engleski

Metastatic gastric carcinoma - a case report

Introduction: Gastric cancer is one of the most common cancers worldwide. It presents a major global health problem with large geographical variations in incidence, with the highest rates in North-East Asia, South and Central America and Eastern Europe, and the lowest rates in Western Europe, Sub-Saharan Africa, Australia and North America. Most patients with gastric cancer already have advanced, incurable disease at the time of presentation. Gastric adenocarcinoma often develops as a consequence of chronic atrophic gastritis or intestinal metaplasia and is strongly associated with Helicobacter pylori infection. Most gastric cancers are sporadic, while familial gastric cancer accounts for 1-3% of gastric cancer cases. Hereditary gastric cancer includes three main syndromes: hereditary diffuse gastric cancer (HDGC ; this is the only one that has been genetically elucidated), gastric adenocarcinoma and proximal gastric polyposis (GAPPS) and familial intestinal gastric cancer (FIGC). In addition to genetic factors, a number of environmental factors, such as Helicobacter pylori infection and consumption of high-salt foods, may contribute to carcinogenesis in gastric cancer. Unhealthy lifestyle, alcohol consumption and smoking are additional risk factors for gastric cancer. Case report: In this report, we describe the case of a 50-year-old man who presented with dyspepsia in May 2020. An esophagogastroduodenoscopy was performed, and a tumor of the distal esophagus and cardia was found. A biopsy was taken and pathological examination revealed human epidermal growth factor receptor 2 (HER-2) positive adenocarcinoma. A computed tomography (CT) scan was done and it 21 showed metastases in the liver and suspicious nodules in the lungs. In June 2020, first-line treatment of the metastatic disease was started: chemotherapy with cisplatin and capecitabine, with the addition of HER-2 blockade with trastuzumab. After 4 cycles of treatment, our patient was hospitalized due to worsening general condition, vomiting, weight loss and inability to eat solid food. A thorough diagnostic workup was performed and a CT scan showed right-sided pneumonia and disease progression: enlargement of the primary tumor, increased number of liver metastases and increase in the size of pre-existing metastases. He was treated with antibiotics for pneumonia and underwent a percutaneous endoscopic gastrostomy (PEG). In December 2020, a second line of treatment was started: chemotherapy with paclitaxel and ramucirumab. Our patient tolerated the therapy very well and radiological follow-up after the first three cycles showed an excellent response to therapy. We continued with the therapy and over time, our patient’s condition improved. He also gained weight: he started treatment at 70 kilograms and after 9 treatment cycles weighed 108 kilograms. In addition, in October 2021, at his request, his PEG was removed. To date, we have continued with the same treatment and our patient’s disease is still stable.

gastric cancer, chemotherapy, liver metastases, PEG

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