Delayed Spontaneous Regression of Metastatic Gastric Cancer: A Case Report of a Rare Finding

Abstract

We discuss the case of a 74-year-old male who was referred with episodes of vomiting, nausea, and weight loss. Ultrasound abdomen had suggested multiple liver metastases and a triple-phase CT scan of abdomen-pelvis confirmed the same. His oesophago-gastro-duodenoscopy (OGD), also known as upper endoscopy (EGD), showed a large ulcerated lesion at the lesser curvature, which was later confirmed to be poorly differentiated adenocarcinoma on biopsy. The patient was started on palliative chemotherapy, which he tolerated poorly, but a CT scan had suggested a minimal reduction in the size of liver metastasis. He was given two cycles of chemotherapy; however, due to poor tolerance and unresponsiveness to chemotherapy, he was referred to palliative care. The patient declined any medical support for the next six years, after which he visited his general practitioner (GP) for a follow-up review. Routine blood tests showed new-onset mild iron deficiency anaemia. He denied any symptoms. He was referred to Gastroenterology for repeat OGD, and it showed a tiny nodular area in the stomach at the site of previous cancer, which was reported as non-specific chronic inflammation on biopsy, and CT abdomen showed a marked reduction in size and number of liver metastases. On further clinical review, he reported feeling well and his anaemia resolved without any intervention.

Case Details

Disease Location

Stomach, liver

Personal Characteristics

74-year-old male of south asian descent. With a past medical history of diabetes mellitus type 2, chronic kidney disease (ckd), and hypertension, which were all well-controlled with medical therapy.

Clinical Characteristics

History of nausea, vomiting, and unintentional weight loss. Ultrasound suggested multiple liver metastases, gastroscopy, and CT scan to confirm the findings seen on the ultrasound. His CT scan confirmed multiple liver metastases. The gastroscopy showed a large, malignant-looking ulceration at the lesser curvature of the stomach. Biopsy reported a poorly differentiated adenocarcinoma. Diagnosis of gastric adenocarcinoma (histopathology) with widespread metastasis (radiological) to the liver was made. The patient was started on palliative chemotherapy with epirubicin, oxaliplatin, and capecitabine. After the second cycle, chemotherapy was stopped.

Remission Characteristics

Six years later, a repeated ogd showed a tiny nodular area in the stomach at the site of previous cancer, which was reported as non-specific chronic inflammation on biopsy, and CT abdomen showed a marked reduction in size and number of liver metastases.

Treatment & Mechanisms

Clinical Treatment

Biopsy, chemotherpay (one cycle)