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Abstract: The patient came to the hospital with cough and sputum. A lung mass was found on chest CT examination and the pathological biopsy showed adenocarcinoma. The doctor then performed other tests on the patient and found a tumor in the stomach. The pathology was finally diagnosed as “gastric hepatic adenocarcinoma with pulmonary metastasis”, which is a rare type of adenocarcinoma. After chemotherapy and symptomatic treatment, the patient’s symptoms such as cough and sputum disappeared and she was able to take care of herself basically.
Basic information】Female, 67 years old
Disease Type】Gastric hepatocellular adenocarcinoma with pulmonary metastasis
Hospital】The Second Hospital of Guangzhou Medical University
Date of Consultation】November 2021
Treatment plan] Chemotherapy (sindilizumab injection, oxaliplatin injection, capecitabine tablets) + metoclopramide tablets to stop vomiting + montelukast to stop diarrhea + fatty milk amino acid (17) glucose (11%) injection for intravenous nutrition
【Treatment cycle】 Hospitalization for 3 days, outpatient follow-up for 2-3 weeks, chemotherapy for 6 times
Treatment effect】The patient’s cough and sputum disappeared, and he was able to take care of himself basically.
I. Initial consultation
The patient visited our hospital for “recurrent cough and sputum for 1 month”. The patient complained of recurrent coughing and white mucous sputum, accompanied by sore throat and itchy throat, without fever or runny nose for the past month. The examination showed that the patient’s pharynx was not red, the tonsils were not large, the breath sounds of both lungs were clear, and a small amount of dry and wet rales could be heard. Blood test suggested that the serum carcinoembryonic antigen was significantly elevated. CT examination of the chest suggested multiple small nodules in both lungs and multiple enlarged lymph nodes in both lung hilum and mediastinum, considering “central lung cancer in the right lung, with a high possibility of metastasis in the mediastinum, both lungs and bilateral pleura”. According to the preliminary diagnosis of “lung occupancy and lung cancer”, he was admitted to the hospital.
Treatment process
After discussion in the department, the patient was immediately scheduled for “CT-guided percutaneous mediastinal lymph node aspiration biopsy”, and the postoperative pathology report was “pulmonary invasive carcinoma, combined with morphology and immunohistochemistry, hepatocellular adenocarcinoma or metastatic hepatocellular carcinoma was considered”. Combining the CT imaging features and the pathology report, it was concluded that the adenocarcinoma in the patient’s lung was more likely to be metastatic, and the search for the primary site should be continued. The patient was persuaded to undergo a whole-body PET-CT scan, which revealed localized thickening of the stomach wall and increased metabolism, and the possibility of gastric cancer was considered. Based on the current examination results, the patient was finally diagnosed as “adenocarcinoma of the stomach and liver with pulmonary metastasis” and was given chemotherapy with Sindilizumab injection + Oxaliplatin injection + Capecitabine tablets. The patient was discharged from the hospital after 3 days of hospitalization and was ordered to be followed up on an outpatient basis for 2-3 weeks. During chemotherapy, the patient had severe gastrointestinal side effects such as diarrhea, vomiting, and inability to eat, and was given metoclopramide tablets to stop vomiting, montelukast to stop diarrhea, and fatty milk amino acid (17) glucose (11%) injection for intravenous nutritional support.
III. Treatment effect
The patient’s cough and sputum have completely disappeared after completing 6 times of chemotherapy, and she can basically take care of herself. The concentration of serum carcinoembryonic antigen decreased to within the normal range. CT-enhanced examination of the chest and abdomen showed that the lung tumor and enlarged lymph nodes as well as perigastric metastatic lymph nodes had shrunk and decreased compared with the initial diagnosis, and the efficacy was evaluated as partial remission (PR). The patient, who had advanced malignant tumor, had mood swings and suicidal tendency when she was first informed of her condition. After long time accompanying and patient counseling by doctors and family members, as well as the visible treatment effect, the patient is now emotionally stable and willing to actively cooperate with doctors.
IV. Notes
The patient has advanced gastrointestinal malignant tumor, and it is gratifying for the doctor to recover to this extent. Patients should pay attention to the following points after discharge.
1. Delayed gastrointestinal side effects may occur after chemotherapy, such as vomiting and diarrhea, etc. Patients must pay attention to the frequency of vomiting and diarrhea, and if they are too frequent, they should contact their doctors as soon as possible to avoid serious consequences such as dehydration and electrolyte disorders.
2. Review the blood routine and liver and kidney function every week to detect the serious side effects that may be induced by chemotherapy in time.
3. Pay attention to nutrition, the incidence of malnutrition in patients with gastrointestinal tumor is significantly higher than other tumors, so pay attention to supplementing enough high-quality protein and adhere to the principle of eating less and more meals, because the patient’s gastrointestinal tract, after the double blow of tumor and chemotherapy, has extremely poor tolerance to the amount of food, and it is easy to have diarrhea and indigestion induced by eating more.
V. Personal insight
Confirming the primary site of malignant tumor is the most crucial step in choosing treatment plan. The initial pathological examination of this patient showed adenocarcinoma, but it is only a pathological term, we cannot assume that it is primary lung adenocarcinoma just because the adenocarcinoma is located in the lung, it is also possible that adenocarcinoma from other sites metastasized to the lung, and the treatment plan for adenocarcinoma in different sites may be very different, so more in-depth examination should be performed to determine the site of origin. In addition, psychological and emotional care for patients with advanced cancer is as important as oncology treatment.