Intraluminal Metastases in Gastric Cancer: A Rare Postoperative and Post-therapy Event

Gastric cancer is the second most common cancer worldwide, with a frequency that varies greatly across different geographic locations (Bozzetti et al., 1999))Gastric cancer is metastatic at the time of diagnosis in 33% of cases. But metastases to small bowel and large bowel is rare.51-year-old gentleman with past history of total gastrectomy 10 months back and completed 6 cycles of chemotherapy and 28 fractions of radiotherapy, presented with generalized tiredness, loss of weight and loss of appetite. On evaluation with CECT abdomen, he was found to have multiple polypoidal lesions in small bowel as well as colon. Colonoscopy and biopsy were done from rectosigmoid polypoidal lesion, which proved to be metastatic lesions from gastric carcinoma. Since the lesions were multifocal and did not cause any complete obstruction of the small bowel or colon, no resection was attempted and the patient was sent for palliative chemotherapy. The most common sites of metastasis in gastric carcinoma are liver, peritoneum, lung, and bone. Gastric carcinoma metastazing to intraluminal sites like small bowel and large bowel are rare. The development of intraluminal metastases within a relatively short time frame (one year) suggests an aggressive nature of the disease. Confirmation of recurrence often comes with a grim prognosis, highlighting the challenging nature of managing the disease at this stage. There is no consensus statement regarding the management of cases in which pathological report show isolated tumour cells at margin of specimen rather than truly positive margins as in this case.