Gastric Cancer Presenting with Extremely Rapid Growth: Unprecedented Morphologic Change in a Short Time and Endoscopic Estimation of its Doubling Time

Abstract

We encountered a case of gastric cancer that was initially detected as a deep hemorrhagic ulcer without surrounding irregular elevation, followed by rapid protrusion in less than 1 month. Using endoscopic images in the follow-up study, we estimated the doubling time (DT) of this unusual tumor as 9.2 days. Since the doubling time of gastric cancer is generally fairly long due to exfoliation of many cancer cells into the gastric lumen, this cancer presented with extremely rapid growth. Besides, this case reinforces that follow-up study is important in terms of clinical management of ulcerative lesions.

Early Gastric Cancer Exfoliating into Gastric Lavage (GL1 EGC) Shows a More Aggressive Behavior and Poorer Survival Compared to the Non-Exfoliative Counterpart (GL0 EGC)

“…More recently, in fact, other features such as lymphovascular invasion, tumor budding and mixed-type Lauren classification have been investigated and associated with higher risk of LNM and worse overall survival rates (6-9). Since malignant mucosal cells, following the sixth metastatic route (Figure 3), can be found in stomach juice and GL of GC patients and have been also associated with particularly aggressive phenotypes of cancers, for our study we elected GL as biological material to be cytologically analyzed with staging and prognostic intent (17,18). Following analysis of 96 GC patients (16 EGCs plus 80 AGCs), we assessed GL1 as indicative of aggressive tumor phenotype: compared to GL0 counterpart, in fact, GL1 correlated with statistical significance to many other aggressive parameters (advanced tumor depth, lymph node and distant metastases, angiolymphatic and peri-neural invasion, Lauren diffuse type, presence of signet-ring cells and necessity of palliative treatment -respectively, p=0.0274, p=0.0324, p=0.0446, p=0.0287, p<0.0001, p=0.0413, p<0.0001, p=0.0184), entailed worse OS, PFS, DFS, TTP (approximately 18 vs. 32 months, p<0.05) and resulted to be an independent prognostic factor for poor OS at multivariate analysis (p=0.0287).…”

Characteristics of Advanced Gastric Cancer Undetected on Gastroscopy

“…One study reported that the doubling time of advanced gastric cancer was only nine days. 18 In such a case, even though the second endoscopic examination revealed a very large advanced gastric cancer, the first endoscopic examination, only a few months earlier, may have been normal.…”