What happened, in summary

A 58-year-old man was diagnosed with early gastric cancer during screening in 2001. The 5 cm lesion was poorly to moderately differentiated adenocarcinoma and appeared confined to the stomach lining. Gastrectomy was recommended because the tumor was outside standard criteria for endoscopic treatment, but he declined surgery and chose endoscopic submucosal dissection instead.

The resection margins were clear and no lymphovascular involvement was seen, although the procedure was considered non-curative because of the tumor characteristics. He was monitored closely with endoscopy, imaging and tumor markers. For 8 years there was no evidence of recurrence.

In 2010 he developed back pain. Bone scans showed abnormalities in the spine and pelvis, and biopsy of the lumbar spine confirmed poorly differentiated adenocarcinoma resembling the original gastric cancer. No other primary cancer was identified, supporting late bone metastasis from the gastric tumor. He received methotrexate plus fluorouracil chemotherapy, then developed disseminated intravascular coagulopathy and died in August 2011, nearly 10 years after his original gastric-cancer diagnosis.