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Q. My pathology report says stomach cancer and lymph node enlargement. Kindly help me.

Answered by
Dr. Arvind Guru
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Aug 23, 2021

Hi doctor,

In pathology report there is asymmetric mural wall thickening in the antral pyloric region. There are enlarged lymph nodes in the perigastric and portal lymph nodes. I am attaching my pathology reports. Kindly help me.

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Hi,

Welcome to icliniq.com.

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 proper opinion complete report is required so that there are no omissions. If the disease has not spread any further from 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.

Hi doctor,

Thank you.

I have attached the CT scan report. Kindly give your opinion.

#

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.

Hi doctor,

We got a PET scan report. Doctor suggested chemotherapy followed by surgery. I have attached the PET scan report. Kindly give your opinion.

#

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 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.


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