Gastric Cancer Presenting With Painful Skeletal Muscle Metastases

What happened, in summary

A 42-year-old man had 3 months of repeated vomiting of stale food, diffuse abdominal pain and swelling, and a 15 kg weight loss. During the following month, severe pain developed in his lower back and left thigh, limiting walking and keeping him in bed for more than half of the day. He appeared undernourished and pale, had abdominal fluid, and had marked tenderness over the left lower back with restricted movement of the left hip.

Endoscopy found a tumor in the distal stomach. The painful psoas and other soft-tissue lesions were initially considered separately, with infection and sarcoma among the possibilities. Histology and immunohistochemistry instead confirmed gastric adenocarcinoma with skeletal muscle metastases. The finding established advanced disease at diagnosis.

A self-expanding metal stent was placed across the antropyloric region to relieve the gastric outlet obstruction. His ECOG performance score was 3, showing that he was too unwell for chemotherapy, radiotherapy, surgery, or local treatment of the muscle deposits. Care therefore focused on symptom relief and end-of-life support. His wife described feeling shattered by the advanced diagnosis but also supported by the doctors and nurses who cared for him.