Concluded Case

CARCINOMA STOMACH - Recurrence after 2 years of surgery and chemothera

A 62 years old diagnosed as carcinoma of stomach 1 year back and Total Gastrectomy with D2 lymphadenectomy and oesophago- jejunal anastomosis done followed by six cycles of chemotherapy. Now after 2 years - a follow up PET scan reveals hepatic metastasis - but oesophago- jejunal junction show no recurrence. Treatment options in this case . Whether now chemotherapy will help the prognosis or outcome. Opinion from experts is welcomed

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Concluded answer
As per the available evidence till now presence of hepatic metastasis is considered for palliative care and no role of resection although individual cases has been reported to undergo resection provided patient is fit enough to tolerate surgery. Can advise palliative chemotherapy or ablation of lesion for symptomatic improvement.
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Gastric cancer with liver metastases (GCLM) is generally classified into two types: one is synchronous metastases, which defined as metastases occurring before or during surgery or within 6 months after gastrectomy, and the other is metachronous metastases, which defined as metastases identified at least 6 months after gastrectomy. As this hepatic metastasis has occured with involvement of Left hepatic artery and thrombosis of portal vein with involvement of retroperitoneal and peri portal nodes... it's an advanced disease which would be classified as inoperable.... Gastric cancer with liver metastasis is defined as advanced gastric cancer and remains one of the deadliest diseases with poor prognosis. Many chemotherapy and novel molevuler agents are now available including Nivolumab but despite treatment, median survival remains between 7 and 14 months.. so palliative therapy from my side
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As per the available evidence till now presence of hepatic metastasis is considered for palliative care and no role of resection although individual cases has been reported to undergo resection provided patient is fit enough to tolerate surgery. Can advise palliative chemotherapy or ablation of lesion for symptomatic improvement.
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Image guided biospy of the liver lesions. HPE, Her 2 Neu testing. Then can plan for chemotherapy based upon n the initial chemotherapy patient has received. Or if Her2 positive then targetted therapy can be planned. Options many based on the diagnosis. Very rarely liver lesion could be tuberculosis,so entire treatment changes
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In view of age of patient and previous episode of melignency.. Its metastasis...any treatment can prolong the spanog longitivity to some extent but in a long run prognosis is very poor.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
Chemotherapy treatment can prolong life span itself no change in outcomes
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Chemotherapy with targeted therapy will help
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Lobectomy ( left lobe of liver) followed by chemo- EPIRUBICIN, OXALIPLATIN and Oral Capicitabine .
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Condurango ornithogalum
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