Gastric cancer in very young adults: apropos four patients and a review ofthe literature

Whether gastric cancer in young adults differs from gastric cancer in older patients has been a controversial issue. It has long been suspected that y oung patients with gastric cancer have different biological features with a more aggressive course of disease and a poorer prognosis than older patien ts. This, however, has not been firmly substantiated. We report on the clin ical course of four patients (three female and one male) with locally advan ced (n = 1) or metastasized (n = 3) non-resectable gastric cancer diagnosed under the age of 29 years (23, 25, 27, 28 years). Prior to diagnosis, all three women had recently been pregnant (1-22 months). Diagnosis was endosco pically biopsy-proven and staging work-up was performed by primary explorat ive surgery (n = 1), laparoscopy and explorative surgery (n = 1) or CAT sca n and ultrasound (n = 2). The delay between initial symptoms and diagnosis was 8-22 weeks (median, 10 weeks). The histology was signer-ring cell (n = 2) or undifferentiated (n = 2) gastric cancer. All patients had the diffuse type of gastric cancer according to Lauren. Patients were treated with the FLAP polychemotherapy regimen consisting of leucovorin, 5-fluorouracil, do xorubicin and cisplatinum, as previously reported. The best response after chemotherapy was partial in two patients. Two patients showed progressive d isease. Secondary surgery was performed in three responding patients (one o f them responded only locally). One patient achieved no evidence of disease after complete tumor resection (RO). In two patients surgery was palliativ e (R2/exploration). Three patients died 6, 4 and 8 months after diagnosis. One patient is still alive. In our series, very young adults with gastric c ancer had adverse clinical and pathological features. In accordance with ot her reports, we observed a predominance of female patients and a possible a ssociation with recent pregnancies. Though the delay between the first symp toms and diagnosis in our patients was no different from that reported for older patients, special emphasis should be given to prompt referral and dia gnostic investigations, ensuring the diagnosis of gastric cancer early in t he course of disease.