SYNCHRONOUS GASTRO-INTESTINAL MALIGNANCIES - A CASE SERIES

Abstract

The occurrence of multiple gastrointestinal
cancers in the same patient was previously
thought to be extremely rare. But
with advancements in investigative modalities
and with greater implementation
of screening programs, the occurrence of
synchronous Gastro-intestinal cancers is
being increasingly recognised. Apart
from it being a diagnostic oddity, the importance
of a synchronous primary is
that the diagnosis alters the prognosis
and management of the patient considerably.
In this case series, we report
three cases of synchronous cancers,
where both the first and the second primary
cancers were found in the gastrointestinal
tract. Case 1 65 year old Male
presented to us with history of recurrent
stale food vomiting and dysphagia. He
was diagnosed to have synchronous oesophageal
and gastric cancers. The oesophageal
cancer was poorly differentiated
squamous cell carcinoma and the
gastric malignancy was a moderately differentiated
adenocarcinoma. Case 2 70
year old lady presented with symptoms
of gastric-outlet obstruction and
dyschezia.
She was found to have synchronous gastric
and rectal cancer. The gastric cancer
was a poorly differentiated adenocarcinoma
and the rectal malignancy was a
well differentiated adeno-carcinoma. Patient
had omental deposits at presentation.
Case 3 59 year old male presenting with
dysphagia, was found to have dual oesophageal
cancers. One lesion was well differentiated
while the other was a poorly differentiated
squamous cell carcinoma. Each
of the cancers was symptomatic and in all
three patients curative management was
not possible, since the cancers were advanced.
We suggest screening upper GI
endoscopy in those with colorectal cancers
and vice-versa, so that synchronous GI
cancers can be diagnosed at an early
stage, thereby making curative treatment
options feasible.