title: Synchronous triple cancers of the pancreas, stomach, and cecum treated with S-1 followed by pancrelipase treatment of pancreatic exocrine insufficiency.
abstract: BACKGROUND
  Pancreatic cancer is frequently complicated by malignancies in other organs. However, synchronous triple cancers including pancreatic cancer have been seldom reported in the English language literature.
  
  
  METHODS
  We describe the rare case of a 77-year-old man with triple cancers of the pancreas, stomach, and cecum. Biopsies revealed that all three tumors were adenocarcinomas. The pancreatic and gastric tumors were positive for cytokeratin 7 and negative for cytokeratin 20, whereas the cecal tumor was negative for cytokeratin 7 and positive for cytokeratin 20. K-ras mutations were present at codon 12 in the pancreatic tumor and at codon 13 in the cecal tumor, but were absent from the gastric tumor. Since the three tumors had different characteristics, the patient was diagnosed with synchronous triple cancers. Because invasive surgery was required to remove all three tumors and the patient had risk factors for surgery, we elected to treat him with chemotherapy. All three cancers were markedly reduced in size by treatment with cycles of 100 mg/day S-1 for 2 weeks, followed by a 1-week rest. The patient later developed hypoproteinemia and anasarca, which was diagnosed as pancreatic exocrine insufficiency due to pancreatic head cancer. Treatment with pancrelipase resulted in dramatic improvements in hypoproteinemia and anasarca.
  
  
  CONCLUSIONS
  This is the first case report in which S-1 was effective in triple cancers of the pancreas, stomach, and cecum. Patients with pancreatic head cancer should be monitored for pancreatic exocrine insufficiency.
authors.affiliation: Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Japan. ohtsubo@staff.kanazawa-u.ac.jp.
authors.forename: Koushiro
authors.initials: K
authors.lastname: Ohtsubo
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ishikawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nanjo
authors.forename: Shinji
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Yamada
authors.forename: Hisatsugu
authors.initials: H
authors.lastname: Mouri
authors.forename: Kaname
authors.initials: K
authors.lastname: Yamashita
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yasumoto
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Gabata
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ikeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takamatsu
authors.forename: Sakae
authors.initials: S
authors.lastname: Iwakami
authors.forename: Seiji
authors.initials: S
authors.lastname: Yano
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics / Q000378:metabolism; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002430:Cecal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D004338:Drug Combinations; D004487:Edema / Q000139:chemically induced / Q000188:drug therapy; D006801:Humans; D007019:Hypoproteinemia / Q000139:chemically induced / Q000188:drug therapy; D053554:Keratin-20 / Q000032:analysis; D053552:Keratin-7 / Q000032:analysis; D008297:Male; D009154:Mutation; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D010094:Oxonic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D020799:Pancrelipase / Q000627:therapeutic use; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D005641:Tegafur / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D018631:ras Proteins / Q000235:genetics
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations; C117307:KRAS protein, human; D053554:Keratin-20; D053552:Keratin-7; D011518:Proto-Oncogene Proteins; C079198:S 1 (combination); D005641:Tegafur; D020799:Pancrelipase; D010094:Oxonic Acid; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins