Antral Gastric Cancer with Gastric Outlet Obstruction – Preventable by Screening? A Case Report
Oskar Maria Voll, Lucy Marlen Zimmermann, Haftstein Eva-Maria Sophia
(University of Medicine, Pharmacy, Science and Technology “George Emil Palade”of Targu Mures, Romania)Università degli Studi di Catania
Abstract
Introduction – Background: Gastric Adenocarcinoma is the most common type of gastric cancer, most common location in the lesser curvature. Most patients are asymptomatic in early stages, developing unspecific symptoms, such as weight loss, loss of appetite and nausea, in later stages. That is why the diagnosis in most cases is late and so far, screening is recommended only by Japanese researchers. The aim of the study is to present a case of gastric adenocarcinoma with the complication of outlet obstruction to set more focus on screening methods established by Japanese researchers.
Methods: A 82-year-old patient presented in the hospital with regurgitation, vomiting and weight loss. He had a subtotal colectomy for colon cancer 5 years ago. During the general examination a tumoral mass was palpable in the hypogastric region. On the CT a tight tumor stenosis in the duodenal bulb and D1 with adjacent tumor adenopathy (celiac and peripancreatic), and multiple hepatic metastasis, and right and left portal branch thrombosis was detected. A biopsy through esogastroduodenoscopy was performed with the histopathological result of a low grade gastric tubular adenocarcinoma which is moderately differentiated.
Results: Thus, a palliative intervention was indicated due to the outlet obstruction. A laparotomy was performed. Liver biopsy was made revealing liver metastases and adhesiolysis of the proximal part of jejunum with gastroenteroanastomosis.
Discussion – Conclusion: This case raises the question of measures of early detection of gastric cancer. In Japan there is a national screening program for gastric cancer. Every 2-3 years endoscopic screening is recommended for adults older than 50 as stated by the guideline of the Japanese national screening program. According to studies the screening is cost-effective and is said to prevent approximately 63% of gastric cancer mortality, compared with no endoscopic screening. Thus, endoscopic screening might be beneficial in other countries as well. With gastric cancer being detected at earlier stages compared to Western countries, the overall survival rate of gastric cancer is higher in Japan.
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