A LONG TERM SURVIVOR WITH ADVANCED GASTRIC CANCER SHOWING MULTIPLE METACHRONOUS EXTRAPERITONEAL METASTASES

Abstract

Gastric metastases to other organs are often unresectable, and even resectable caases have to have an extremely poor prognosis. This time we experienced a long-term survivor for 7 years and 2 months after the initial operation for gastric cancer; during of which multiple metachronous extraperitoneal metastases were successfully treated by operations, radiation and chemotherapy.
The patient was a 56-year-old woman who had undergone a total gastrectomy with D2 lymph nodes dissection for advanced gastric cancer in July, 1990. Four years later, the patient was admitted to our department because of an umbilical tumor and was diagnosed as having an umbilical metastasis, socalled Sister Mary Joseph's nodule, from a previously-treated gastric cancer by fine needle aspiration cytology. She underwent an extirpation of the umbilical tumor.
Three months later she noticed a swollen lymph node in the right axilla and several nodules suggesting intramuscular metastases in the abdominal rectus muscle. Furtheremore, 4 months after the extirpation of the axillary lymph node, which was histologically diagnosed to be metastatic gastric cancer, her right breast showed a cancerous skin change and bilateral inguinal lymph nodes enlarged. Therefore, radiation therapy at a total dose of 50Gy on both sites was added, followed by several courses of systemic chemotherapy using methotorexate and 5-fluorouracil.
Our aggressive combined therapy was effective, and gave her a long-term surrvival without spoiling the quality of her life for as long as 7 years and 2 months.