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Suggest treatment for stomach cancer

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Posted on Thu, 19 May 2016
Question: Hi Doctor
My father had reported weight loss of 8+Kg over last two months and his weight is still going down, He has difficulty digesting food and get burps even if he drink water. Loss of appetite, Nausea are the other symptoms. He has gone very lean and has lot of weakness. his ALP & GGT are high, HB is 13.4 and Iron and calcium are low. We went to a local doctor and he suggested Ultrasound and then CT. As per CT, it looks like my father probably has Stomach cancer with Liver metastasis. His biopsy report for stomach tumour was done yesterday and is awaited however doctors here are very certain that he has it. The tumour in the stomach is of size 7.3* 6.8* 6 cm. Liver has multiple lesions mainly in right lobe of liver and CT report also says portal vein thrombus. When we consulted the GI surgeon , he suggested that chemotherapy is the only option and we should consult a medical oncology. We have done the PET CT whole body today as well . I know I should wait for biopsy but just wanted to check whether radiation therapy like cyber knife or surgery is any option? Should I consult radiation oncologist and a different surgeon? Please help. Many thianks

Regards
XXXXX
doctor
Answered by Dr. Indranil Ghosh (42 minutes later)
Brief Answer:
chemotherapy is only option

Detailed Answer:
Hi XXXXX,
I am sorry to know about your dad. This indeed appears to be advanced stomach cancer with spread to liver. This is unfortunately incurable.

Only option is to proceed with chemo. After the biopsy report obviously. Biopsy report can be expedited if doctor speaks to pathologist.

Radiation or cyberknife has got no role here. Same for surgery, unless there is a block in stomach outlet which needs to be bypassed.

So I think consulting a medical oncologist is appropriate.

Hope this helps. I will be available for follow up.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Indranil Ghosh (21 minutes later)
Thank you doctor Indranil for your response, yes it is very unfortunate indeed. I feel so helpless watching him die in front of my eyes.

Could you please advise:

1) How much life expectancy can we guess?
2) How can we make his last days better. Is there any digestive enzyme, Ayurveda medicine or anything we should give him that can help him digest food better?
3) How do we know if he can withstand Chemo?

Many Thanks
Regards
XXXX
doctor
Answered by Dr. Indranil Ghosh (1 hour later)
Brief Answer:
difficult to predict life expectancy

Detailed Answer:
Without seeing a patient personally, it is very difficult to predict life expectancy. Even after seeing it is hardly accurate. But overall, metastatic stomach cancer patients survive around a year on average.

some medicines can definitely be given to improve his quality of life. This is called palliative medicine. The medical oncologist can prescribe those himself or else he can send him to a palliative care specialist.

Whether he can tolerate chemo is entirely dependant upon his general health and blood parameters. Only the medical oncologist who is treating him can make this judgement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (24 hours later)
Thank you Dr. Indranil. I have attached the PET CT report of him that we received. Could you please help me interpret it and advise what it says? Has it spread to lungs/neck? One strange thing I observed is in the report of liver, it says that liver is normal in size but the earlier CT says liver is enlarged(18 cm). Also this report says a big lesion measuring 7.4 cm * 4.9 cm whereas that was not stated in last CT. Please help and interpret the extent of the spread. many thanks
doctor
Answered by Dr. Indranil Ghosh (1 hour later)
Brief Answer:
lung nodule too small

Detailed Answer:
The lung nodules and neck lymph nodes are too small to characterize but possibility of spread is there. Liver spread is definite. PET CT is more accurate so we will go by that only. Liver size is of no importance at this point. The liver spread matters.

Again I would suggest chemo.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (18 hours later)
Thank you Doctor . Can you also please also advise if the disease is communicable or if we need to practice any precaution when we take care of him? Also I was told by someone cancer is mostly in genes so should I get any screening done etc. for myself,

Also Is Medanta in XXXXXXX a better hospital or Apollo Indraprasta in XXXXXXX for cancer treatment? thanks

Regards
XXXXX
doctor
Answered by Dr. Indranil Ghosh (9 hours later)
Brief Answer:
not communicable

Detailed Answer:
Hence no need to take special precautions. Just one cancer in family doesn't warrant genetic testing.

Both are good hospitals. Anyone should be fine.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (17 hours later)
Thnx doc, I today received the biopsy report, attached, please could you interpret it for me, what does this signify, also the oncologist I met today suggested that we should go for repeat biopsy tomorrow. I have attached his prescription. But the question is why do we need to do it again?

Also please advise me if chemotherapy drugs depends on the doctor or is it going to be same treatment/dose irrespective of the doctor and depends on the source of cancer being treated. Reason I ask is because we are from XXXXXXX and currently in XXXXXXX So I am confused whether I should continue the treatment here in XXXXXXX where the doctors are more competent or should I take him back to his hometown in XXXXXXX Thanks
doctor
Answered by Dr. Indranil Ghosh (2 hours later)
Brief Answer:
biopsy has confirmed cancer

Detailed Answer:
only for hercept test they probably need more sample. If hercept positive, an antibody called herceptin is added to chemo. But result not much altered. It is very costly also. So if you do not consider adding herceptin, no repeat biopsy required.

Delhi/NCR has strong oncology team. XXXXXXX is also upcoming center. You can take one chemo at XXXXXXX and continue further at /Jammu as per their prescription.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (2 days later)
Thank you Dr Indranil. What tests do they do before Chemo? I was told an Heart echo would be required? Also What are the drugs you think he will be given for the treatment? Just to ensure I have some knowledge and can ask the doctors right questions. Also will he have to be admitted and for how long.

How do we decide whether we should continue his treatment or will he be better off by not doing further Chemo. Some people told me that chemo is so strong that people go to wheelchair straight after that, is it that bad?Will he be able to live a semi-normal life after chemo? He is still able to eat & walk somewhat now, I hope Chemo will improve his quality of life and not deteriorate.

I will be in touch with you constantly throughout his treatment. Thank you for your support & guidance so far.

Regards
XXXXX
doctor
Answered by Dr. Indranil Ghosh (1 hour later)
Brief Answer:
Many protocols are there

Detailed Answer:
Hi....

Some blood tests are done before chemo. Echo is also done often.

There are various drugs and regimens for chemo. Commonly used rugs are 5FU, capecitabine, oxaliplatin, cisplatin, epirubicin, paclitaxel, docetaxel, etc in various permutations and combinations. Exact regime will be fixed by treating doctor.

If the patient is generally fit and up and about then chemo is given. Otherwise not. Judgement best taken by treating doctor.

Some patients do respond and have better quality of life but others do not. Very difficult to predict before starting treatment.

Regards.

Above answer was peer-reviewed by : Dr. Deepak
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Follow up: Dr. Indranil Ghosh (45 hours later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Indranil Ghosh (5 hours later)
Brief Answer:
Hercept test negative

Detailed Answer:
Yes , I've reviewed them

So no role for Herceptin. Only chemo to be given.

Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Indranil Ghosh

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Suggest treatment for stomach cancer

Brief Answer: chemotherapy is only option Detailed Answer: Hi XXXXX, I am sorry to know about your dad. This indeed appears to be advanced stomach cancer with spread to liver. This is unfortunately incurable. Only option is to proceed with chemo. After the biopsy report obviously. Biopsy report can be expedited if doctor speaks to pathologist. Radiation or cyberknife has got no role here. Same for surgery, unless there is a block in stomach outlet which needs to be bypassed. So I think consulting a medical oncologist is appropriate. Hope this helps. I will be available for follow up. Regards