{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:32:43Z","timestamp":1777415563375,"version":"3.51.4"},"update-to":[{"DOI":"10.12688\/f1000research.24353.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T00:00:00Z","timestamp":1606867200000}}],"reference-count":21,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T00:00:00Z","timestamp":1606867200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Primary gastric cancer remains one of the most prevalent malignancies worldwide. Often patients remain asymptomatic until it is detected at an advanced stage with a poor prognosis. Thus, it\u2019s characteristically difficult to initially diagnose until it becomes late stage, at which point prognosis becomes poor. Pernicious anemia is a classic risk factor for the development of primary gastric cancer, but is uncommonly seen in clinical practice. Over time, patients who produce the autoantibodies to intrinsic factor that cause pernicious anemia typically will present initially with clinically significant megaloblastic anemia and peripheral neuropathy. However, patients can also present with more nonspecific signs and symptoms. Thus, clinicians should remain vigilant as circulating anti-intrinsic factor antibodies only worsen the disease over time and increase the risk of developing primary gastric cancer. This report not only presents the rare concurrent diagnosis of pernicious anemia and gastric cancer, but also aims to increase clinical awareness of these two conditions\u2019 classic association because early diagnosis and treatment significantly impacts morbidity and mortality.<\/ns3:p>","DOI":"10.12688\/f1000research.24353.2","type":"journal-article","created":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T09:40:06Z","timestamp":1606902006000},"page":"604","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Case Report: Simultaneously diagnosed gastric adenocarcinoma and pernicious anemia \u2013 a classic association"],"prefix":"10.12688","volume":"9","author":[{"given":"Syed","family":"Kamran","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattias K.","family":"Dilling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5519-7758","authenticated-orcid":false,"given":"Nathaniel A.","family":"Parker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Alderson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan D.","family":"Tofteland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quoc V.","family":"Truong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2020,12,2]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"26-38","DOI":"10.5114\/pg.2018.80001","article-title":"Epidemiology of gastric cancer: global trends, risk factors and prevention.","volume":"14","author":"P Rawla","year":"2019","journal-title":"Prz Gastroenterol."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"1149-55","DOI":"10.3748\/wjg.14.1149","article-title":"Role of symptoms in diagnosis and outcome of gastric cancer.","volume":"14","author":"G Maconi","year":"2008","journal-title":"World J Gastroenterol."},{"key":"ref-3","first-page":"1133-40","article-title":"Gastric cancer: diagnosis and treatment options.","volume":"69","author":"J Layke","year":"2004","journal-title":"Am Fam Physician."},{"key":"ref-4","first-page":"175-85","article-title":"Gastric cancer: prevention, risk factors and treatment.","volume":"4","author":"H Zali","year":"2011","journal-title":"Gastroenterol Hepatol Bed Bench."},{"key":"ref-5","article-title":"Pernicious Anemia","year":"2019"},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"236-41","DOI":"10.3121\/cmr.4.3.236","article-title":"Megaloblastic anemia and other causes of macrocytosis.","volume":"4","author":"F Aslinia","year":"2006","journal-title":"Clin Med Res."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"97-103","DOI":"10.2147\/JBM.S25620","article-title":"Optimal management of pernicious anemia.","volume":"3","author":"E Andres","year":"2012","journal-title":"J Blood Med."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"229-45","DOI":"10.1097\/00005792-199107000-00001","article-title":"Neurologic aspects of cobalamin deficiency.","volume":"70","author":"E Healton","year":"1991","journal-title":"Medicine."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"375-382","DOI":"10.1111\/apt.12177","article-title":"Systematic review: gastric cancer incidence in pernicious anaemia.","volume":"37","author":"L Vannella","year":"2013","journal-title":"Aliment Pharmacol Ther."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"2282-89","DOI":"10.1016\/j.cgh.2015.05.040","article-title":"Cancer risk after pernicious anemia in the US elderly population.","volume":"13","author":"G Murphy","year":"2015","journal-title":"Clin Gastroenterol Hepatol."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"565-8","DOI":"10.1016\/j.autrev.2014.01.042","article-title":"Diagnosis and classification of pernicious anemia.","volume":"13","author":"N Bizzaro","year":"2014","journal-title":"Autoimmun Rev."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"376-81","DOI":"10.12968\/bjon.2014.23.7.376","article-title":"Patient journeys: diagnosis and treatment of pernicious anaemia.","volume":"23","author":"M Hooper","year":"2014","journal-title":"Br J Nurs."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"2603-11","DOI":"10.1182\/blood-2016-10-569186","article-title":"Vitamin B12 deficiency from the perspective of a practicing hematologist.","volume":"129","author":"R Green","year":"2017","journal-title":"Blood."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"1106-7","DOI":"10.1111\/apt.13595","article-title":"Letter: gastric cancer and pernicious anaemia - only a minority of UK pernicious anaemia patients have had a gastroscopy.","volume":"43","author":"D Pritchard","year":"2016","journal-title":"Aliment Pharmacol Ther."