How to manage stomach cancer and lymph node enlargement?

Hi,

Welcome to icliniq.com.

I can understand your concern.

I have seen the attached pathology report (attachments removed to protect the patient's identity). It has been diagnosed as stomach cancer. So, the first thing needed here is to know the stage of disease, and for that, a CT (computed tomography) scan of the thorax, abdomen, and pelvis is required. I think you have mentioned a partial report in the query, but for a proper opinion, acomplete report is required so that there are no omissions. If the disease has not spread any further from the lymph nodes, then treatment will include chemotherapy first, and later on, assessment for surgery.

Please revert back for anything specific you want to know.

I hope this was helpful.

Thank you.

Hi,

Welcome back to icliniq.com.

I have gone through the CT report (attachments removed to protect the patient's identity). This CT was done to cover only the abdomen and pelvis.

It is best to get a scan of the chest, also to see whether there has been any spread to the lungs. Also, measure blood CEA (carcinoembryonic antigen) and CA19.9 (cancer antigen) tumor marker levels.

Ideally, after that, the patient should undergo a small diagnostic operation called staging laparoscopy. This is done to see the small-sized spread of the tumor to the rest of the abdominal cavity. This can change treatment planning.

Assuming there is no spread elsewhere, we need to see the fitness level of the patient. If he is active and fit otherwise, he would like to start chemotherapy first. Generally, after two to three cycles of chemotherapy, we assess for response to chemotherapy by repeat CT scan. Based on this scan, surgery will be planned.

So talk to your treating doctor regarding the same.

I hope this was helpful.

Thank you.

Hi,

Welcome back to icliniq.com.

I have gone through the PET (positron emission tomography) report (attachments removed to protect the patient's identity). So with the PET available, a further CT scan is not required. The stage evaluation is mostly complete, but the scan report points to 'perilesional perigastric fat stranding suggesting serosal invasion.'

This finding makes staging laparoscopy with peritoneal lavage cytology all the more justified. This is done to see the small-sized spread of the tumor to the rest of the abdominal cavity. Even with PET and CT not showing spread, there are around 30% chances of such a spread being missed. So I would still do this in this case.

If such a spread is noted, the intent or type of treatment can change. If nothing is detected on staging laparoscopy, then I agree with the plan of chemotherapy followed by surgery. So, I suggest you discuss this with your oncologists.

I hope this was helpful.

Thank you.

Hello,

Welcome back to icliniq.com.

I will get back to you soon after seeing your reports (attachment removed to protect the patient's identity).

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

I have read your query and can understand your concern.

In the previous one, there was a length of 1.18 inches and a thickness of 19 to 20 mm with increased metabolic activity (SUV Max (maximum standardized uptake value) of 5.8), and now, there is a significant reduction in irregular asymmetric mural for a length of 0.9 inches and a thickness of 13 to 14 mm with a reduction in metabolic activity (SUV Max = 3.3). Both size and activity have responded. Also, there is a reduction in the size of a few peripylorus lymph nodes with near complete resolution of metabolic activity, the largest measuring 11 x 7 mm.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

I have read your query and can understand your concern.

It is great to hear back from you. I have seen your attached report (attachment removed to protect the patient's identity). All seems to be fine. Surgery is done well. Margins and nodes are negative. Now, three more cycles of chemotherapy are adequate. In my opinion, radiation will not have any additional benefit, especially if your surgeon is satisfied with the extent of surgery. So, go ahead with chemotherapy if the patient can tolerate it.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

Regarding the PET scan, if the surgery was satisfactory, I would not do any scan at this stage. A CA19-9 (cancer antigen 19-9) value of 6 to 8 is nothing. I would repeat CA19.9 after one month to see the increase. Rest, talk to your treating doctor.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

I have read your query and can understand your concern.

Treatment is already complete. I would do only a CECT (contrast-enhanced computed tomography) of the thorax, abdomen and pelvis, which would also be done only after three months.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

I have read your query and can understand your concern.

In patients who have undergone surgery, a PET scan can pick up things that are actually not cancer and still look like disease. These are mostly just some collections of infection or collected body fluids. And once detected, there is always confusion. This is the primary reason to delay the scan a bit.

To suggest the nature of abnormality picked up on the PET scan, one needs to examine the actual films or CD of the PET scan in detail. So, consult another good radiologist in your city. Further on, you can discuss with your doctor the following options. An endoscopy and, if required, an EUS (endoscopic ultrasound) guided biopsy can be done from this suspicious area.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

Now, we cannot ignore it without proving it with a biopsy. So go for an endoscopy.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.