What happened, in summary

A 33-year-old woman presented after 6 months of upper-abdominal pain, a growing mass, weight loss and poor appetite. Imaging showed a very large upper-abdominal tumor arising from the stomach and compressing the liver hilum and bile ducts, but repeat imaging did not show liver metastasis. Her serum alpha-fetoprotein, or AFP, was markedly elevated, and repeated tissue sampling supported gastric adenocarcinoma.

As the tumor enlarged, she became increasingly cachectic and could not maintain adequate nutrition. A feeding tube and biliary drainage catheter were placed to support nutrition and relieve the obstruction. Because her bilirubin remained severely abnormal, standard gastric-cancer regimens were not feasible. She received one reduced-dose treatment with gemcitabine.

Her clinical condition initially improved but then deteriorated, preventing further chemotherapy. Care became comfort-focused, and she was discharged in stable condition to Saint Vincent Island with her family.