Clinical and pathological characteristics and treatment of gastric cancer during pregnancy

Background: This study was conducted to investigate the clinical and pathological characteristics of patients with pregnancy-associated gastric cancer. Materials and Methods: A retrospective study was performed on nine patients with pregnancy-associated gastric cancer. The clinical data were analyzed. Results: The main symptoms were nausea and vomiting (four cases), epigastric pain (two cases), and chest tightness/abdominal distension (two cases). CA19-9 was increased in six patients of whom five patients showed increased carcinoembryonic antigen (CEA) . The histological types were mainly poorly differentiated adenocarcinoma (five cases) and signet ring cell carcinoma (four cases). The most common metastasis sites were peritoneum (four cases) and ovary (three cases). One case was human epidermal growth factor receptor 2 (HER2) positive. Only three patients underwent radical resection, followed by chemotherapy (oxaliplatin plus S-1 [SOX]). Six patients with advanced cancer were mainly treated with oxaliplatin plus paclitaxel or SOX. After treatment, eight patients were followed up for 1-16 (mean 8.3) months. At 12-14 (mean 12.8) months after treatment, four patients were still alive (44.4%), including three cases of radical gastrectomy and one case with abdominal metastasis. Four patients died 1, 3, 4, and 16 months after diagnosis. Six newborn infants survived without tumor metastasis. Conclusion: Pregnancy-associated gastric cancers are usually of poor differentiation and high malignancy and may present without specific clinical symptoms. CEA and CA19-9 can be used to assist the diagnosis of gastric cancer during pregnancy. Gestational age, pathological type, stage, and patient's wishes should be considered in planning treatment to maximize the benefits of mother and fetus.