Synchronous Triple Cancers of the Pancreas, Stomach, and Cecum Treated with S-1 Followed by Pancrelipase Treatment of Pancreatic Exocrine Insufficiency

摘要

Context Pancreatic canceris frequently complicated by malignancies in other organs. However, synchronoustriple cancers including pancreatic cancer have been seldom reported in theEnglish language literature. Case report We describe the rare case of a77-year-old man with triple cancers of the pancreas, stomach, and cecum.Biopsies revealed that all three tumors were adenocarcinomas. The pancreaticand gastric tumors were positive for cytokeratin 7 and negative for cytokeratin20, whereas the cecal tumor was negative for cytokeratin 7 and positive forcytokeratin 20. K-ras mutations were present at codon 12 in thepancreatic tumor and at codon 13 in the cecal tumor, but were absent from thegastric tumor. Since the three tumors had different characteristics, thepatient was diagnosed with synchronous triple cancers. Because invasive surgerywas required to remove all three tumors and the patient had risk factors forsurgery, we elected to treat him with chemotherapy. All three cancers weremarkedly reduced in size by treatment with cycles of 100 mg/day S-1 for 2weeks, followed by a 1-week rest. The patient later developed hypoproteinemiaand anasarca, which was diagnosed as pancreatic exocrine insufficiency due topancreatic head cancer. Treatment with pancrelipase resulted in dramaticimprovements in hypoproteinemia and anasarca. Conclusions This is thefirst case report in which S-1 was effective in triple cancers of the pancreas,stomach, and cecum. Patients with pancreatic head cancer should be monitoredfor pancreatic exocrine insufficiency.