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"437-47","DOI":"10.1097\/PAS.0000000000000169","article-title":"Poorly differentiated neuroendocrine carcinomas of the pancreas: a clinicopathologic analysis of 44 cases.","volume":"38","author":"O Basturk","year":"2014","journal-title":"Am J Surg Pathol."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"496-513","DOI":"10.1111\/bjh.12959","article-title":"Guidelines for the diagnosis and treatment of cobalamin and folate disorders.","volume":"166","author":"V Devalia","year":"2014","journal-title":"Br J Haematol."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"269-78","DOI":"10.1007\/s12016-010-8218-y","article-title":"Cutting edge issues in autoimmune gastritis.","volume":"42","author":"B Toh","year":"2012","journal-title":"Clin Rev Allergy Immunol."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"2655-68","DOI":"10.1245\/s10434-017-5832-4","article-title":"Prognostic role of primary tumor location in non-metastatic gastric cancer: a systematic review and meta-Analysis of 50 studies.","volume":"24","author":"F Petrelli","year":"2017","journal-title":"Ann Surg Oncol."},{"key":"ref-19","article-title":"Early gastric cancer: Treatment, natural history, and prognosis","author":"D Morgan","year":"2020"},{"key":"ref-20","article-title":"NCCN clinical practice guidelines in oncology","year":"2020"},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"v38-v49","DOI":"10.1093\/annonc\/mdw350","article-title":"Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.","volume":"27","author":"E Smyth","year":"2016","journal-title":"Ann Oncol."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/9-604\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/9-604\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/9-604\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T09:40:09Z","timestamp":1606902009000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/9-604\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,2]]},"references-count":21,"URL":"https:\/\/doi.org\/10.12688\/f1000research.24353.2","relation":{},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,2]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/9-604\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.26868.r66908, Faustina N A. Sackey, Ph.D., FMWI, Loeb Health Research Institute at Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada, 24 Jul 2020, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/9-604\/v1#referee-response-66908","order":0,"name":"referee-response-66908","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.26868.r67562, Talha Badar, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA, 27 Jul 2020, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/9-604\/v1#referee-response-67562","order":1,"name":"referee-response-67562","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Nathaniel Parker<\/b>; \n<i>Posted: 30 Jul 2020<\/i>; Based on my assessment of this report, one could easily argue that this&nbsp;could be someone with history of GERD due to hiatal hernia leading to Barrett's esophagus leading to GE junction adenocarcinoma. The authors should focus on differential diagnosis of conditions leading to GE junction\/gastric adenocarcinoma.&nbsp;\n<b>- Comment acknowledged. This request is out of the scope for this article, and does not align with the article's purpose.&nbsp;<\/b>&nbsp;Prior history of GERD? (Especially with barret esophagus findings, hiatal hernia), eating habits? Occupational and family history? All to be known in patients with gastric cancer to&nbsp;look for possible etiology for cancer diagnosis.&nbsp;\n<b>- All pertinent and\/or available information has been presented and detailed in the case description section.&nbsp;<\/b>Could it be a GE junction tumor, extending to stomach?\n<b>- All pertinent and\/or available information has been presented and detailed in the case description section. Also, this is unlikely based on the EGD images and summary of the report detailed in the article.&nbsp;<\/b>What is sensitivity and specificity of the IF antibody assay?\n<b>- Please see Description section, paragraph 3, sentence 6.<\/b>Why was FLOT chemotherapy used, why not upfront Sx for Stage 1b disease and&nbsp;adjuvant therapy based on surgical pathology? This should be explained in more detail.&nbsp;\n<b>- All pertinent and\/or available information has been presented and detailed in the case.&nbsp;<\/b>Figure 5 is good, I suggest to mention the timeline in weeks\/days\/months from presentation --&gt;&nbsp;diagnosis --&gt; treatment --&gt; transition to hospice.&nbsp;\n<b>- Comment acknowledged. The authors decline to make the suggested change based on the differences in figure style presentation not providing additional value and clarity to the overall figure and article.&nbsp;<\/b>Introduction, paragraph 3, the third sentence&nbsp;needs better structuring.&nbsp;\n<b>- Comment acknowledged. The authors decline to make the suggested change. This sentence is adequate and its current structure is justified.&nbsp;&nbsp;<\/b>The references need to be better formatted, especially 5, 13 and 19.&nbsp;\n<b>- Comment acknowledged. The authors decline to make the suggested change because the current format of this reference was made by the Editors.<\/b>","URL":"https:\/\/f1000research.com\/articles\/9-604\/v2#referee-comment-5785","order":2,"name":"referee-comment-5785","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.26868.r74105, Martyn Hooper MBE, The Pernicious Anaemia Society, Bridgend, UK, 10 Nov 2020, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/9-604\/v1#referee-response-74105","order":3,"name":"referee-response-74105","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}