Metastatic gastric cancer in a 23- year-old female Zambian diagnosed posthumously: A case report

Introduction: Gastric cancer is one of the leading causes of cancer mortality globally and in Zambia, its exact burden is unknown. Here, we present a case of gastric cancer in a young adult that was diagnosed posthumously. Clinical details: A 23-year-old female patient was referred to the largest tertiary care institution in Zambia, the University Teaching Hospital (UTH). She had been followed up at a district hospital. The patient had a three months’ history of ill-health with symptoms of anaemia, abdominal pain and distension. Upon arrival at UTH, she was noted to be very frail, with pallor, tachycardia and gross abdominal distension and a nodular irregular liver, measuring 10cm below the costal margin. A digital rectal examination revealed the presence of melena. She had no jaundice, lymphadenopathy or finger clubbing but had bilateral pedal oedema. A provisional diagnosis of hepatocellular carcinoma complicated by upper gastrointestinal bleeding was made. Subsequent investigations revealed normal alpha fetoprotein, a Transient Elastography value of 75kPa and negative hepatitis B and C serology. Computerised tomography scan showed multiple liver masses with ascites. The patient continued to deteriorate despite supportive management and died on day 10 of admission. A post mortem was done which revealed a primary gastric adenocarcinoma with metastasis to the liver, lungs and pancreas. Conclusion: This is an example of a case of gastric cancer that was not detected while the patient was alive. It illustrates how cases of gastric cancer would be missed by the Zambia National Cancer Registry recording system.