That dyspepsia in the young could be cancer
A 34-year-old male civil servant presented with 6 months history of upper abdominal discomfort associated with recurrent vomiting of stale food residue, anorexia, early satiety and weight loss. He had no history of dysphagia, odynophagia or haematemesis. He had no history of ingestion of alcoholic beverages, smoked food or a family history of GI malignancy.\nPhysical examination revealed a chronically ill looking, pale young man, with no lymph node enlargement. Abdominal examination showed epigastric tenderness and succussion splash, but digital rectal examination was essentially normal.\nUpper GI endoscopy findings revealed a distended stomach with a circumferential, firm, ulcerated mass with necrotic surface at the antrum obstructing the gastric outlet, and a deformed pyloric ring making it difficult to intubate the duodenum []. Histology of the biopsy specimen showed a moderately differentiated adenocarcinoma of the gastric mucosa with no evidence of H. pylori in the biopsy sample [].\nHe was worked up and had a partial gastrectomy with Bilroth II drainage procedure, and was placed on anti-cancer chemotherapy – Irinotecan and 5-fluorouracil. His clinical condition improved initially but later deteriorated with worsening abdominal distention, ascites and pedal oedema. A second exploratory laparatomy done about 3 months later revealed disseminated disease with malignant ascites and bowel obstruction. He succumbed to the disease a few days later.