Two surgery+postoperative chemotherapy, multiple malignant tumors OS is far greater than pancreatic cancer!

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At present, the incidence of primary cancer (MPC) around the world is gradually increasing. MPC refers to a primary malignant tumor that occurs at the same part or organs at the same time or organs.

This article introduces a rare MPC case, published in the Front Oncol journal, which reports in detail in the case report of a 77 -year -old with synchronized esophageal gastric cancer and duodenal adenocarcinoma. For female elderly patients with pancreatic adenocarcinoma (PDAC), this cancer combination is very rare and difficult to treat.

During clinical diagnosis and treatment, experts need to judge which tumor of priority treatment, evaluate the harm of a single tumor and further arrange treatment. Therefore, multi -disciplinary teams need to design personalized treatment plan for the patient.

The patient finally achieved the overall survival time of 18 months, which was extended by 63%to 200%from the median survival time (6 ~ 11 months) of patients with advanced pancreatic cancer.

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Patients, female, 77 years old, due to mild abdominal pain and intermittent fever (the maximum temperature is 39 ° C), jaundice and skin itching have appeared for 5 days. During the regular physical examination of each year, the abdominal ultrasound examination diagnose the duodenal mass.

&& gastroscopy: There are superficial ulcers at the junction of the esophagus and gastric, and multiple lumps appear in the duodenum (see Figure 1).

Figure 1: Gastroscopy

&& pancreatic resonance bile duct pancreatic angiography (MRCP) examination: The end of the bile duct can be seen, the lumen is completely occluded, the lesion range is about 2.6x1.7 cm, suspected of malignant tumors (see Figure 2). The pancreas is visible to the position, with a size of about 2.0x2.3 cm. The boundary is unclear, and the possibility of malignant tumors cannot be ruled out.

Figure 2: MRCP inspection

&& Endoscopy biopsy: The pathological results show that the gastrointestinal and duodenal nipple tissue of the esophagus and gastrointestinals have adenocarcinoma (see Figure 3A).

Figure 3: Pathological examination

Elderly MPC patients, multi -disciplinary joint treatment

Patients underwent two operations in the hospital.

The first surgery of &&: Under the endoscopic mucosal deprivation (ESD) under the whole body anesthesia, the final pathological results are displayed as a moderate differential glandular cancer at the gastric gastric gastric (Figure 3B);

&& Second surgery: Abdominal detection was performed under the whole body anesthesia. During the operation, there was an irregular tumor in the pancreas. The tumor was tightly attached to the intestinal membrane blood vessels and could not be separated. The size was about 3x4 cm. The results of the pancreas during the operation showed adenocarcinoma (Figure 3C).

The 14th day after the second operation was discharged. In the first month after the operation, the patient resumed the pre -surgery diet.

&& Six cycles of chemotherapy: From June 10th to October 21st, 2019, patients received six cycles of chemotherapy in the Department of Internal Medicine of the oncology.

After six chemotherapy, the patient's tumor logo is not normal (CEA 15.25 ng/ml; CA199 580.6 U/ml; CA242 & 200 U/ml). No evidence of tumor progress or distant metastasis.

&& Proton radiation therapy: Four months later, the patient's CA199 level increased to 20000 U/ml, and the chest MRI displayed the thoracic spine transfer. The patient was then received in February 2020. Radiation therapy has obtained some encouraging results, and the patient's CA199 level once dropped to 700 U/ml.

Unfortunately, lung metastases were detected in June 2020, and the level of CA199 in patients rose again, and eventually died of cancer and disease on August 27, 2020 (see Figure 4).

Figure 4: Patient treatment and progress process

MPC diagnosis and treatment summary

MPCs often occur in respiratory and digestive systems. Esophagal cancer and oral pharyngeal cancer are the most common type of MPC types. Some studies reports that the incidence of multiple primary cancer patients is 5.2%to 23%, of which the incidence of various primary cancers in the digestive system is 2%to 17%.

The MPC of pancreatic cancer in this patient is relatively rare. In the previous MPC pathological reports, the combination of more common associated with pancreatic cancer is: pancreatic cancer and liver cell carcinoma; pancreatic cancer and bile cancer; pancreatic and gastric cancer; pancreatic cancer and pancreatic cancer and pancreatic cancer; Breast cancer; pancreatic cancer and colon cancer. In addition, the connection between pancreatic cancer and other lung cancer, kidney cancer, cervical cancer, ovarian cancer, prostate cancer, and thyroid cancer is weak, and the report frequency is low.

MPC mechanism

Some studies have speculated that the development of MPC is related to unhealthy lifestyle, genetic susceptibility, side effects of chemotherapy and radiotherapy, and weak immunity.

In this case, the patient's overweight BMI is 27.7kg/m2. High BMI is a recognized risk factor for malignant tumors, especially the digestive tumor.

In addition, the patient had previously undergone some thyroid slicing, and hormone disorders may also be a risk factor for tumor development. In the end, the factors that cannot be ignored are that the aging tumors are susceptible to increase and the related immunity is weakened. MPC treatment choice

When diagnosing and treating a variety of primary cancers, surgery or biopsy should be used as soon as possible to make clear diagnosis.

