What is the treatment for adenocarcinoma?

Hi,

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I understand your concern.

A 69-year-old woman began medical evaluation because of persistent abdominal pain and bloating. She had undergone a CT scan of the chest which showed interstitial changes considered to be typical for COVID-19. The follow-up image showed biliary distension with a gallstone. She had a laparoscopic cholecystectomy which showed chronic cholecystitis. Presumably because of continued symptoms an FDG PET-CT scan was done which showed a mass in the antrum of the stomach which was not FDG avid in the initial report, but a later report indicates that FDG avidity had decreased suggesting that the first image did have an increase in SUV. Upper endoscopy revealed an infiltrative process partially narrowing the gastric outlet.

A biopsy showed diffuse-type gastric cancer. Her daughter indicated during a virtual consultation that H. pylori was identified. The patient was treated with triple-drug therapy. Imaging showed no evidence of metastatic disease. Molecular diagnostics including PDL1, HER2, and MSI were not reported in this initial evaluation. It was elected to proceed with neoadjuvant therapy and she received four cycles of FLOT treatment. She tolerated this reasonably well. A repeat FDG PET-CT scan showed a metabolic response. The mass appeared to be less extensive.

After that, she underwent a distal radical gastrectomy. Histopathology showed again poorly differentiated adenocarcinoma but notes mixed types including signet cell as well as poorly differentiated adenocarcinoma. Lymph vascular invasion was present. The tumor was staged T2 N1. Immunohistochemistry now returned showing a CPS score of 5; HER2 was described as negative; the tumor was microsatellite stable. Claudin 18.2 was positive in greater than 75 % of tumor cells. The tumor mutation burden was 2. No CDH1 mutations were noted. PDCD1 had an allele fraction of 50% and was described as a variant of uncertain significance.

Germline DNA is not reported but note that this was mentioned in the tumor insight report. PDCD1 has been associated with an increased risk of lung cancer, if germline DNA testing was not formally done. Consider including PDCD 1. The tumor cellularity was described to be 15 to 20 % so some genomic alterations may have been not identified, see below for a suggestion to repeat next-generation sequencing from an adequate cellular tumor biopsy and plasma CT DNA. She has recovered well from surgery and has regained one kilogram of weight.

I hope this information will help you.

Thanks.