What happened, in summary

An 84-year-old woman was first diagnosed with gastric cancer 6 years earlier, at age 78, after longstanding burning discomfort in the upper abdomen and chest. Endoscopy showed a large ulcer in the gastric antrum, and biopsy found poorly differentiated adenocarcinoma with signet-ring cell features. CT showed thickening of the antral wall and small nearby lymph nodes.

Subtotal gastrectomy was planned, but she declined the operation. She received treatment for Helicobacter pylori infection and used medication for dyspeptic symptoms, but she did not undergo cancer-directed surgery or systemic therapy.

Six years after the original diagnosis, she remained alive, described herself as healthy and had a good appetite, although she had lost 12 kg. Repeat endoscopy still showed a large gastric ulcer, and biopsy again confirmed poorly differentiated signet-ring cell adenocarcinoma. Her unusually long course represents more than 6 years living with an untreated gastric cancer that remained clinically non-aggressive compared with the usual behavior described for this subtype.