Diagnosis
Mucinous adenocarcinoma of the stomach and gastroesophageal junction, Stage IV. Status post 1st cycle of chemotherapy. Epithelial formations of the colon.
Patient:
Female, 56 years old, Russia
Physician:
Prof. Dr. med. Stefan Kersting, Chief Physician of the Department of Surgery, Greifswald University Hospital
Patient's Complaints & History
Complaints of general weakness. Further examination revealed a malignant lesion of the stomach with peritoneal carcinomatosis (metastases). Histological report: mucinous adenocarcinoma with solid clusters of signet-ring cells. Admitted to the department of systemic cancer therapy for the 1st cycle of chemotherapy. What treatment approach could you recommend?
Opinion of Prof. Dr. Stefan Kersting
In this case, we are dealing with peritoneal stomach cancer, which is fundamentally a palliative situation where primary surgical intervention is not indicated. In line with current protocols, we would also recommend chemotherapy.
The provided medical report is comprehensive, and the treatment administered covers all necessary aspects. The patient received adequate oncological treatment. The choice of chemotherapy and immunotherapy was made in accordance with the histological evaluation of the tumor (PD-L1 / CPS assessment).
For this type of tumor, chemotherapy according to the FLOT protocol is recommended, typically for 4 cycles. Following this, a repeat CT scan of the chest and abdomen, esophagogastroduodenoscopy (EGD), and diagnostic laparoscopy are required for restaging.
Overall, the therapeutic recommendations and treatment are identical to those at our cancer center. In this regard, from my perspective, treatment in Germany would not offer any additional value for the patient at this stage.
Nevertheless, we always evaluate whether multimodal therapy is feasible and reasonable. We would recommend a repeat CT scan after the 4th cycle of chemotherapy.
If the combined immunochemotherapy proves effective against the tumor process—reducing the peritoneal carcinomatosis to a localized focus around the stomach—and the patient remains in good general condition, an individualized approach with total gastrectomy and resection of peritoneal metastases could be considered.
If necessary, the surgical procedure is combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
Whether this treatment plan is suitable in this case can only be determined after reviewing all complete medical records. This includes CT scans of the chest and abdomen, and ideally, pictures/videos of the diagnostic laparoscopy.
To discuss this treatment option, you are welcome to contact me again and provide current CT scans alongside previous imaging.
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