Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.150
Peer-review started: October 31, 2017
First decision: November 8, 2017
Revised: November 18, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: January 7, 2018
Processing time: 68 Days and 20.2 Hours
A 53-year-old man, referred after detection of a tumorous bony lesion in the 2nd lumbar vertebra during evaluation for back pain.
The patient had no significant medical history, except for having undergone gastrectomy due to gastric ulcer 15 years prior.
Primary bone neoplasm, metastatic bone tumor.
Serum alkaline phosphatase, calcium, carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9 and lactate dehydrogenase (LDH) levels were within normal range.
Magnetic resonance imaging of the spine showed a suspicious metastatic lesion in the 2nd lumbar vertebra, with enhancing signal intensity on a T2-weighted image. Gastroduodenoscopy showed a Borrmann type III lesion at the remnant stomach lesser curvature.
A bone biopsy taken at the 2nd lumbar vertebra led to diagnosis of metastatic adenocarcinoma. Gastric lesion was diagnosed as poorly differentiated adenocarcinoma by biopsy.
The patient underwent total gastrectomy and lumbar vertebrae metastasectomy, followed by aggressive palliative chemotherapy.
Gastric cancer with bone metastasis is relatively rare and associated with poor prognosis. Known factors associated with longer median survival times for patients with bone metastasis include isolated bone metastasis, well differentiated tumors, palliative chemotherapy and zoledronic acid treatment. On the other hand, high-level LDH, CEA and CA19-9, serum hypercalcemia, poor performance status, and involvement of multiple bones are associated with shorter survival times. Small studies have reported survival gain in gastric cancer patients with synchronous distant metastasis who underwent resectable gastric surgery plus metastasectomy.
Gastrectomy is a partial or total surgical removal of the stomach. Metastasectomy is the surgical removal of metastases, which are secondary cancerous growths that have spread from cancer originating in another organ in the body.
Aggressive local therapy, including gastrectomy with metastasectomy and palliative chemotherapy, may be an effective therapeutic option for improving survival in patients with resectable primary gastric cancer and bone metastasis.