A 63-year-old man presented to the hospital after 3 months of upper abdominal discomfort, during which his symptoms gradually worsened with acid reflux, belching (burping), and black stools for 10 days. During the period of symptoms, the patient’s appetite deteriorated and he lost approximately 5 kg of weight.
After initial examination, the physician suspected gastric cancer and performed gastroscopy, which revealed an irregular ulcer about 2 cm × 5 cm in size in the gastric sinus near the gastric outlet, which was reported as a hypofractionated adenocarcinoma after biopsy.
How to treat? Chemotherapy first, then surgery
The doctor performed further abdominal CT and found localized thickening of the gastric wall in the sinus region. Although no other metastases were found, the tumor infiltrated deeply into the gastric wall and had the potential to break through the outermost plasma membrane and invade liver tissue. In order to improve the chances of radical resection of the tumor, after a multidisciplinary discussion, the doctors recommended trying 2 cycles of chemotherapy before surgery.
After 2 cycles of docetaxel + tegeo, the patient’s repeat CT and ultrasound endoscopy showed significant tumor shrinkage and a significant chemotherapeutic effect. Subsequently, he underwent a “major distal gastrectomy”. The postoperative pathology showed that the tumor infiltrated the submucosa (T2 stage) without lymph node metastasis (N0), and the pathological stage was stage IB.
Why? Preoperative neoadjuvant chemotherapy improves radical resection rates
For gastric cancer with deep local infiltration, surgery is likely to be difficult or difficult for radical resection, and often requires 2 to 4 cycles of neoadjuvant therapy before surgery to wait for the tumor to become smaller and downstage before surgery.
In this case, the patient had locally advanced gastric cancer and multiple gastric cancer lesions, which involved a large area and would likely invade the surrounding liver tissue. The patient’s liver is likely to be invaded. Usually, neoadjuvant chemotherapy can significantly reduce the size of the primary tumor and lower its pathological stage, thereby reducing the difficulty of surgery, narrowing the scope of surgery, and reducing the chance of intraoperative dissemination of tumor cells, thus increasing the likelihood of radical resection of the tumor.
The patient continued to receive 4 cycles of chemotherapy with the original regimen after surgery and was followed for 1.5 years with no signs of recurrence or metastasis.
Summary
Patients with gastric cancer do not necessarily undergo surgery immediately after diagnosis. For tumors that are locally large or have regional lymph node metastases, physicians generally recommend preoperative neoadjuvant therapy first, a strategy that also improves the chances of radical resection for patients with gastric cancer. After 2 cycles of chemotherapy, CT showed a significant reduction in the sinusoidal lesion and a significant reduction in the perigastric nodules and masses.