Early Detection and Treatment of Gastric Carcinoma In Situ: A 60-Year-Old Man's Successful Recovery
Summary: This case highlights the successful treatment of a 60-year-old male patient who experienced intermittent upper abdominal pain and bloating before meals. After undergoing a gastroscopy, he was diagnosed with gastric antral ulcer, and a biopsy confirmed high-grade intraepithelial neoplasia with focal in situ carcinoma. Given the localized nature of the cancer, a minimally invasive radical gastrectomy was performed, followed by supportive medication therapy. Due to the early stage of the disease and absence of metastasis, the patient made a full recovery with complete resolution of symptoms.
Key Information:
- Age/Sex: 60-year-old male
- Diagnosis: Gastric Carcinoma In Situ
- Hospital: Tianjin Fifth Central Hospital
- Treatment: Laparoscopic radical gastrectomy + supportive drug therapy
- Recovery Time: 16 days hospitalization, follow-up after one month
- Outcome: Complete symptom relief, no signs of recurrence
Initial Consultation:
In July 2021, the patient visited the clinic complaining of intermittent upper abdominal pain that worsened before meals and at night, accompanied by bloating. There were no signs of nausea or vomiting. Physical examination revealed no abnormal findings, but a gastroscopy identified an ulcer in the antrum. A biopsy confirmed high-grade dysplasia with early cancerous changes, leading to a diagnosis of gastric in situ carcinoma. Prompt hospitalization and surgical intervention were recommended to prevent possible metastasis.
Medical Intervention:
Preoperative tests showed no contraindications. The patient underwent laparoscopic radical gastrectomy, during which a small ulcer lesion was identified in the gastric antrum. Postoperative pathology confirmed that the cancer was confined to the mucosa. Following surgery, the patient received intravenous medications including pantoprazole sodium and fat emulsion for nutritional support, and gastrointestinal decompression was applied. By day six, enteral nutrition was gradually introduced, and oral intake resumed shortly thereafter. Abdominal ultrasound on day nine confirmed no fluid accumulation, allowing for removal of the drainage tube.
Recovery and Follow-Up:
The patient experienced mild postoperative discomfort, which was effectively managed with metoclopramide. He was also prescribed bismuth aluminate granules to protect the gastrointestinal mucosa and support healing. With minimal surgical trauma and rapid recovery, the patient was discharged after 16 days. Follow-up imaging confirmed good gastric emptying and no residual symptoms. A one-month follow-up was scheduled to monitor wound healing and overall recovery.
Recommendations for Post-Surgery Care:
Despite the successful treatment, patients may experience temporary digestive discomfort. It is advised to avoid spicy, cold, or overly acidic foods such as persimmons, hawthorns, or sticky rice dumplings. Gradually transitioning to a regular three-meal pattern over 1–3 months is recommended. Annual outpatient follow-ups are advised for the first year, with possible extension if no abnormalities are detected.
Importance of Early Detection:
This case underscores the critical importance of early diagnosis in gastric cancer. When detected at the in situ stage, the cure rate can exceed 95%. However, early-stage gastric cancer often presents with subtle or no symptoms, making regular screening essential for high-risk individuals. Those with a family history of gastric cancer, chronic atrophic gastritis, Helicobacter pylori infection, or dietary habits involving high salt intake and low fruit and vegetable consumption should undergo annual gastroscopy. Even without risk factors, persistent abdominal discomfort should prompt timely medical evaluation.