Vision changes leading to diagnosis of unresectable gastric adenocarcinoma

What happened, in summary

A 50-year-old man sought eye care for 3 months of blurred vision in both eyes. Nine months earlier, he had experienced a pulmonary embolism and leg-vein thrombosis, and over the same period he had lost 10 kg. Eye examination showed a characteristic pattern called bilateral diffuse uveal melanocytic proliferation, a rare paraneoplastic condition that can signal an underlying cancer.

Because of the ocular findings, doctors recommended a search for malignancy. PET/CT showed a highly active lesion in the gastric antrum and multiple metabolically active lymph nodes in the perigastric, retroperitoneal, mediastinal and left supraclavicular regions. Gastroscopy was then performed, and biopsy confirmed poorly differentiated gastric adenocarcinoma.

The imaging raised concern for distant lymph-node spread, and the cancer was considered unresectable.

Systemic chemotherapy was recommended, but his overall condition was considered too poor to tolerate it. He chose palliative care because of the unresectable cancer and financial constraints. At the latest documented point, his care was focused on palliation rather than anticancer treatment.