant to pay attention to the development of second primary cancer
in the preoperative evaluation period, in the exploration during surgery, and in the postoperative follow up period. The systemic investigation and examination of patients with gastric cancer should be performed in detail,
and all organs should be examined carefully during surgery. The early diagnosis of seconadary primary cancer provides a longer survival and a better quality of life (28).
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