Management of gastric cancer with liver metastasis in a pregnant woman

Gastric cancer during pregnancy is very rarely seen. The complaints and symptoms of gastric cancer are non-specific and many of these symptoms are frequently masked by factors related to normal pregnancy. Also abdominal examination cannot be done easily and in an optimal manner due to the gravid uterus. Here we report the treatment and follow up management of metastatic gastric cancer in a 38 year-old multiparous woman with 31 weeks of pregnancy.
A 38 year-old woman with G10P8A1 and 31 weeks of pregnancy was admitted to maternity outpatient clinic with the complaints of nausea, vomiting and constipation since 4 days. On palpation a solid lesion with 1.5 cm size was palpable in the subxiphoid region. The abdominal examination could not be performed due to the gravid uterus however, a solid nodule with largest diameter of 5 cm was observed on the liver suspected as metastasis. On the explorative laparotomy, a tumoral mass with multiple peripheral lymphadenopathies were observed in the posterior gastric antrum, pancreas and colon median entry-invasive artery. Multiple metastases in the omentum and liver with large amount of acid in the abdomen were present.
Early diagnosis and treatment is important for the prognosis of the gastric cancer. The complaints and symptoms of gastric cancer are non-specific and many of these symptoms can be seen similarly during normal pregnancy period. If the same symptoms recur during pregnancy or failure to respond to therapy, gastrointestinal system should be evaluated endoscopically.