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Diagnosed with advanced gastric cancer. Suspected the cancer moved to bones. Suggest some treatment

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My aunt aged 70 was diagnosed with advanced gastric cancer (stage 4). She went in for XXXXXXX vein thrombosis and from there they suspected something else being wrong. The diagnosis was made December 26th 2011. The doctors claim that the cancer has moved to the bones, though she complains of no bone pain. She started treatment (Taxol/cabo) and received weekly treatment, with one week of rest (3 weeks of tx and 1 week of rest). She has responded very well, her bloods while at first were over the top have now come down to almost normal levels. Over the summer months her oncologist has her on Taxol maintenance treatment. She is feeling much better but I would like to know what the game plan should be going forward. While the doctor claims bone mets, when I challenge and say how he can be so sure (why not osteoporosis) he doesn't give definites. Something tells me we may be overlooking something. I don't want this to be palliative treatment. She is doing so well, why not treat to put this cancer into remission?
Posted Tue, 28 Aug 2012 in Cancer
Answered by Dr. Robert Galamaga 4 hours later
Hello and thank you for sending your question.

Your question is a very good one and I will work on providing you with some information and recommendations.

First of all I want to make it very clear that it is not possible to Keuer advanced gastric cancer. At the same time, however, it is possible to use medications like chemotherapy to keep the cancer under control.

So far the treatment has not been palliative. The oncologist has been using very good standard chemotherapy medications to keep the cancer under control it to slow the progression of the disease.

Unfortunately, the usual natural course of this type of malignancy is that the cancer will eventually start your progress. The Taxol at this point can be given until there is some type of progression of the disease. If that happens a possible alternative might be considered.

I completely understand your desire to want to put this into complete remission. Unfortunately we do not have the ability to do that in the setting of advanced disease.

Regarding bone metastasis this can be seen on CT scan or on PET Scan studies. Sometimes x-rays will show some changes as well. Your doctor should be able to clearly explain this to you. Please ask him to explain it in detail so that you can understand this. Sometimes as oncologists we might assume that our patients or families understand something when in fact that might not be the case.

Again I know this is a very difficult and stressful situation. I hope that I can provide you with some answers that will help you moving forward. Again the oncologist is treated with very good medication so far and I would not recommend any different course.

If you have any additional concerns I would be happy to discuss those with you.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Diagnosed with advanced gastric cancer. Suspected the cancer moved to bones. Suggest some treatment 19 hours later

Thank you for your response. It is my belief that doctors take on a very apathetic view on tx when they are dealing with older patients.

there have been many instances where patients have been cured. I am not looking for psychology but more options. For instance in Japan there are drugs that have lead to cure. The response I get when I talk to the oncologist is that well Japanese behave differently to drugs thus your aunt may not respond well. Doctors treat off indication and test cocktails all the time.

What I am looking for is some direction. For example what if her bloods come down to completely normal levels and what the doctor feels are bone mets are actually osteoporosis. Then possibly they have misdiagnosed stage 4 and surgery could be an option.

Answered by Dr. Robert Galamaga 12 hours later
Hello and thank you for the additional follow-up.

As far as I know there are no blood tests which can tell you if gastric cancer is in some type of complete remission or cure. Regarding the changes in the bones hi again would encourage you to discuss this with the oncologist. If the changes in the bones were seen on bone scan or MRI or PET scan these all have varying degrees of clinical significance.

If you are holding an impression that the oncologist is not empathetic I suggest you seek a second opinion or change primary oncologic care to a new doctor. There are many stories which we can read on the Internet or in some article which claims that certain diseases including this type of cancer can be cured but again no doctor will practice this type of medicine until it has been proven in large clinical trials. If you're seeking some type of medicine which is only being used in experimental state you will need to change or travel to see different physicians perhaps even internationally.

If you're looking for experimental therapies in the United States you will need to go to large university centers such as Mayo Clinic or University of Chicago. These are institutions which provide the ability of certain patients to participate in clinical trials.

I thank you again for submitting your question. If you're looking for direction as far as where to go from here it sounds like you need to see a new doctor. If you are not connecting with the oncologist then it is time for you to see somebody who might have a different perspective.


Dr. Robert

Above answer was peer-reviewed by
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