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Napoleon Bonaparte's gastric cancer: a clinicopathologic approach to staging, pathogenesis, and etiology

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 52–57 (2007)Cite this article

Abstract

Background Numerous hypotheses on the cause of Napoleon Bonaparte's death have been proposed, including hereditary gastric cancer, arsenic poisoning, and inappropriate medical treatment. We aimed to determine the etiology and pathogenesis of Napoleon's illness by a comparison of historical information with current clinicopathologic knowledge.

Investigations Evaluation of Napoleon's clinical history, original autopsy reports, and of historical documents. The clinicopathologic data from 135 gastric cancer patients were used for comparison with the data available on Napoleon.

Diagnosis At least T3N1M0 (stage IIIA) gastric cancer. Napoleon's tumor extended from the cardia to the pylorus (>10 cm) without infiltration of adjacent structures, which provides strong evidence for at least stage T3. The N1 stage was determined by the presence of several enlarged and hardened regional (perigastric) lymph nodes, and the M0 stage by the absence of distant metastasis. Analysis of the available historical documents indicates that Napoleon's main risk factor might have been Helicobacter pylori infection rather than a familial predisposition.

Conclusions Our analysis suggests that Napoleon's illness was a sporadic gastric carcinoma of advanced stage. Patients with such tumors have a notoriously poor prognosis.

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Figure 1: Macroscopic pictures of gastric lesions.
Figure 2: The association between tumor size and tumor stage in data from surgical resections of 135 gastric cancer patients.

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Acknowledgements

We thank Professor Jeremy Jass, Professor Richard Dirnhofer, and Kristi Baker for their advice on editing this manuscript, and Dr Niels Willi for providing us with macroscopic pictures of gastric ulcers and cancers.

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Authors and Affiliations

  1. and LM Terracciano is a Professor of Pathology and the Head of the Molecular Pathology Division at the Institute of Pathology, A Lugli is an Attending Physician, G Singer is an Associate Professor and an Attending Physician, University Hospital of Basel, Switzerland.,

    Alessandro Lugli, Gad Singer & Luigi M Terracciano

  2. I Zlobec is a PhD student in the Department of Pathology, McGill University, Montreal, Canada.,

    Inti Zlobec

  3. A Kopp Lugli is a resident in anesthesia at the Kantonsspital Aarau, Switzerland.,

    Andrea Kopp Lugli

  4. RM Genta is a Professor of Pathology and Medicine (Gastroenterology) at the University of Texas Southwestern Medical Center at Dallas and the Chief of the Department of Pathology at the Dallas Veterans Affairs Hospital, TX, USA.,

    Robert M Genta

Authors
  1. Alessandro Lugli
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  2. Inti Zlobec
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  3. Gad Singer
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  4. Andrea Kopp Lugli
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  5. Luigi M Terracciano
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  6. Robert M Genta
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Corresponding author

Correspondence to Robert M Genta.

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The authors declare no competing financial interests.

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Lugli, A., Zlobec, I., Singer, G. et al. Napoleon Bonaparte's gastric cancer: a clinicopathologic approach to staging, pathogenesis, and etiology. Nat Rev Gastroenterol Hepatol 4, 52–57 (2007). https://doi.org/10.1038/ncpgasthep0684

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  • DOI: https://doi.org/10.1038/ncpgasthep0684

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