Complications of the Gastric Cancer in a Rheumatology Practice: a Literature Review and Clinical Case Study

Introduction. The problem of the diagnosis and treatment of the patients with cancer, in particular, with localization of it in the stomach, is one of the most pressing problems of today, both in Ukraine and throughout the world. The incidence of cancer is traditionally high in many countries, with males being twice as high as women. Annually in the world about 750 thousand new cases of gastric cancer are registered. Ukraine ranks eighth among the 48 countries in the world, which account the oncological diseases, by the indices of cancer. In the structure of mortality from malignant tumors, stomach cancer takes second place as in men (after malignant neoplasms of the lungs) and women (after breast cancer). In 2006, the incidence of stomach cancer in Ukraine was 27.4 per 100 thousand people, which significantly exceeds the world population – 15.6 per 100 thousand population. Aim. To make an overview of modern literature on the complications of gastric cancer in the practice of a doctor-rheumatologist and describe a clinical case. Materials and methods. The content analysis, the method of system and comparative analysis, the bibliosemantic method of study of the actual scientific researches concerning complications of gastric cancer in the practice of the doctor-rheumatologist, and the clinical case have been described. Results. It is presented the clinical case of arthralgic syndrome caused by the remote bone stomach cancer metastases in the practice of the doctor-rheumatologist. Diagnostic algorithm for the patient's examination, directed by a family doctor with a suspicion of reactive arthritis, in the conditions of a rheumatologic hospital presupposes the use of a number of laboratory tests, most of which are performed in private laboratories. These tests were performed, signs of rheumatologic disease were not detected, but an increase of alkaline phosphatase level in serum by almost 12 times became the reason for reversing the search for the cause of bone tissue damage. X-ray examination of bone: focal changes has not been detected, chest x-ray has suspected metastasis in the lungs. Scintigraphic studies have revealed multiple metastatic bone defects. The ways of optimizing of the diagnosis search in patients with bone pain, elevated levels of alkaline phosphatase and burdened oncological history are outlined. It is noted that the optimal and most rational method of diarrhea in these situations is to study the level of alkaline phosphatase in the serum of the patient and make the scintigraphy with 99mTc-MDP. Conclusions. Taking into account the practical rheumatology, the article focuses on the optimal diagnosis of the patients experiencing pain in the bones, having the elevated levels of alkaline phosphatase, and the patients burdened with a cancer anamnesis. The studies on the problem show that the most effective and rational diagnostic method of gastric cancer is 99mTc-MDP scintigraphy.