Question: A 67-year-old man with a past medical history of well-controlled diabetes mellitus type 2, a recent episode of acute kidney injury owing to bilateral distal ureteral strictures of unknown etiology treated with bilateral ureteral stenting and percutaneous nephrostomy tube placement, and a remote history of adenocarcinoma of the gastric cardia, presented with a 27-pound weight loss, worsening lower abdominal pain, and change in stool for 2 weeks. Two years before the current presentation, he had been diagnosed with invasive adenocarcinoma (Figure A) of the gastric cardia (Seifert type 3) arising in a background of Helicobacter pylori gastritis with intestinal metaplasia following presentation with melena, for which he received neoadjuvant chemotherapy with epirubicin, cisplatin, and capecitabine, followed by total gastrectomy and Roux-en-Y esophagojejunostomy reconstruction (pathology showed the depth of invasion at muscularis mucosa, negative margins, and no lymph node metastasis), and postoperative chemotherapy with the same regimen.