Gastric Carcinoma and Renal Cell Carcinoma as an Atypical Presentation of Multiple Primary Malignancies

A Case Report and Review of the Literature

J. A. Martín-Pérez; C. Torres-Silva; R. Tenorio-Arguelles; D. A. García-Corona; S. Silva-González; J. A. Dominguez-Rodriguez; I. De Alba-Cruz; J. F. Nagore-Ancona; J. A. González-Luna; K. A. López-Bochm

Disclosures

J Med Case Reports. 2020;14(234) 

In This Article

Discussion

Gastric carcinoma (GC) is the second most frequent GI neoplasm worldwide, occupying fifth place in cancer mortality globally and representing 4% of cancer cases diagnosed in Mexico to 2018.[27]

The incidence of GC in presentation with another SPM varies from 0.7–11%.[2,3,5,6,17–20,22,26] SPMs in relation to CG are most often tumors due to colorectal, lung, and liver cancer.[14,17–19,28] Synchronous renal cell carcinoma is very rare (0.11–0.37%) finding in our review with an incidence of 0.10% and with a 2:1 male-female ratio. The incidence of synchronous cancer has been found to be higher in GC in early stage than in advanced stages (5.2% versus 2.4%).[19,20]

The present study describes a rare case of a female patient in her seventh decade with a history of chronic smoking, presenting with nonspecific gastrointestinal symptoms and weight loss. During the diagnostic protocol, a left kidney tumor was found. She underwent surgery by partial gastrectomy with anastomosis and left radical nephrectomy.

The most common presentation in patients seeking medical attention early is related to signs and symptoms associated with GC; the aforementioned is of utmost importance, since at the time of diagnosis they are usually in the early clinical stage, which makes it possible to carry out a comprehensive approach offering conservative and even curative treatments. However, early signs and symptoms are nonspecific, and include GI bleeding and nonspecific abdominal pain, accompanied by weight loss in up to 40% of patients over a period of 2–3 months. For this reason, it is necessary to carry out, in all cases, a workup ranging from laboratory studies (including tumor markers), radiology (abdominal CT with contrast), and EGD with biopsies to rule out or confirm the diagnosis or other incidental findings.

In our review we found that the risk factors with the greatest impact were chronic smoking and advanced age (over 60 years).[2,4,17,18,20,22–24,29–31] Males are more frequently affected, with a 2:1 male/female relationship.[32–35] Another finding was that there is still no genetic alteration or association that links the synchronous presentation of both types of cancer, as noted by Betge et al. in their 2011 study, where they analyzed a group of patients with a well-differentiated clear cell RCC presentation and aggressive and poorly differentiated gastric cancers. They were unable to associate a known hereditary cancer syndrome, and this will have to be explored in future studies.[36]

The treatment most frequently reported in our review, and which coincides with that we carried out in the present study, was the resection of both primary tumors at the same surgical time; the most commonly performed technique was partial gastrectomy with anastomosis and radical nephrectomy, since it has been shown to have a better prognosis and long-term survival in patients.[37] It is worth noting that the involvement of the left kidney (87.5%) was much more predominant than the right kidney in the articles included in our review.[5,6,19,22–24] No cause or association can be concluded related to this finding.

Finally, survival is dependent on the primary tumor with the most advanced clinical stage, as this will determine the patient's prognosis and the appropriate management, ranging from chemotherapy to radiotherapy, and even including surveillance exams to rule out a recurrence or metastasis at a distant site or the possibility of a new tumor in another organ, since these patients are predisposed to the development of MPM.[38–40] Continuing with surveillance indefinitely is suggested in this group of patients due to the risk of recurrence.

We consider that the exclusion of studies written in a language other than English or Spanish could be considered a limitation, particularly due to the high prevalence in Asia.

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