However, pancreatic cancer is an aggressive tumor with high mortality and poor prognosis. When patients with pancreatic cancer have a variety of primary cancers, multiple disciplines of pancreatic cancer should be given priority. In this case, ESD is first used to remove esophageal gastric tone disease. Due to the local progress of the tumor and the wishes of the patient's family members, the pancreatic duodenal resection, but the radiotherapy during surgery is combined with postoperative assistance chemotherapy, and used in time to use it in time There was no observation of tumor progress or long -distance metastasis during the six cycle chemotherapy periods, which indicates that the combination of radiotherapy and postoperative adjuvant chemotherapy can control the growth of advanced pancreatic cancer to a certain extent.

In this case, patients received proton radiotherapy when they were metastasis, and the level of CA199 decreased significantly (drop from 20000 U/ml to 700 U/ml). A proton radiation therapy is an outer radiation therapy for the treatment of local advanced diseases. It uses a proton beam to provide a highly focused radiation dose to tumors. In recent years, proton radiotherapy has also received more and more attention in the treatment of pancreatic cancer. This treatment is expected to extend the survival time of some sensitive patients. Patients in this case also show a good treatment response at the beginning of treatment. Although the patient died after the overall survival period of 18 months, it was much longer than the median survival time (6 ~ 11 months) of patients with local advanced pancreatic cancer.

In short, MPC treatment needs to adhere to the concept of multi -disciplinary comprehensive treatment, and personalized and precise treatment is particularly valuable for patients with multiple primary cancer. The experience of this case and the summary analysis part will provide guidance and reference for clinicians.

Expert Introduction

Professor Wang Chengfeng

Director of Ghost Stomach Surgery of Cancer Hospital of the National Academy of Medical Sciences of the National Cancer Center

Molecular Oncology National Key Laboratory PI, chief physician, secondary professor

Doctorate instructor of Beijing Union Medical College

Doctorate instructor of the School of Science and Technology Innovation, Beijing University of Aeronautics and Astronautics

Enjoy experts from the State Council's special allowance experts and famous doctors of the country

Main professional areas and achievements: mainly engaged in the diagnosis and treatment of pancreatic and gastric tumors and related basic research. In particular, in the aspects of comprehensive treatment of pancreatic cancer based on the standardized diagnosis and treatment of pancreatic cancer, and the comprehensive treatment of pancreatic cancer based on the radiotherapy (IORT), it has reached the international leading level; focused on the gene sequencing of pancreatic cancer, 3D spatial structure and other related studies, published 200 papers, of which, of which More than 60 articles (NG, THERANOSTICS, Advanced Science, etc.), IF: 200 points, Chinese series of journal papers 50 articles. Leading the formulation of more than 10 diagnosis and treatment specifications, guidelines and expert consensus of international and domestic pancreatic cancer and gastric cancer, and multiple research results have been cited by international guidelines and consensus such as NCCN guidelines. Responsible for more than 20 national and provincial and ministerial topics. More than 10 items such as the second prize of the Ministry of Education's Science and Technology Progress

Main academic part -time job: Director of the ISIORT, director of the International During the International Substitute, Vice President of the Chinese Medical Association Cancer Branch, Vice President of the China Medical Education Association, executive director of the China Medical Care International Exchange Promotion Association, Executiveer China Medical Education Association Executive Directors, chairman of the pancreatic disease branch of China Medical and Health Care International Exchange Promotion Association, Chairman of the abdominal tumor branch of the China Medical Education Association, Deputy Chairman of the Care Cancer Specialist Committee of the Chinese Medical Association, and the Care Cancer Specialist Committee of the Cross -Strait Medical Exchange Association The chairman of the Association, the Vice Chairman of the Micro Innovation Branch of the Cross -Strait Medical Exchange Association of Cross -Strait Cross -Strait.

Expert Introduction

Professor Du Yongxing

National Cancer Center/Chinese Academy of Medical Sciences Cancer Hospital Cord -stomach Stomach Surgery, attending physician, doctorate in medicine

Graduated from Peking Union Medical College, mainly engaged in the foundation and clinical study of digestive tumors such as pancreatic cancer and gastric cancer. He is good at minimally invasive minimally invasive surgical treatment. He has published more than ten papers in Cancer Research, Cancer Letters, Advanced Science and other papers. Reports at international conferences such as ASCO, ACS, ESMO ASIA.

He presided over 1 National Natural Youth Fund and participated in 6 national and provincial and ministerial topics. He has been awarded a number of honorary titles such as excellent graduates of ordinary colleges and universities in Beijing, an outstanding doctoral dissertation thesis of Beijing Union Medical College, and a postdoctoral post doctoral after the State Fund Commission.

At present, he is the youth committee member of the Care of the Pancurry Diseases Branch of the China Medical and Health Care International Exchange Promotion Association, the Youth Member of the Health Popular Science Branch, the Youth Member of the Stomach Cancer Committee of the China Anti -Cancer Association, and a member of the Popular Science Branch of the China Anti -Cancer Association.

references:

[1] Yongxing Du, Yunjie Duan, Lipeng Zhang, Zongting Gu, Xiaohao Zheng, Zongze Li, Chengfeng Wang. A Female With Synchronous Multiple Primary Malignant Tumors in the Esophagogastric Junction, Duodenum and Pancreas: Case Report and Review of the Literature. Front Oncol. 2022; 12: 890587.published online 2022 May 30. Doi: 10.3389/fonc.2022.8905877 The frontier information you want you want

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