Patient complaints of pain abdomen and multiple episodes of vomitting. Patient gave history of significant weight loss. Patient only had undergone few investigations (reports attached) . Pls discuss how to investigate and manage this case

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On the present images it looks like a case of proximal stomach carcinoma. Most probably adenoca As this is not a common location for Lymphoma. It's a locally advanced malignancy possibly metastatic (para-aortic lymph Node seen on CT). Better to start the patient on neoadjuvant chemotherapy. The international standard is ECF but I have seen from my experience that Indian patients respond better to DCF(docetaxel, cisplatin, 5fu) or TPF ( Paclitaxel, cisplatin, fu). This should be followed by proximal / total gastrectomy based on response along with distal pancreatosplenectomy with D2 resection +/- paraortic sampling ( not done in indian scenario, but done as D3 in Japanese setting). If lymph node positive postop CTRT ( latest ASCO update) or post op chemotherapy ( 3#CT - SX - 3#CT). If dysphagia can consider stenting else usually by end of first chemo, the dysphagia reduces significantly

Ca pancreas with stress duodenal ulcer frcp with biopsy HP for confirmation for diagnosis pet scan if ca confirm

What is the biopsy report?If it's adenocarcinoma stomach,then neoadjuvent chemotherapy with cis-platin,fluorouracil regimen followed by surgery depending on the response to chemotherapy. If it's lymphoma,then radiotherapy can be of help.

Obviously patient should be stabilized first.Gastric stent can be applied in the mean-time as palliative measure or nasojejunal tube can be applied for nutrition.
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Gastric carcinoma with metastasis in pancreas Biopsy HP gi scopy Opinion of oncosurgeon

first biopsy confirmation should be done followed by metastatic workup in the form of chest x ray or ct chest if biopsy came out as malignancy. if it is adenocarcinoma, perioperative chemotherapy or initial surgery followed by adjuvant chemoradiation should be given

Seems more towards lymphoma. Biopsy with IHC is must. Serum CEA and LDH can be done. Other metastatic work up CECT chest. FJ. Then to proceed with chemo radiation if lymphoma else chemotherapy for adenocarcinoma.

Advised biopsy, carcinoma stomach.

Dear Dr plz take a biopsy and also send ESR CT ABDOMEN (P+C) PROPERLY 1.POSSIBILITY OF NEOPLASTIC GROWTH 2.IT MAY ALSO ABDOMINAL KOCH 3.IN ACUTE INFECTION CAN CAUSE A MESSENTRIC LYMPHANDENOPATHY

yes u are right
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ca stomach.stage iv . confirm biopsy as malignancy. adeno ca. stabilise the patient . repeat cect abdomen and chest . if signs of obstructions , stabilise. plan is Palliative chemo therapy

Biopsy is a must to rule out malignant.if biopsy proved. .then he needs chemotherapy. first symptomatically can be treated..fr pain abdomen.blood transfusion a must.

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