What happened, in summary

A 45-year-old woman underwent distal gastrectomy in 2006 for Stage I gastric signet-ring cell carcinoma. One year later, cancer recurred in the remaining stomach and invaded the distal pancreas. She underwent completion total gastrectomy with removal of the distal pancreas and spleen, followed by 6 cycles of 5-fluorouracil plus cisplatin chemotherapy.

Two years later, another recurrence developed near the intestinal reconstruction and caused obstruction. A third operation removed that tumor and reconstructed the bowel connection. She declined additional chemotherapy and remained well for about 3 years.

A later scan then found a left adrenal mass. In 2012 she underwent a fourth operation, which removed the adrenal tumor along with the left kidney, part of the transverse colon and involved bowel tissue. Pathology showed metastatic signet-ring cell carcinoma matching her gastric cancer, making this a Stage IV recurrence.

She received 7 cycles of S-1 chemotherapy after the adrenal surgery. At 12 months of follow-up, there was no definite evidence of recurrence, roughly 7 years after her original gastric-cancer operation.