Simultaneous triple cancer of the esophagus, pancreas and rectum treated with multimodal strategies: a case report
Background Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge becau...
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| Published in | Surgical case reports Vol. 6; no. 1; pp. 259 - 7 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
02.10.2020
International Academic Publishing Co Ltd Japan Surgical Society |
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| Online Access | Get full text |
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| Abstract | Background
Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy.
Case presentation
Here, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann’s operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence.
Conclusions
The treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer. |
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| AbstractList | Abstract Background Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy. Case presentation Here, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann’s operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence. Conclusions The treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer. BackgroundDue to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy.Case presentationHere, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann’s operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence.ConclusionsThe treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer. Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy. Here, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann's operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence. The treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer. Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy.BACKGROUNDDue to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy.Here, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann's operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence.CASE PRESENTATIONHere, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann's operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence.The treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer.CONCLUSIONSThe treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer. Background Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is still a very rare finding whose frequency is not yet known. Treatment of simultaneous triple cancer is a clinical challenge because it requires multimodal strategies including surgery, chemotherapy and radiotherapy. Case presentation Here, we present the case of a 74-year-old male with triple cancer involving esophageal and pancreatic cancer, and rectal carcinoma. Each cancer was surgically resectable, but simultaneous resection of all cancers seemed to cause too much surgical stress for the patient. First, we performed a laparoscopic Hartmann’s operation for rectal cancer to minimize the risk of postoperative complications. Then treatment for pancreatic cancer was initiated by administering neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. The pancreatic tumor shrank in size, so pancreatoduodenectomy was performed. We chose S-1 as adjuvant chemotherapy. The esophageal cancer showed regression during the treatment of the other two cancers, likely because the chemotherapeutic agents administered for pancreatic cancer had some effect on the esophageal cancer. Definitive chemoradiotherapy was selected instead of esophagectomy because the patient had already undergone two major surgeries. The patient is still alive nine months after the whole course of treatment with no sign of recurrence. Conclusions The treatment of triple cancer requires an elaborate strategy to determine which cancer has to be dealt with first and which can be treated later. An aggressive multimodal treatment strategy may be an important option for a patient with triple cancer. |
| ArticleNumber | 259 |
| Author | Tamura, Shigeyuki Sasaki, Yo Imamura, Hiroki Mokutani, Yukako Hirose, Hajime Endo, Shunji Takeda, Masashi Kidogami, Shinya Yoshioka, Shinichi Hashimoto, Yasuji Kishimoto, Tomoya |
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| Keywords | Simultaneous triple cancer Pancreas Rectum Esophagus |
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| References_xml | – reference: TachimoriYOzawaSNumasakiHFujishiroMMatsubaraHOyamaTComprehensive registry of esophageal cancer in Japan, 2009Esophagus20161311013710.1007/s10388-016-0531-y – reference: HuiQuLiuYBiD-SClinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysisSurg Endosc2015293608361710.1007/s00464-015-4117-x – reference: HannahKChristopherJTrevorDThe effect of multiple primary rules on population-based cancer survivalCancer Causes Control20132461231124210.1007/s10552-013-0203-3 – reference: WatanabeTMuroKAjiokaYHashiguchiYItoYSaitoYJapanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancerInt J Clin Oncol20182313410.1007/s10147-017-1101-6 – reference: BuiattiECrocettiEAcciaiSGafaLFalciniFMilandriCIncidence of second primary cancers in three Italian population-based cancer registriesEur J Cancer199733182918341:STN:280:DyaK1c7jtFKitQ%3D%3D10.1016/S0959-8049(97)00173-1 – reference: KitagawaYUnoTOyamaTKatoKKatoHKawakuboHEsophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1Esophagus20191612410.1007/s10388-018-0641-9 – reference: Japan Pancreas SocietyClassification of Pancreatic Carcinoma20194OsakaKanehara & Co., Ltd. – reference: MinasSStavrosPGregorisISotiriosBHaralabosKMultiple primary malignancies: a case report of two casesChin J Cancer Res2014262215218 – reference: Japan Esophageal SocietyJapanese Classification of Esophageal Cancer, 11th Edition: Part IEspphagus201714113610.1007/s10388-016-0551-7 – reference: BoutePPageCBietACuvelierPStrunskiVChevalierDEpidemiology, prognosis and treatment of simultaneous squamous cell carcinomas of the oral cavity and hypopharynxEur Ann Otorhinolaryngol Head Neck Dis20141312832871:STN:280:DC%2BC2M7nvVSltQ%3D%3D10.1016/j.anorl.2013.10.003 – reference: TummalaPHowardTAgarwalBDramatic survival benefit related to R0 resection of pancreatic adenocarcinoma in patients with tumor ≤ 25 mm in size and ≤1 involved lumph nodesClin Transl Gastroenterol201343e3310.1038/ctg.2013.4235151313615697 – reference: CalleryMPChangKJFishmanEKTalamontiMSTraversonLWLinehanDCPretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensusAnn Surg Oncol2009161727173310.1245/s10434-009-0408-6 – reference: YamatoHKawakamiHKuwataniMShinadaKKondoSKubotaKPancreatic carcinoma associated with portal vein tumor thrombus: three case reportsInter Med20094814315010.2169/internalmedicine.48.1049 – reference: EisenhauerEATherassePBogaertsJSchwartzLHSargentDFordRNew response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)Eur J Cancer.20094522282471:STN:280:DC%2BD1M%2Fgs12rug%3D%3D10.1016/j.ejca.2008.10.026 – reference: BrierleyJDGospodarowiczMKWittekindCInternational Union Against Cancer (UICC): TNM Classification of Malignant Tumours20178OxfordWiley-Blackwell – reference: UesakaKBokuNFukutomiAOkamuraYKonishiMMatsumotoIAdjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomized, non-inferiority trial (JASPAC 01)Lancet2016388100412482571:CAS:528:DC%2BC28Xps1yhtLo%3D10.1016/S0140-6736(16)30583-9 – reference: HamabeAItoMNishigoriHNishizawaYSasakiTPreventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratificationAsian J Endosc Surg20181122022610.1111/ases.12439 – reference: ChariSTKellyKHollingsworthMAThayerSPAhlquistDAAndersenDKEarly detection of sporadic pancreatic cancerPancreas20154469371210.1097/MPA.0000000000000368 – reference: Japanese Society for Cancer of the Colon and Rectum. 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Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous... Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple cancer is... BackgroundDue to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However, simultaneous triple... Abstract Background Due to the development of diagnostic imaging technology, we have increased chance of detecting multiple primary cancers. However,... |
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| SubjectTerms | Case Report Case reports Chemotherapy Colorectal cancer Esophageal cancer Esophagus Medicine Medicine & Public Health Pancreas Pancreatic cancer Pancreaticoduodenectomy Radiation therapy Rectum Simultaneous triple cancer Surgery |
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| Title | Simultaneous triple cancer of the esophagus, pancreas and rectum treated with multimodal strategies: a case report |
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