Keterangan
The location of the stomach cancer and the extent of its spread determine how it is treated. Stomach cancer is also referred to as gastric cancer. However, other elements including a person's age, general health, and preferences might also be crucial. If possible, surgery to remove the cancer is usually included in treatment since it provides the highest chance for long-term survival. However, if the cancer has progressed far or if a person is not in good enough health for it, surgery might not be a good option. In addition to or instead of surgery, other therapies like chemotherapy and radiation therapy are frequently used in medical care. In some circumstances, newer therapies including immunotherapy and medicines with specific targets may be beneficial.
Ringkasan
- The discussion focuses on evaluating gastric cancer, specifically stage 4, and the treatment approaches used in clinical practice. A case of a 66-year-old diabetic woman presenting with symptoms suggestive of gastric issues led to the discovery of a friable mass in the stomach's pylorus, diagnosed through GI endoscopy and biopsy. Gastric cancers are increasingly observed in younger Asian populations.
- Risk factors for gastric cancer include salt-preserved foods, nitrate content in food and water, Helicobacter pylori infection, and smoking combined with alcohol. Histopathology reveals that 95% of stomach cancers are adenocarcinomas, with intestinal and diffuse types being the most common. The diffuse type is often found in younger individuals, prompting investigation for hereditary gastric cancer syndrome in patients under 45.
- A key recommendation is to avoid sending patients with stomach masses directly for surgery without staging via PET-CT scans. Surgery on the primary tumor in stage 4 cancer has not demonstrated survival benefits. Chemotherapy is the primary treatment for stage 4 gastric cancer, aiming for palliative care and symptom relief rather than a cure.
- Treatment decisions become complex when dealing with mixed adenoneuroendocrine carcinoma, requiring selection of chemotherapy agents effective against both components. The case presented involved a mixed tumor initially treated with cisplatin and etoposide, targeting the neuroendocrine component, followed by a switch to FOLFOX6 after the neuroendocrine component disappeared, revealing a 100% adenocarcinoma. The patient further received Pactytaxyl and Seramza (VEGF inhibitor) after progression, resulting in a prolonged survival beyond expectations based on published data.
- Important aspects of treatment include selecting chemotherapy wisely, sequencing molecules effectively, and knowing when to adjust the regimen based on the histology and response. The success of treatment sequences can extend life expectancy beyond the limits suggested by existing literature.
- Take-home messages emphasized the incurable nature of stage 4 cancer, the importance of PET-CT scans for staging and response evaluation, and the role of chemotherapy. In contrast to stage 4, surgery is the primary treatment for stage 1, 2, and 3 gastric cancer, with chemotherapy serving as an adjunct, and radiation therapy's role remains debatable.
Contoh Sertifikat
Tentang Pembicara
Dr Srinath Bharadwaj
Medical oncologist at Apollo Cancer centre
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