Diagnosis
Gastric cancer metastases to the urinary bladder. Lymph node involvement. Suspected liver metastases.
Patient:
Female, 69 years old, Kazakhstan
Physician:
Dr. med. Christian Müller, Medical Director of the Clinic for Internal Oncology, Hematology and Palliative Care, Clinic Essen-Mitte
Medical Conclusion and Expert Opinion by Dr. Christian Müller:
One year ago, the patient underwent surgical resection for gastric carcinoma. According to the histopathological report of the excised tissue, the diagnosis was identified as adenocarcinoma, grade G3, stage pT3 pN0 R0.
A PET-CT scan performed 15 months ago revealed lymph node metastases in the left upper abdomen. Postoperative adjuvant chemotherapy, which generally improves the prognosis for gastric cancer, does not appear to have been administered.
Recent abdominal MRI and whole-body PET-CT scans demonstrate a tumor mass in the urinary bladder. A biopsy was performed during a cystoscopy. Histopathological examination of the specimen confirmed metastatic gastric carcinoma (positive for CK, CDX2, and β-catenin).
We are dealing with peritoneal or hematogenous metastasis—a systemic recurrence of the previously diagnosed and treated gastric carcinoma. I fully agree with the assessment made by my colleagues in Kazakhstan: palliative chemotherapy is required in this case. There is currently no clinical indication for surgical intervention.
Patient's Question:
My general condition has deteriorated significantly recently, and I am deeply afraid that I might not be able to tolerate chemotherapy. Are there any alternative treatment options available?
Dr. Christian Müller's Response:
I completely understand your concerns regarding the potential risks and side effects of chemotherapy. However, in complex clinical situations like this, making a definitive treatment decision remotely is extremely challenging. To accurately assess your physical capacity and select a safe, modified protocol, a comprehensive personal examination and full clinical evaluation are required.
As a potential alternative, localized radiation therapy directed at the metastatic site could be considered. However, this approach carries substantial risks due to the close proximity of the tumor to the bowel loops.
The provided materials are for informational purposes only and do not replace an in-person medical consultation. Any procedures or treatments must be prescribed by a licensed physician.
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