Abstract
Early gastric cancer was suspected in a 71-year-old woman during an upper gastrointestinal tract imaging test in November 2008, and she consulted the Department of Gastroenterology at Ojiya General Hospital. Esophagogastroduodenoscopy showed early gastric double cancers, so laparoscopy-assisted distal gastrectomy was performed in December. The final diagnosis was stage IA. Follow-up was conducted in the Department of Gastroenterology. The carcinoembryonic antigen (CEA) level was elevated, at 17ng/mL, in May 2009. Thus, she received a detailed examination. However, a definitive diagnosis of recurrence was not made. As the rise of serum CEA continued, a TS-1/cisdiamine dichloroplatinum treatment was started in August. Chemotherapy was effective, and the CEA levels decreased gradually. Symptoms of anemia were observed in December when the fourth period of chemotherapy treatment had been completed. Esophagogastroduodenoscopy showed a hemorrhagic tumor in the anastomosis in January 2010, so a total remnant gastrectomy was performed in January 2010. Immunohistochemical staining for alpha-fetoprotein (AFP) was positive. A rise in serum AFP occurred just before the total remnant gastrectomy, and we diagnosed it as the gastric cancer producing AFP. After the total remnant gastrectomy, both serum CEA and AFP levels normalized. Although the patient was taking TS-1 after discharge, she developed a recurrence with multiple pulmonary metastases in July, and various systemic chemotherapies are currently being performed.
