Synchronous multiple primary cancers of the stomach and duodenum in aged patients: Report of two cases

We describe herein the cases of two aged patients found to have synchronous multiple primary cancers of the stomach and duodenum. The first patient wa s an 82-year-old man who was preoperatively diagnosed as having gastric can cer after presenting with signs of pyloric stenosis. At laparotomy, duodena l cancer was incidentally found to have infiltrated the transverse colon. A pancreatoduodenectomy and right hemicolectomy with radical lymph node diss ection was performed. Two early well-differentiated adenocarcinomas of the stomach and an advanced poorly differentiated adenocarcinoma of the duodenu m were confirmed. This patient is now well without any evidence of recurren ce more than 5 years after surgery. The second patient was a 77-year-old ma n who was also diagnosed as having gastric cancer after presenting with sig ns of pyloric stenosis. Preoperatively, duodenal cancer was detected by end oscopy. A pancreatoduodenectomy and partial colectomy with radical lymph no de dissection was performed because the duodenal cancer was suspected of ha ving infiltrated the transverse colon. An early moderately differentiated a denocarcinoma of the stomach and an advanced moderately differentiated aden ocarcinoma of the duodenum were confirmed, but the duodenal cancer was not seen to invade the transverse colon microscopically. This patient died of c ancer 7 months after surgery. Because multiple primary cancers commonly dev elop in elderly patients, a precise preoperative diagnosis must be made and optimal treatment applied.