[A Case of Advanced Gastric Cancer Treated Effectively with Combination Chemotherapy of Paclitaxel plus Ramucirumab].

A 74-year-old man was referred to our hospital because of a gastric tumor. A Borrmann type 2 gastric tumor was found on upper gastrointestinal endoscopy, but tissue biopsy indicated only necrotic tissue and the preoperative diagnosis was difficult. Contrast CT and FDG-PET revealed lymphadenopathy at multiple sites accompanied by high accumulation of FDG in the perigastric lymph nodes, left upper collarbicular fossa, bilateral hilar ganglia, and longitudinal cauda. Because the tumor was strongly suspected to be gastric cancer or malignant lymphoma, distal gastrectomy was performed. The tumor was finally diagnosed as a poorly differentiated adenocarcinoma with multiple lymph node metastasis. S-1 plus cisplatin therapy was administered as first-line chemotherapy, and paclitaxel(PTX)plus ramucirumab(RAM)therapy was administered as secondline chemotherapy. PTX plus RAM therapy was effective, and the patient achieved complete remission(CR), as observed on imaging. However, because adverse events such as numbness in the periphery of the limbs were noted, PTX plus RAM therapy was discontinued per the patient's request. Currently, 13 months since the interruption of treatment, the CR has been maintained, as determined on imaging.

[A Case of Rectal Carcinoid with Liver and Lymph Node Metastases Treated by a Two-Stage Operation].

A 77-year-old woman was admitted to our hospital with the chief complaint of chest pain. CT showed a liver tumor that was 45 mm in diameter. A colonoscopic examination revealed a submucosal tumor in the lower rectum, which was diagnosed by histopathology as a neuroendocrine tumor (NET), grade 2. Liver biopsy confirmed the diagnosis of a liver metastasis from a rectal carcinoid. Considering surgical stress and possible complications, we first performed hepatectomy followed by low anterior rectal resection in a two-stage operation. Histopathological examination revealed that the rectal carcinoid was 14 mm in diameter with four lymph node metastases. After surgery, treatment with an octreotide LAR was initiated. The patient remained disease-free for 1 year 8 months after surgery.

[Local excision of T1b anal canal cancer - a case report].

We performed transanal local excision of anal canal cancer in a 51-year-old man. The tumor was detected as an Isp polyp(7 mm)on the dentate line, by colonofiberscopic examination. Pathological findings indicated adenocarcinoma(T1b). The patient desired preservation of anal function, and hence refused abodominoperineal rectal transection with lymph node dissection. We obtained informed consent for recurrence, and observed the patient rigorously. No recurrence or metastasis has been detected 3 years and 3 months after tumor excision. We propose that transanal local excision might be a treatment option for early stage cancer of the anal canal.

[Two-year survivor in response to gemcitabine-based chemotherapy for advanced pancreatic cancer with multiple lung metastases].

A 65-year-old woman was admitted to our hospital for appetite loss and jaundice. Abdominal CT scan and ultrasonography both revealed a tumor in the head of the pancreas. Chest CT scan showed multiple nodules in both lungs. The patient was diagnosed as having advanced pancreatic cancer with multiple lung metastases. The primary tumor showed a partial response to the administration of gemcitabine 1,000 mg/m2 on days 1, 8 and 15 of a 28-day cycle. Concurrent treatment with 5-fluorouracil (200 mg/day) was efficacious against the lung metastases. One year later the pancreatic and lung tumors had enlarged, and cisplatin (20 mg/body) was added to the protocol. For 20 months the patient was treated as an outpatient, maintaining good quality of life. The patient died of progressive disease 25 months after her first hospital admission.