“This is not me”: patient, family, cultural and clinician considerations in cases of severe cancer-related debility

Dr. Viny: A 45-year-old female emergency room nurse with a history of sarcoidosis and Roux-en-Y gastric bypass surgery for morbid obesity experienced 2 months of abdominal pain, nausea, and vomiting. The patient was initially evaluated in another hospital in the northeastern United States where she underwent an exploratory laparotomy that demonstrated evidence of colonic microperforation. During surgery, the patient underwent lysis of adhesions, transverse colon resection, and an omental biopsy. Preliminary pathologic analysis at the local treating institution from the colon and omental biopsy was deemed consistent with a primary epithelial ovarian cancer. The patient’s hospital course was further complicated by development of a jejunal stricture ultimately requiring a draining gastrostomy tube. The patient was transferred to Memorial Sloan Kettering Cancer Center (MSKCC) for further management with pathology review at MSKCC concluding that the above specimens were instead consistent with adenocarcinoma of either upper gastrointestinal, pancreaticobiliary, or appendiceal primary location.