title: Gastric adenocarcinoma presenting with persistent, mild gastrointestinal symptoms in pregnancy. A case report.
abstract: BACKGROUND
  Mild gastrointestinal symptoms are common during pregnancy but can also be the only symptoms in stomach cancer until the late stage. Clinicians' reluctance to pursue diagnostic studies appears to be a major contributing factor to delayed diagnosis and poor outcome. We report a case of maternal death to alert clinicians to this rare possibility.
  
  
  METHODS
  A 36-year-old woman had persistent, mild epigastric discomfort, nausea, vomiting and frequent episodes of dark stools since the second trimester of pregnancy. These were attributed to peptic ulcer and an iron supplement given, without investigation. Gastroscopy was performed only at 32 weeks of gestation, when the patient had heavy hematemesis. Biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma of the stomach. Cesarean section was performed after steroid therapy. Advanced stomach cancer with stomach perforation was found. Curative surgery was not possible. The patient died four weeks after delivery.
  
  
  CONCLUSIONS
  Stomach cancer is a rare complication of pregnancy. Delay in diagnosis is commonly due to clinicians' reluctance to request diagnostic studies and the nonspecific symptoms of the disease. Early recognition and diagnosis are the only possibilities for a better outcome. Clinicians must be alert to this possibility and include this in the differential diagnosis of minor gastrointestinal discomfort during pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, China.
authors.forename: Y M
authors.initials: YM
authors.lastname: Chan
authors.forename: S W
authors.initials: SW
authors.lastname: Ngai
authors.forename: T T
authors.initials: TT
authors.lastname: Lao
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D005773:Gastroscopy; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D009325:Nausea / Q000209:etiology; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000473:pathology; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014839:Vomiting / Q000209:etiology