Patient: total gastrectomy 7.5 years ago due to gastric cancer. Recently, I feel difficult to swallow meals, no vomiting, no pain. Gastroscopy was done last week: there was erosion at the anastomosis and blood leakage. The biopsy revealed mild to moderate granulation and anomalous hyperplasia at the anastomosis. Is it residual gastric cancer? If yes, is it possible to treat with medication only? Is it effective? (Because the patient does not want to undergo further surgery) Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Hello, Amanda. From the patient’s symptoms and gastroscopy report (recently, he felt difficult to swallow, gastroscopy: there is erosion at the anastomosis and blood leakage. Slicing laboratory tests, found mild to moderate granulation and heterogeneous hyperplasia at the anastomosis.) If the anastomosis is severe, the anastomosis can be treated with anastomotic dilatation. Patient: Dr. Guo: Hello. Thank you for your reply. I am talking about my father above. Last week, he had another gastroscopy at the request of the doctor, and the report showed adenocarcinoma, I wonder if this is residual gastric cancer. The doctor ordered a full body PET test today, which is very expensive. Why do I need a PET test when the doctor didn’t order it 7.5 years ago? My father is still in relatively good health, he eats a lot, and he has no pain. Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Amanda: Hello. The second gastroscopy and biopsy report is adenocarcinoma, then the diagnosis of residual gastric cancer can be confirmed, PET is a kind of examination method to identify benign and malignant tumors and find distant metastases, which is more expensive and more reliable than general imaging examination. In view of your father’s condition, this test is not very necessary and surgery can be considered, but other tests should be used to further understand whether there are distant metastases before surgery. Preoperative chemotherapy and other comprehensive treatment should be given to improve the outcome if necessary. Patient: Thank you, Dr. Guo. I had an increased CT of the abdomen two weeks ago, and no problems were found in the lungs, liver, kidneys, and other internal organs, but there was a problem in the area of the spout, so the doctor ordered another gastroscopy, which concluded that it was adenocarcinoma. The tumor indicators in the blood test were also out of range. The doctor said that if there is no metastasis after the PET test, the tumor can be cured by surgery. Do I need chemotherapy again? If there is metastasis, there is no need to operate, is there no more treatment? Dr. Guo, you can see that my father looks fine now, will there be metastasis? I would like to ask Dr. Guo to give me some more guidance, thank you. Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Amanda: Good New Year. PET is only advanced compared with other available tests, not absolute. negative test result does not completely exclude the possibility of distant metastasis, nor can it say that it will not recur. As for the need of postoperative adjuvant chemotherapy, the conclusion should be made after a comprehensive evaluation based on intraoperative conditions, postoperative pathology and the patient’s general condition. The presence of distant metastasis is a sign of the progress of gastric cancer, and the occurrence of distant metastasis will make treatment more difficult, but it cannot be said to be incurable. Patient: Hello, Dr. Guo. I’m sorry to bother you again since you just started work in the New Year. The PET results from a year ago showed no metastases, which the doctor said was a good result and meant that surgery was possible. Yesterday I took my father to the hospital and thought I could be hospitalized, but the specialist in the abdominal surgery department said that surgery is not recommended because it is very risky and does not guarantee a cure and may lead to other morbidities. Chemotherapy was recommended. This was different from the previous chemotherapy specialist who said that as long as there was no metastasis, the surgery would be able to cure the disease and restore it to a normal person. These two very different statements were a bit unacceptable to me. Dr. Guo, if surgery is really not possible, can the spread of cancer be controlled by chemotherapy alone? Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Amanda: Hello. There are risks in any treatment for malignant tumors, and it is normal that each doctor can have different opinions due to different perspectives and experiences in considering the problem. I suggest you consult several experts before making a comprehensive judgment. My advice is: if your father is in good general condition (as you described earlier) and has no serious organ dysfunction, surgical treatment is preferred. If it is convenient for you, you can also collect the medical history and bring the patient to the outpatient clinic to have a look, which is the most objective. Patient: Sorry, Dr. Guo, for bothering you again. I had a consultation with a different specialist today and he requested a GI test. (I didn’t make the test because I didn’t take my father there today.) Please advise Dr. Guo, what is the GI test for? If I go on the same day, can I get the report on the same day? GI is an upper gastrointestinal tract barium meal angiography. Patient: Dr. Guo, thank you. My father is confirmed to be ready for surgery and was just admitted to the hospital today. I am very grateful for Dr. Guo’s guidance and help, I really appreciate it! Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Amanda: Thank you for your trust and support as well. Patient: Dr. Guo, good afternoon. It’s been almost 3 months since my father’s surgery, and I haven’t taken him for a review yet. His diet is good, he can eat 6 meals a day, and the amount is very large, he can eat thin rice, noodles, meat and vegetables. However, the night before last, he said he had abdominal discomfort (he ate a total of 10 meatballs during the day), bloating and pain, and sometimes there are hard lumps. Yesterday he ate some antibiotic tablets and he was fine, he could eat again, so I didn’t take him to the hospital, I told him to pay attention to his diet and not to eat too much. But I was always a little worried. If I were to take my father to the hospital for a review, what would be the main tests? I don’t know if he needs chemotherapy or not. Guo Yuewu, Department of Medical Oncology, Shanghai Sixth People’s Hospital: Amanda: Hello. Patients with residual gastric cancer should pay more attention to their dietary habits after surgery and eat less and more meals. The items to be reviewed in the hospital include gastroscopy, abdominal ultrasound, X-ray chest film, serum tumor markers, etc. As to whether chemotherapy is needed, the decision can be made only after seeing the patient and combining the results of the review.