内容紹介
A Case of Gastric Cancer Accompanied by Disseminated Carcinomatosis of Bone Marrow Wherein Long-Term Chemotherapy Was Enabled by Early Supportive Palliative Care
Summary
Here we report gastric cancer accompanied by bone marrow carcinomatosis in a patient for whom long-term chemotherapy was enabled by early pain-relief therapy. A 45-year-old man was admitted to our hospital because of back pain associated with multiple spinal tumors in June 2011. Blood tests showed a trend toward disseminated intravascular coagulation(DIC)and gastric cancer was suspected as the primary lesion. Because pain was severe, emergency pain relief was provided by flurbiprofen axetil and a continuous subcutaneous infusion of fentanyl citrate. After bone marrow examination gave a diagnosis of poorly differentiated adenocarcinoma, we performed sequential methotrexate(MTX)and 5-fluorouracil(5-FU)therapy. The therapy successfully decreased tumor marker levels, and alkaline phosphatase and lactate dehydrogenase levels normalized. Finally, gastric cancer accompanied by bone marrow carcinomatosis was diagnosed. Because the patient had anxiety and spiritual pain from the time of admission, psychiatric care was also required. In November 2011, the tumor recurred, and we switched therapy to a combination of S-1 and cisplatin. The patient's pain was controlled by combined treatment with a fentanyl patch and etodolac, and he was discharged in December 2011. However, severe pain recurred and pain therapy was continued. DIC developed in February 2012 and transiently resolved after resuming combination therapy with MTX and 5-FU; however, it subsequently recurred, leading to the patient's death in May 2012.
要旨
早期から疼痛緩和を行うことにより,約1年の長期生存が得られる化学療法を施行できた胃癌骨髄癌症の1例を経験したので報告する。症例は45歳,男性。2011年6月,腰背部痛にて当院整形外科を受診し,多発脊椎腫瘍と診断され入院。原発巣として胃癌が疑われた。検査施行の体位保持のため,激痛に対しフルルビプロフェンアキセチル+フェンタニル持続皮下注射により緊急除痛を行った。骨髄検査で低分化型腺癌の診断となり,DIC傾向を認めたため化学療法(MF療法)を開始。治療にて腫瘍マーカーは低下し,ALP,LDHは正常化した。胃生検結果と合わせ胃癌骨髄癌症と診断した。入院当初から不安やスピリチュアルペインがあり,精神ケアも必要であった。同年11月,腫瘍が再燃し治療をS-1+CDDP併用療法に変更した。鎮痛補助薬を一時使用するもフェンタニルパッチ,エトドラクの併用で痛みはコントロールされ,12月退院。2012年2月,腰背部痛の再燃とDICの併発を認め,疼痛治療とMF療法再開にてDICを一時的には脱したが,同年5月死亡した。
目次
Summary
Here we report gastric cancer accompanied by bone marrow carcinomatosis in a patient for whom long-term chemotherapy was enabled by early pain-relief therapy. A 45-year-old man was admitted to our hospital because of back pain associated with multiple spinal tumors in June 2011. Blood tests showed a trend toward disseminated intravascular coagulation(DIC)and gastric cancer was suspected as the primary lesion. Because pain was severe, emergency pain relief was provided by flurbiprofen axetil and a continuous subcutaneous infusion of fentanyl citrate. After bone marrow examination gave a diagnosis of poorly differentiated adenocarcinoma, we performed sequential methotrexate(MTX)and 5-fluorouracil(5-FU)therapy. The therapy successfully decreased tumor marker levels, and alkaline phosphatase and lactate dehydrogenase levels normalized. Finally, gastric cancer accompanied by bone marrow carcinomatosis was diagnosed. Because the patient had anxiety and spiritual pain from the time of admission, psychiatric care was also required. In November 2011, the tumor recurred, and we switched therapy to a combination of S-1 and cisplatin. The patient's pain was controlled by combined treatment with a fentanyl patch and etodolac, and he was discharged in December 2011. However, severe pain recurred and pain therapy was continued. DIC developed in February 2012 and transiently resolved after resuming combination therapy with MTX and 5-FU; however, it subsequently recurred, leading to the patient's death in May 2012.
要旨
早期から疼痛緩和を行うことにより,約1年の長期生存が得られる化学療法を施行できた胃癌骨髄癌症の1例を経験したので報告する。症例は45歳,男性。2011年6月,腰背部痛にて当院整形外科を受診し,多発脊椎腫瘍と診断され入院。原発巣として胃癌が疑われた。検査施行の体位保持のため,激痛に対しフルルビプロフェンアキセチル+フェンタニル持続皮下注射により緊急除痛を行った。骨髄検査で低分化型腺癌の診断となり,DIC傾向を認めたため化学療法(MF療法)を開始。治療にて腫瘍マーカーは低下し,ALP,LDHは正常化した。胃生検結果と合わせ胃癌骨髄癌症と診断した。入院当初から不安やスピリチュアルペインがあり,精神ケアも必要であった。同年11月,腫瘍が再燃し治療をS-1+CDDP併用療法に変更した。鎮痛補助薬を一時使用するもフェンタニルパッチ,エトドラクの併用で痛みはコントロールされ,12月退院。2012年2月,腰背部痛の再燃とDICの併発を認め,疼痛治療とMF療法再開にてDICを一時的には脱したが,同年5月死亡した。