Numan ÇİM, ERBİL KARAMAN, OSMAN TOKTAŞ, Gülhan GÜNEŞ, Erkan ELÇİ, Esra ANDIÇ, SERHAT EGE, Recep YILDIZHAN

Management of gastric cancer with liver metastasis in a pregnant woman

The complaints and symptoms of gastric cancer are non-specific and many of these symptoms are frequently masked by factors related to normal pregnancy. A 38 year-old woman with G10P8A1 and at 31 weeks of pregnancy was admitted to a maternity outpatients' clinic complaining of nausea, vomiting and constipation during the previous 4 days. On palpation a solid lesion of 1.5 cm was palpable in the subxiphoid region. A solid nodule with largest diameter of 5 cm was observed on the liver and suspected to indicate metastasis. Under endoscopic examination, ulcerovegetan, fragile and malignant mass that surrounded and narrowed the gastric antrum and extended to an angular notch was seen. The biopsy that was taken from lesion was revealed to be the result of a malignant epithelial tumor of poorly differentiated adenocarcinoma. During the explorative laparotomy, a tumoral mass with multiple peripheral lymphadenopathies was observed in the posterior gastric antrum, pancreas and colon median entry-invasive artery. Multiple metastases were present in the omentum and liver with a large amount of acid in the abdomen. The patient was considered inoperable due to the gastric cancer being in a terminal stage and adjuvant chemotherapy was planned. Early diagnosis and treatment is important for the prognosis of gastric cancer. The complaints and symptoms of gastric cancer are non-specific and many of these symptoms are similar to those seen during a normal pregnancy. If the same symptoms recur during pregnancy or there is a failure to respond to therapy, the gastrointestinal system should be evaluated endoscopically.

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