Synchronous gastric and pancreatic adenocarcinomas in a 76-year-old woman

What happened, in summary

A 76-year-old woman presented with left-sided abdominal pain, nausea, poor appetite and a 10-pound weight loss. Imaging showed marked growth of a known pancreatic cystic lesion. Biopsy confirmed pancreatic adenocarcinoma, and she underwent an extended Whipple procedure.

Pathology unexpectedly found a second cancer in gastric tissue at the surgical margin. Repeat upper endoscopy and mapping biopsies confirmed poorly differentiated gastric adenocarcinoma with focal signet-ring cell morphology involving the stomach lining and submucosa. Additional testing supported that the gastric and pancreatic tumors were separate primary cancers rather than one cancer spreading to the other.

The treatment plan addressed both cancers. She started 5-fluorouracil-based systemic therapy while radiation was directed to the pancreatic area, with the intention of later performing further pancreatic surgery and possible gastrectomy. Her baseline health continued to deteriorate, however, leading to repeated hospitalizations and failure to thrive. She was unable to tolerate the planned chemoradiation course, and the intended gastric surgery was never reached. She and her family chose palliative care, and she died shortly afterward.