Recurrent gastric cancer with bone metastases, venous thrombosis and chylothorax

What happened, in summary

A 62-year-old man was diagnosed in 2017 with diffuse-type gastric adenocarcinoma after weight loss and difficulty swallowing. He received neoadjuvant epirubicin, oxaliplatin and capecitabine followed by laparoscopic gastrectomy. Postoperative pathology showed residual node-positive disease with clear margins. Persistent nausea and poor intake left him too unwell for planned adjuvant chemotherapy.

Eleven months into follow-up, CT for renewed weight loss showed enlarged lymph nodes in several regions, although recurrence could not yet be confirmed by biopsy. Over the following months he developed abdominal pain, leg swelling and shortness of breath. Later imaging showed bilateral pleural effusions, thrombosis extending from the jugular to the subclavian vein, and multiple bone lesions in the spine and pelvis. Drainage of the left pleural effusion produced milky fluid with high triglycerides, confirming chylothorax. No malignant cells were found in the pleural fluid.

A biopsy of a bone lesion finally confirmed recurrent poorly differentiated gastric carcinoma, establishing metastatic disease. Because of his declining condition, palliative chemotherapy was considered too burdensome. He returned to primary care with best supportive care and died a few months later.