title: Ultra-late recurrences of gastro-intestinal carcinoma after primary resection: the mechanism of dormancy.
abstract: Curative resection of limited gastro-intestinal carcinoma does not always mean curation with tumor-free long-term survival. We present two cases of ultra-late recurrence 14 years after initial treatment. In the first case a 50-year-old male underwent in 1997 a subtotal esophagectomy with tubulation of the stomach for a localized Barrett carcinoma. Postoperative staging showed a poorly differentiated adenocarcinoma, pT1N1 (stage IIB). In May 2011, 14 years after the initial resection, multiple bone metastases were diagnosed and a biopsy confirmed the poorly differentiated carcinoma with the same characteristics as the primary tumor. Investigations showed no evidence for a new primary tumor. The second case is a 52-year old man who underwent a low anterior resection for a small rectal cancer in 1997, histologically a well differentiated adenocarcinoma, stage IB (pT2NO). In December 2011 multiple metastases were diagnosed and a biopsy showed a metastasis from a mucinous carcinoma, suggestive for a colorectal carcinoma. There was also no evidence for a new primary tumor. Although the prognosis of limited esophageal and colorectal cancer is good, recurrence is always possible and an ultra-late recurrence may exceptionally occur. The mechanism of tumor dormancy is described.
authors.affiliation: Department of Gastroenterology, AZ Turnhout, Turnhout, Belgium. jos.janssens@azturnhout.be
authors.forename: J F
authors.initials: JF
authors.lastname: Janssens
authors.forename: M
authors.initials: M
authors.lastname: T'Syen
authors.forename: S
authors.initials: S
authors.lastname: Verhaegen
authors.forename: K
authors.initials: K
authors.lastname: Spaepen
authors.forename: G
authors.initials: G
authors.lastname: Verbeeck
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016629:Esophagectomy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D013997:Time Factors