Fulminant Evolution of Stomach Cancer during Pregnancy

Case Report

Austin J Clin Case Rep. 2014;1(11): 1051.

Fulminant Evolution of Stomach Cancer during Pregnancy

González-Mesa E*, Armenteros MA, Molina A and Herrera J

Malaga University Hospital, Malaga University School of Medicine, Spain

*Corresponding author: Ernesto González-Mesa, Malaga University Hospital, Arroyo de los Angeles St, 29011-Málaga, Spain

Received: September 10, 2014; Accepted: September 22, 2014; Published: September 24, 2014


The incidence of stomach cancer associated to pregnancy has been reported as high as 1/1000, especially in some Asiatic regions. Its diagnosis poses a challenge for obstetricians since even in the advanced stages of the disease it is clinically characterized by nonspecific gastrointestinal symptoms such as epigastric pain, nausea, vomiting or early satiation, among other manifestations. Such alterations are easily attributable to the discomfort normally associated to pregnancy. We present the case of a 33-years old Caucasian pregnant woman, with an uneventful pregnancy until the moment that a gastric cancer was diagnosed in the 26th week of her fifth pregnant. A fulminant and catastrophic evolution followed the diagnosis.

Keywords: Gastric cancer; Cancer and pregnancy; Maternal death; High risk pregnancy


CT: Computed Tomography; MRI: Magnetic Resonance Imaging; PCI: Peritoneal Carcinomatosis Index


The incidence of stomach cancer associated to pregnancy is estimated to be 1/1000, though the existing data are inconclusive. In the last three decades there has been a notorious increase in the number of stomach cancers diagnosed in pregnant women – one of the underlying causes being the increase in maternal age during this period of time. Another possible cause is the fact that pregnancy is now subjected to closer monitoring than in the past, and this facilitates the diagnosis of cases that were previously not detected [1].

To date it has not been possible to demonstrate that pregnancy acts as a cause or risk factor for the development of cancer. In fact, the incidence of malignant disease in pregnant women is similar to that observed in non-pregnant women of the same age group [1]. Haas [2] demonstrated a lower incidence than expected of all cancers in pregnant women and speculated that women with subclinical cancers do not usually become pregnant, presumably due to decreased libido resulting from constitutional symptoms. It has also been suggested that conception, implantation, or early embryonic development could be disrupted by hormonal or immunological factors concomitant to malignant disease.

The diagnosis of cancer during pregnancy poses a challenge from the medical, personal, social and moral perspectives. In effect, we have a conflictive situation: on one hand we need to treat the malignancy in order to improve the maternal prognosis, and on the other hand we need to continue pregnancy in order to improve the fetal prognosis. The management of these two patients therefore requires a multidisciplinary approach involving obstetricians, oncologists and psychologists, among others.

The most frequent tumor locations in pregnant women are the skin, cervix, breast, hematological system, ovary and colon. In this respect, stomach cancer represents 0.1% of the cancers diagnosed in pregnant women [1].

Case Report

A 33-year-old Caucasian pregnant woman presented to the Emergency Room of Málaga University Hospital in week 25+1 of her fifth pregnancy, feeling some contractions and abdominal discomfort. This was her fifth pregnancy. She had three prior miscarriages (negative thrombophilia study), and one spontanous 28 weeks preterm delivery due to preterm premature rupture of membranes, three years before.

She belonged to a family of Romanian in migrants that came to Spain six months ago. In her family history, her father was suffering from lung tuberculosis and cirrhosis. Her mother committed suicide some years before. She smoked for years near a pack of cigarettes a day, although she reduced during pregnancy up to 7 cigarettes a day.

The patient was admitted for clinical observation due to a funneled cervix measuring 17-19 mm and irregular contractions, with no other symptoms. The blood tests revealed anemia (hemoglobin 10.4 g/dl) and a C-reactive protein concentration of 108 mg/L as isolated findings. On the second day of admission the patient developed abdominal discomfort, fullness sensation and bloating. Abdominal ultrasound and complete blood tests were requested due to progression of the abdominal bloating and worsening of the clinical condition. The parameters were again found to be within normal ranges, with normal transaminase and blood amylase levels, except for a C-reactive protein increase to 137 mg/L and a platelet count of 585,000/mm3. While in wait of the abdominal ultrasound report, obstetric ultrasound was performed, revealing a fetus in the cephalic position with correct biometric data, an estimated fetal weight of 900 g, and normal placental and amniotic fluid data. The cervical length was 13 mm, and ascitic fluid in moderate amounts was observed in both flank regions (Figure1). Abdominal ultrasound revealed apparent thickening of the gastric wall and pancreas (more pronounced in the tail region), with no evidence of any solid mass. Important anechoic ascitic fluid was noted, with no presence of septae, located predominantly in the perihepatic and perisplenic regions, in both flanks, and in the upper retroperitoneum.

Citation: González-Mesa E, Armenteros MA, Molina A and Herrera J. Fulminant Evolution of Stomach Cancer during Pregnancy. Austin J Clin Case Rep. 2014;1(11): 1051. ISSN : 2381-912X