CA STOMACH

A 35 year old patient has been admitted in our hospital for epigastric
pains and vomiting.
I had seen him before as out patient and I had done an OGD on him
diagnosing a prepylori ulcer.
I had given him treatment with PPI and I had advised him to come back
in case of no improvement. I would have liked to perform a biopsy on
that ulcer but I did not because of financial problems of the patient.
Unfortunately, in spite of my advice, I have not seen him again before
the above admission, when I have repeated OGD and I have found a
completely different situation. The ulcer had now become a huge,
ulcerated mass around the pylorus. The mass was heavily covered with
fibrin and easily bleeding at the touch of the gastroscope.
I have this time taken multiple biopsies and sent them for
histopathology. The problem is that my biopsy is very late: in fact I
believe the ulcer I had seen previously was already a cancer and may
be it would have been easier to treat this patient in an early stage
of the disease. The biopsy report will take about 2 weeks to come
back.
Probably our surgery will be late, and even chemotherapy will not be
effective for a patient with advanced disease.

Dr Beppe Gaido