What happened, in summary

A 56-year-old woman presented with severe swelling of both legs, early satiety and abdominal discomfort. CT imaging showed marked narrowing of the inferior vena cava from mass effect, a 3-cm gastric antral mass and omental implants. Biopsy of the stomach showed moderately differentiated intestinal-type adenocarcinoma. The disease was Stage IV gastric cancer.

She began capecitabine plus oxaliplatin chemotherapy. Her leg swelling improved substantially after treatment, consistent with reduced pressure from the cancer. After the fourth cycle, she developed gastrointestinal bleeding from the gastric tumor and required further evaluation.

HER2 testing was positive, and treatment changed to paclitaxel plus trastuzumab. At the latest follow-up, she was receiving cycle 5 of this regimen. She reported better appetite and energy, and the severe leg edema had improved, although she continued to experience abdominal bloating.