Stage I Gastric Cancer Among Five Synchronous Gastrointestinal Cancers

What happened, in summary

A 52-year-old man was referred for anal pain and intermittent blood-tinged stool, and a broad gastrointestinal workup unexpectedly identified five independent primary cancers. Colonoscopy found three separate colorectal tumors, while endoscopy showed an early gastric lesion on the posterior wall of the antrum and imaging identified another mass in the jejunum. The gastric tumor was treated during the same major operation as the other cancers. He underwent subtotal gastrectomy, total proctocolectomy with an end ileostomy and segmental resection of the jejunum. Gastric pathology showed a moderately differentiated tubular adenocarcinoma of intestinal type. The tumor had invaded the submucosa, and none of the 19 examined gastric lymph nodes contained cancer, supporting Stage I disease. After surgery, adjuvant FOLFOX-based chemoradiotherapy was focused on the separate Stage III rectal cancer, which had the highest stage among the synchronous tumors. The patient continued regular follow-up after recovering from the combined surgery and additional rectal-cancer treatment. At 6-year follow-up, he had no recurrence or metastasis and remained in good general health despite the unusual presentation with five primary gastrointestinal cancers at the same time.