What happened, in summary

An 84-year-old man was diagnosed with gastric cancer during a routine medical check-up. Endoscopy showed an approximately 5 cm tumor in the upper stomach, and biopsy confirmed moderately differentiated adenocarcinoma. CT showed no distant metastases. He underwent total gastrectomy with regional lymph-node dissection. Pathology showed tumor invasion into the subserosa and cancer in 1 of 37 regional lymph nodes, consistent with Stage II disease.

Adjuvant S-1 chemotherapy was recommended, but it was not given because of his age. Eighteen months after surgery, CT found a new 2 cm lesion in the spleen. By 23 months, the lesion had grown to about 5 cm and his CEA level had risen. PET/CT showed strong uptake only in the spleen, with no other organ involvement.

At 86, 26 months after the original gastrectomy, he underwent splenectomy. Pathology confirmed that the splenic tumor was a metastasis from his gastric adenocarcinoma. Because this was distant spread, his highest and latest known cancer stage was Stage IV despite successful removal of the metastatic lesion.

He received no chemotherapy after splenectomy. At the latest follow-up, he remained well and had achieved 5 years without recurrence after removal of the solitary splenic metastasis.