Carcinoma of gastro-oesophageal junction in a pregnant woman

Gastric carcinoma during pregnancy is extremely rare, with reported incidence of 0.016–0.1%. However, the numbers may have increased in recent years because of the increase in maternal age at the time of the first pregnancy [1, 2]. The diagnosis of gastric cancer in pregnancy is often delayed and it is detected at an advanced stage. No standard treatment has been established because of its rarity, delay in diagnosis, and limited treatment options. A major concern in these cases is the condition of the foetus. There are different views about whether or not to terminate the pregnancy and whether to apply systemic therapy.
In this letter, we present a case of advanced stage cardia carcinoma that was diagnosed in the first trimester of pregnancy.
A 42-year-old woman, gravida 4, para 2 was admitted to our clinic in January 2012 with diagnosis of cardia cancer (adenocarcinoma). The patient denied any comorbidities, and family history was not significant. She had not been treated for gastroesophageal reflux disease or Helicobacter pylori infection in the past. Before the conception, the patient was an active smoker. She denied abusing alcohol. The patient was 17 weeks pregnant on admission. At seventh week of gestation she presented loss of appetite, vomiting, abdominal pain, and dysphagia. At the eighth week upper gastrointestinal endoscopy demonstrated a tumour originating from the cardia (Figure 1). The histopathological diagnosis was gastric carcinoma (adenocarcinoma tubulare). Pregnancy was dated as the eighth week in obstetric ultrasound examination. Development of the foetus was normal. There were no abnormalities other than increased thickness of the cardia wall in an abdominal ultrasound examination. The patient and family were informed about her situation, she did not agree to terminate the pregnancy, and surgery was planned as the treatment of choice. At 18 weeks of gestation a trans hiatal (Orringer) operation was performed. There were no perioperative complications. Histological examination revealed the tumour to be of intestinal type. According to Lauren classification – adenocarcinoma tubulare G3 cardia, 5.5 × 4.9 × 3.5 cm in size, infiltrating entire thickness of the cardia wall and surrounding fat tissue. Immunohistochemical examination detected overexpression of HER 2 receptor. Metastases in 2 lymph nodes was found (pT3N1M1). Surgical margin was negative for tumour cells Postoperatively, foetal ultrasonography confirmed the...


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