title: [A case of gastric cancer accompanied by disseminated carcinomatosis of bone marrow wherein long-term chemotherapy was enabled by early supportive palliative care].
abstract: Here we report gastric cancer accompanied by bone marrow carcinomatosis in a patient for whom long-term chemotherapy was enabled by early pain-relief therapy. A 45-year-old man was admitted to our hospital because of back pain associated with multiple spinal tumors in June 2011. Blood tests showed a trend toward disseminated intravascular coagulation(DIC) and gastric cancer was suspected as the primary lesion. Because pain was severe, emergency pain relief was provided by flurbiprofen axetil and a continuous subcutaneous infusion of fentanyl citrate. After bone marrow examination gave a diagnosis of poorly differentiated adenocarcinoma, we performed sequential methotrexate(MTX)and 5-fluorouracil(5-FU)therapy. The therapy successfully decreased tumor marker levels, and alkaline phosphatase and lactate dehydrogenase levels normalized. Finally, gastric cancer accompanied by bone marrow carcinomatosis was diagnosed. Because the patient had anxiety and spiritual pain from the time of admission, psychiatric care was also required. In November 2011, the tumor recurred, and we switched therapy to a combination of S-1 and cisplatin. The patient's pain was controlled by combined treatment with a fentanyl patch and etodolac, and he was discharged in December 2011. However, severe pain recurred and pain therapy was continued. DIC developed in February 2012 and transiently resolved after resuming combination therapy with MTX and 5-FU; however, it subsequently recurred, leading to the patient's death in May 2012.
authors.affiliation: Hospice,Japan Baptist Hospital.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamagiwa
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Amakawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeda
authors.forename: Akiko
authors.initials: A
authors.lastname: Fukuda
authors.forename: Satoko
authors.initials: S
authors.lastname: Ito
authors.forename: Shinya
authors.initials: S
authors.lastname: Nakayama
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shiotani
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
authors.forename: Kenkichi
authors.initials: K
authors.lastname: Kita
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019046:Bone Marrow Neoplasms / Q000556:secondary / Q000628:therapy*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D013997:Time Factors