gastric cancer is the second most frequent neoplasm of the alimentary tract after the large intestine .
5,103 people in poland were affected by it in 2008 . the case - to - death ratio of around 1 indicates unfavourable prognosis as to recovery from this disease [ 1 , 2 ] .
this poor result is determined by the fact that it is rarely ( only in around 8% ) detected in the form of early gastric cancer , in the mildly symptomatic or asymptomatic phase . in most patients
it is diagnosed at a higher degree than the 1st degree of disease progression and its classic symptoms are weight loss , continuous and dull pain in the epigastrium , loss of appetite , nausea , vomiting and chronic bleeding [ 3 , 4 ] .
the existence of gastric cancer metastasis to the ureter has been described twice in the literature to date .
a female patient , age 67 , was diagnosed at the district hospital ( 22.04 - 30.04.2010 ) because of intensified symptoms of left - sided renal colic . based on the conducted usg and single - phase computed tomography tests of the abdominal cavity and the pelvis , dilation of the ureter
was found because of its infiltration by a pathological focus with the dimensions of 28 mm  15 mm .
another lesion was located nearby at the level of the left iliac muscle  30 mm  27 mm  20 mm , adhering to the sigmoid colon .
tissue infiltration of the pelvis minor wall was found descending in the direction of the left appendages .
colonoscopy was conducted and in this test the large intestine was described without pathology , while the gynaecological usg test confirmed the presence of fluid in the pelvis . during her stay the patient was treated with analgesic and diastolic medication and then referred for further treatment at the regional oncology centre . because of reported pain complaints , she was immediately admitted to the department of oncological surgery on the day of her visit to the outpatient clinic ( 04.05.2010 ) .
the urologist consulting the patient indicated the possibility of kidney damage due to ureteral obstruction with recommendation for an accelerated operation .
therefore , pre - operative diagnostics were not extended beyond the tests received from the district hospital .
the patient underwent surgery on 10.05.2010 and intraoperatively , besides the expected neoplastic tumour of the left ovary with infiltration of the ureter , numerous neoplastic foci were also found : a sigmoid colon tumour , a caecum tumour , a tumour of the body of the stomach and two single tumours in the omentum .
because of the resectability of the neoplastic foci described above , the operation plan adopted earlier was changed and the following were performed in succession with palliative intention : partial gastrectomy by the rydygier method , right - sided hemicolectomy , left ovariectomy and sigmoid resection . after restoring the continuity of the alimentary tract ,
the tumour occluded the lumen , which is why segmental ureterectomy was performed with end - to - end anastomosis over a pigtail catheter .
the patient passed the post - operative period without complications , except a two - day fever .
because of the expected alimentary tract failure , parenteral nutrition was included on the 1st day after the procedure and blood deficits were supplemented with 2 units of erythrocyte mass and 7 units of plasma .
on the 9th day after the operation , the patient was discharged home in a good general condition with recommendations for further treatment .
the received postoperative histopathological protocol indicated that the stomach was the origin of the neoplastic process .
to lauren ) , type i ( acc . to goseki ) , of a stomach adenocarcinoma with a g2 malignancy degree , with occupation of the whole thickness of the stomach wall , with the following immunohistochemical characteristics : ck7(+++ ) , ck20(++ ) , ca125(+ ) , mucicarmine(+ ) .
neoplastic infiltrations along nerves and neoplastic embolisms of blood vessels , as well as metastatic foci in the greater omentum , were observed in the specimen . because of the palliative partial gastrectomy type , only 3 lymph nodes were described in this specimen and all of them contained neoplastic cells . besides the above
, histopathological confirmations were obtained of the metastatic character of the foci in the ovary , caecum and sigmoid colon .
the cancer occupied large and small intestine walls without infiltration of the mucous membrane and the immunohistochemical characteristics were identical as for the primary lesion . according to the above protocol , excision within tissues with a healthy margin of these organs was achieved .
the widening of the left ureter is visible ( marked by arrow ) focus of metastatic carcinoma in the ureter wall
. microscopic section , he staining , magnification 40 neoplastic invasion in the ureter wall .
