Renal cell cancer (RCC) accounts for approximately 3% of all adult
malignancies. RCC has a
metastasis rate of approximately 25%, which is most commonly to the lungs (>50%). On the contrary, RCC
metastasis to the gastrointestinal tract (excluding the liver) is very uncommon and ranges from 0.2 to 0.7%. Thus, a
gastric cancer in a patient with known metastatic RCC would most likely be secondary to
metastasis. We present the first reported case of a metastatic RCC coexisting with a new-onset primary
gastric cancer and a review of management using guidelines from metastatic RCC to the stomach. An 82-year-old African American male with papillary RCC status post left
nephrectomy with recurrence of liver
metastasis presented with
failure to thrive shortly after his third cycle of
chemotherapy despite stable disease by imaging studies. He had received 7
chemotherapy cycles of
Gemzar,
Nexavar, and
Avastin prior to admission. He subsequently had a drop in his
hemoglobin and was found to have hemoccult positive stool in the setting of recent
Avastin. Endoscopic evaluation showed a 3 cm ulcerated mass in the cardia which was biopsied. The biopsy showed invasive and poorly differentiated gastric
adenocarcinoma unrelated to his RCC. The patient subsequently underwent partial
gastrectomy with loop
gastrojejunostomy for resection of his stage 1 primary gastric adenocarcioma. The surgery also facilitated future
chemotherapy (
Avastin), which could not be given prior to surgery due to its side effect of
bleeding. The patient did not receive adjuvant chemoradiation for his
gastric cancer due to his comorbidities at the time and was doing well at a one month follow-up. Metastatic RCC and primary
gastric cancer can coexist, especially when there is an overlap of risk factors such as smoking or
nitrosamines. The management of a
gastric cancer in the setting of metastatic RCC is similar to the management of solitary primary gastric
carcinoma. Treatment of the primary
gastric cancer can facilitate future
chemotherapy such as
Avastin, which has been recently approved for the treatment of metastatic RCC.