Dr. Pawar Satyajit Jalinder
Medical oncology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My mother is 65 years old. She is diagnosed with stomach cancer stage 4. We consulted the situation with five top oncologists and based on their suggestions we decided not to put her under chemotherapy. We are keeping her under supportive care at home. She is not taking any medicine for cancer as of today.
The current concern is that she is 45 kg in weight and is able to take only liquid food since diagnosis. She does take semi-solid (mashed) food sometimes but it maybe twice or thrice in a week. As you can see in her PET scan attached, the tumor may be causing physical obstruction for the food to pass from stomach to the path down and also from time to time she feels some liquid with stale smell raising up her stomach. She wants to eat but unable to do so because of this weird nausea-like feeling.
Can you please suggest some medications to overcome the above problem? Or is there any other way she could be given enough nutrition to manage the situation? Looking for your help at the earliest possible.
Hello,
Welcome to icliniq.com.
I have gone through her reports. (attachment removed to protect patient identity).
As per the above reports, it looks like metastatic stage 4 gastric cancer. And as I can gather from history above, the decision of supportive care only without any chemotherapy is taken.
For gastric cancer, surgery remains the best palliative treatment specially if there are features of obstruction as seen in her case. But usually, surgery is not preferred in view of its invasive nature. Her symptoms can be explained by moderate luminal obstruction of the stomach. In that case, another option is to go ahead with percutaneous jejunostomy for feeding which bypasses the stomach and helps in maintaining nutrition. If such a facility is not available then an endoscopic feeding jejunostomy tube can be tried. Sadly only medications such as antinausea drugs will not help much as the problem is due to mechanical obstruction.
I hope this helps.
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Medical oncology
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