Synchronous gastric and ovarian cancer successfully treated with FOLFOX therapy: a case report and review of the literature

Synchronous gastric and ovarian cancer is extremely rare, and there have been no case reports. Here, we present the first case of synchronous gastric and ovarian cancer successfully treated with chemotherapy and surgery. A 72-year-old Japanese woman presented at our hospital with upper abdominal pain and vomiting. She was diagnosed with gastric cancer after undergoing upper gastrointestinal endoscopy. Simultaneously, ovarian cancer was also suspected based on imaging studies which showed a 9 cm cystic lesion with a solid part on the right ovary. Since her gastric cancer was considered inoperable due to the extent of the lesion, she was treated with four courses of oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX therapy). Since both gastric and ovarian cancer lesions were found to be reduced in size, laparoscopic total gastrectomy (D1 dissection, with Roux-en-Y reconstruction), bilateral adnexectomy, and partial omentectomy were performed. Based on pathological and immunohistochemical findings, the diagnosis of synchronous cancer of poorly differentiated carcinoma of the stomach and endometrioid carcinoma of the ovary was made, and it became clear that FOLFOX therapy was effective especially against ovarian cancer. The patient is currently undergoing postoperative chemotherapy with FOLFOX + nivolumab. She remains alive 8 months after surgery, with no active lesions. This is the first report of a patient with synchronous gastric and ovarian cancer, suggesting that FOLFOX therapy may be effective as a first-line treatment of endometrioid carcinoma of the ovary.