Hello doctor, My father had surgery a month back for stomach cancer bleeding tumor and in the histopathological report after surgery showed that metastatic deposits of the tumor have been found in six lymph nodes. I request you to kindly advice what would be the best possible treatment in this scenario.
Hello. As seen in your reports, your father had stomach cancer, which is stage III. He will definitely need further treatment to avoid recurrence of the tumor. Usually, treatment should be started within 6 to 8 weeks. He has two options: Only chemotherapy or Chemotherapy and radiotherapy. Before that, I would advise you for CT scan and tumor markers like CEA and CA 19.9 to look for any evidence of residual disease at four weeks after surgery as residual disease after surgery will be taken as high risk. If you are able to get a PET CT then it is better. There are certain poor markers in his tumor (attachment removed to protect patient identity) like signet ring histology, lymphovascular and perineural invasion, node positivity, and a bit close margin. These all factors make him a high risk for recurrence. Though there is no definite advantage of chemo and radio vs chemo only, those who are at high risk for recurrence benefit from chemo and radio. So in his case, I would opt for chemo and radiotherapy. But before going ahead with this, I will definitely need to assess the patient's general condition and how he is taking his nutrition. Whether he is fit to receive this treatment. Otherwise, I would opt for chemotherapy only. Therefore, I would advise you to take further treatment at the center which has both facilities.  Depending on what type of chemo regime is followed the duration of treatment will be around six months. On an average, around 50 % patient with stage III stomach cancer will be alive at the end for three years if they receive adequate treatment.