microscopic section , he staining , magnification 100 it is interesting biologically and constitutes the basis for this paper that the ureteral tumour was described by the pathologists not as a neoplastic infiltration encroaching on the ureter , but as a metastatic focus to the ureteral wall .
after the operative treatment , the patient was qualified for palliative chemotherapy and received it from 28.07.2010 .
the first treatment course was according to the eox regimen ( oxaliplatin and capecitabine ) , but because of the occurrence of neutropenic fever the regimen was changed to pf ( cisplatin and 5-fluorouracil ) .
she again received only one course and the treatment was changed once more because newly formed metastatic foci in the liver were located in imaging tests .
next , three chemotherapy courses were administered according to the folfiri regimen ( irinotecan , leucovorin and 5-fluorouracil ) , but only until 11.11.2010 because due to progression of changes in the liver described in examinations the chemotherapy was discontinued and the patient was qualified for symptomatic treatment . according to our knowledge
treatment of gastric cancer in the disseminated phase of the disease aims at extension of life and achieving a good palliative effect .
the recommended methods , allowing the above to be achieved , are chemotherapy or combination radiochemotherapy . in an advanced stage ,
palliative operations on this organ are performed for life reasons and serve to eliminate complications such as bleeding , perforation or obstruction of the organ .
it is indicated that the above complications forced surgical intervention in 1/4 of the patients previously disqualified from operative treatment because of the presence of metastatic foci . according to literature data , patients operated on by palliative resection in the disseminated phase of the disease achieve a survival time of between 9 and 15 months . the survival time is limited by the number of metastatic foci ; when their number is higher than two foci , no statistically significant differences are observed in this scope
. the value of these procedures is increasing because of the reported low perioperative mortality and the observed significant improvement in the further quality of life for these patients [ 513 ] .
it seems that the operative procedure conducted in the presented patient allowed a good palliative effect to be achieved along with loss of severe colic and maintenance of kidney function .
the literature often presents , as characteristic of gastric cancer , blood - borne metastasis to the ovary , termed a krukenberg tumour .
this is a term generally defining metastasis to the ovary , mainly gastric cancer and next colon cancer .
metastases from other organs , such as the lungs , the mammary gland and the uterus , are also possible , though much rarer .
krukenberg tumours are encountered in the course of 2 - 4% of disseminated neoplastic processes .
this is a negative prognostic factor , with varying median survival time after its diagnosis : 12 - 13 months in the course of gastric cancer compared to 17 - 29 months in the course of large intestine cancer .
this undoubtedly results from biological differences in the course of these neoplasms [ 1423 ] . in summary ,
the available literature sources have described this only twice to date ( in 1976 and 2000 ) .
however , nephroureterectomy was conducted in these quoted cases [ 24 , 25 ] . in the presented patient
the kidney was spared and healing of the ureter after end - to - end suture was achieved .
the dissemination of a neoplasm with extremely rarely encountered symptomatology described above is an interesting experience which we wanted to share .
the beginning of the symptomatic disease as a left - sided renal colic is , in itself , a previously unreported case .
 the typical symptoms of advanced cancer of the stomach are well known in clinical practice . 
 the presented case concerns a patient with symptoms of left - sided renal colic , caused by a malignant tumour involving the ureter , which was diagnosed with a ct scan . 
 the multifocal process , involving the stomach , two parts of the colon , the left ovary and the side of the pelvis , was confirmed only during surgery.the resection or partial resection of the above - mentioned organs involved by the malignant process and reconstruction of the alimentary tract as well as the ureter were performed at time of this operation . 
 the patient 's recovery was without any complications . 
 the histopathological findings support the diagnosis of this malignant process as disseminated stomach cancer.in the available literature only two cases of stomach cancer metastasis to the ureter have been described . in both cited examples resection of the ureter with nephrectomy was performed . 
 the review of the literature supports the value of stomach palliative resection in prolonging life and improving quality of life . 
Introduction
Case report
Discussion