What happened, in summary

A 61-year-old man was admitted with upper-abdominal discomfort, jaundice, dark urine, poor appetite and nausea. Imaging strongly suggested hilar cholangiocarcinoma and also showed abnormal thickening of the stomach wall. During surgery, the team found both a bile-duct tumor and a hard mass in the upper stomach. Frozen-section testing confirmed gastric adenocarcinoma.

He underwent resection of the hilar cholangiocarcinoma and radical resection of the proximal gastric cancer during the same operation. Gastric pathology showed moderately differentiated intestinal-type adenocarcinoma extending through the stomach wall and into the lower esophagus. Seven regional gastric lymph nodes were negative, and HER2 testing was negative.

He recovered from surgery apart from a mild biliary fistula. Rather than follow the recommended standardized postoperative treatment plan, he later took oral tegafur. A CT scan in October 2017 showed no apparent metastasis.

In January 2018, he developed anorexia and wasting, and imaging showed multiple metastases in the abdominal cavity in the setting of both cancers. He declined further treatment and died in February 2018, about 10 months after the combined operation.