67-Year-Old Woman Diagnosed with Hepatoid Adenocarcinoma of the Stomach After Persistent Coughing – Effective Treatment Strategies

A 67-year-old woman visited the hospital due to a persistent cough and phlegm production lasting over a month. During her initial examination, a chest CT scan revealed multiple small nodules in both lungs, along with enlarged lymph nodes in the mediastinum and bilateral hilar regions. The imaging suggested the possibility of central lung cancer with metastasis to the pleura and surrounding areas. After a biopsy, the diagnosis was initially reported as invasive lung cancer with features resembling hepatoid adenocarcinoma or metastatic hepatocellular carcinoma.

Following further diagnostic procedures, including a full-body PET-CT scan and gastroscopy with biopsy, the final diagnosis was confirmed as hepatoid adenocarcinoma of the stomach with lung metastasis—a rare subtype of adenocarcinoma. This case highlights the importance of identifying the primary tumor origin, especially when dealing with metastatic cancer.

The patient underwent six cycles of chemotherapy using a combination regimen including sintilimab injection, oxaliplatin injection, and capecitabine tablets. To manage the side effects, she was also prescribed metoclopramide for nausea, loperamide for diarrhea, and received intravenous nutritional support with a fat emulsion containing amino acids and glucose.

After three days of hospitalization and follow-up outpatient care for two to three weeks, the patient showed significant improvement. Her cough and phlegm production completely disappeared, and her serum CEA levels returned to normal. Follow-up CT scans confirmed a reduction in tumor size and fewer metastatic lymph nodes, indicating a partial response (PR) to treatment.

Managing side effects was a critical part of her care plan. Chemotherapy-induced nausea and diarrhea were effectively controlled with medication. Nutritional support played a vital role in her recovery, especially considering the high risk of malnutrition among gastrointestinal cancer patients. Weekly blood tests were conducted to monitor liver and kidney function, as well as overall blood counts.

Emotional and psychological support was also essential during her treatment journey. Initially, the patient experienced significant emotional distress and even had suicidal thoughts. With consistent support from medical staff and family, she gradually regained a positive outlook and became more engaged in her treatment.

Key takeaways for patients and caregivers:
- Monitor for delayed gastrointestinal side effects after chemotherapy.
- Maintain regular blood testing to catch complications early.
- Prioritize nutrition with small, protein-rich meals throughout the day.
- Provide emotional support to help patients cope with advanced cancer.

This case underscores the importance of accurate diagnosis and a comprehensive treatment approach that includes both physical and emotional care. Personalized therapy combined with strong patient support can significantly improve outcomes in rare and advanced cancers like gastric hepatoid adenocarcinoma.