title: [A Case of Advanced Gastric Cancer for Which Curative Resection Was Performed, Despite CEA Elevation].
abstract: A 32-year-old man was admitted to our hospital with the complaint of epigastric pain. Gastrointestinal endoscopy revealed a type 5 advanced gastric cancer at the posterior wall of the antrum. Contrast-enhanced computed tomography (CT) and endoscopic ultrasonography showed a fluid collection, indicating peritoneal metastasis. CEA levels were elevated, at 16.5 ng/mL. A diagnosis was made of cStage Ⅳ (T4aN3H0P1M1), and he underwent first-line chemotherapy using CDDP and S-1. However, this immediately failed with the severe adverse effect of vomiting.Docetaxel and S-1 were adopted as second-line chemotherapy. Since progression of the disease was confirmed after 8 cycles of second-line chemotherapy, nab-paclitaxel was administered as third-line chemotherapy. Despite a trend of increasing CEA after 4 cycles of third-line chemotherapy, CT revealed a tumor volume reduction as well as the disappearance of the fluid collection, after which staging laparoscopy was performed. Based on the finding that non-curative factors such as fluid collection and peritoneal nodules were not observed, distal gastrectomy was performed. Histopathological examination showed a ypStage ⅠA (T1bN0H0P0M0)tumor with a grade 3 therapeutic response to chemotherapy.The patient is currently doing well with no recurrence 11 months after the operation.
authors.affiliation: Dept. of Gastrointestinal Surgery, Sendai Kousei Hospital.
authors.forename: Ataru
authors.initials: A
authors.lastname: Satoh
authors.forename: Junichiro
authors.initials: J
authors.lastname: Yamauchi
authors.forename: Sho
authors.initials: S
authors.lastname: Yasuta
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ikeda
authors.forename: Shota
authors.initials: S
authors.lastname: Fujita
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Shin
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Ajiki
authors.forename: Katsuo
authors.initials: K
authors.lastname: Tsuchihara
authors.forename: Noriko
authors.initials: N
authors.lastname: Kondo
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ishiyama
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D003131:Combined Modality Therapy; D005743:Gastrectomy; D006801:Humans; D008297:Male; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D002272:Carcinoembryonic Antigen