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Linitis plastic, had a family history of it. Is it a fast growing cancer?

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Practicing since : 2004
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What is the best treatment for linitis plastica at the moment, they are going for cure it is not spread to other organs as far they can see. And are there any survivors from this cancer possible?

My other sister died 12 years ago from this cancer now my younger sister has it..she is 44 years
Posted Sun, 22 Apr 2012 in Cancer
Answered by Dr. Indranil Ghosh 2 hours later
Thanks for the query.

I think you had communicated to me earlier. You wanted to know from where you can get the best treatment. I would like to know where your sister is getting treated.

It is a favorable factor that the disease has not spread and she is being treated with curative intent. Probably they are going to downstage her with epirubicin, cisplatin and capecitabine chemotherapy (which is the standard) and then do the surgery (radical gastrectomy). She may also need post-op radiotherapy.

If completely resected, linitis plastica (and gastric cancer in general) is potentially curable. There are many long term survivors worldwide. As a recent paper on linitis plastica says....."Despite recent research on alternative therapies, surgical resection appears the only potentially curative approach."(Ref: Mastoraki A. Hepatogastroenterology 2009)

In your family, there seems to be a hereditary predisposition, hence all first-degree relatives should be under surveillance so that any future cases may be readily detected. Affected members may also have a special type (lobular) breast cancer and needs regular screening for that.

Hope i have answered your query.I will be available for follow up.
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Follow-up: Linitis plastic, had a family history of it. Is it a fast growing cancer? 50 minutes later

Yes that is correct I had communicated earlier with you.

I cannot find the longterm suvivors and I want to believe it, all I can find is 16 months because after surgery it seems that it had spread in the it fast growing or not? Sometimes I read fast then slow..

On september 21 I go for a screening because they think we may have the CDH1 gene, the result of this will be end of this I am afraid about all of this for my sister her kids and kids of the sister that already died from this cancer and of my life.

Here in the Netherlands my sister is treated in EMC Erasmus Hospital in Rotterdam after surgery they give 3 cycles of chemo because radiotherapy is not regulair here. Does radiotherapy in combination with chemo give better results?

I am so sad about all of this, my parents already past away serveral years ago, my sister now my younger sister is sick and I was told that the changes of getting gastric cancer is now bigger and If I have the CDH1 gen my stomage must be removes completely...

So it is very important to be to get a honest answer to I know what we and I can expect.

best regards, XXXXXXX
Answered by Dr. Indranil Ghosh 4 hours later
Thanks for the follow up.

First of all, the 16 months you are quoting is the median survival, a statistic we often use as clinicians but is very confusing for patients. This means that after a complete resection, 50% will survive 16 months or more.

If you go into more depth you will find that around 20-30% are surviving post 5 years, after which recurrence is rare. Of course, it is not optimum but that is what medical science can offer at this point.

Radiotherapy is usually advised if the depth of the tumor is bit more (T3 onwards) or lymph nodes are positive. You have said that in your sister it has probably spread to the lymph nodes. In this case it would be beneficial.

Mutation carriers have a more than 70% lifetime risk of developing gastric cancer and an elevated probability of lobular breast cancer.

Prophylactic gastrectomy has provided many members of affected families with relief from gastric cancer with minimal implications (Ref: Surgical Oncology 2011). Hence it mostly recommended to take out the stomach in mutation carriers who are otherwise healthy.

Wishing you good health.
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Follow-up: Linitis plastic, had a family history of it. Is it a fast growing cancer? 1 hour later
Thank you for your answer, about spread tot the lymph nodes I didn't say that that was the case but I thought that with this cancer there is very little chance that it won't spread? or not?'

Gastic LP/linitis plastica always begins in T3?

If not is the ECX/ECC chemo after surgerey enough?

Can you tell me if this is a fast or slow growing cancer?

thanks for your answers
with love XXXXXXX
Answered by Dr. Indranil Ghosh 24 minutes later
Thanks for the follow up.

1. The biopsy report after surgery will clearly mention whether lymph nodes were involved or not. If you have the report, you can send it to me to YYYY@YYYY to sub:Dr Indranil Ghosh.

2. Not necessarily it starts with T3, it may be T2 also. T1 is usually not seen in Linitis Plastica, but it can be seen in other gastric cancers.

3. As I have mentioned if lymph nodes are involved or T3/T4 tumor, then I will advise Radiotherapy, in addition to chemotherapy.

4. It is an aggressive cancer and hence fast growing.

Hope I have answered your queries.

Best wishes for the health of your sister and entire family.
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Follow-up: Linitis plastic, had a family history of it. Is it a fast growing cancer? 4 hours later
thank you so much for your answers.

About the Radiotherapy that is not usually give as a treatment after surgery. After the third ECX/ECC she has a few weeks to recover and then the surgery and then 3 cycles of ECX/ECC. They take lymfp nodes away.

I am very interested in the radiotherapy that is still in trial here. Which parts will they treat with this radiotherapy, the place where the stomage was?

We will ask for a second opion about this radiotherapy but can you tell me how this works? and what the results are?

I want to sare this information with the doctors here so I want to give them as much information as I can.

I am very thankfull for your assistance and help and can not thank you enough for this

with love XXXXXXX

Answered by Dr. Indranil Ghosh 1 hour later
Hi again,

In case of patients who have received chemotherapy before surgery, if lymph nodes are positive or T3/T4 primary tumor, then radiation (+5FU or Capecitabine) is recommended (Ref: NCCN guidelines 2011). However, continuing only chemotherapy (ECF/ECX) is also an option.

Radiation works by inducing damage in the tumor cells which may be remaining in the surgical site after surgery. Basically the stomach bed will be treated. Treatment will be given 5 days a week for 5 weeks consecutively.

There has been no trial which compared RT+chemo vs chemo alone. But trials which have compared observation vs RT+chemo have shown 30% improvement in survival as compared to observation alone. It is difficult to predict whether radiation will work for your sister but definitely it is worth a consideration.

Wish you good health.

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