Metastatic Gastric Cancer
Low-dose Chemotherapy Led to Remission
[Dr. Azriel Hirschfeld] I am sharing with you today a compelling case study of a patient diagnosed with metastatic gastric cancer in September 2023, who initially faced grim prognoses from another medical institution. Given the extent of his diffuse metastatic disease, the patient was estimated to have only six months to live, raising critical questions about the appropriateness of initiating treatment.
We face the complexities of life-death decision-making when confronted with aggressive cancers. It is a delicate balance between quality of life and aggressive treatment.
After some deliberation we opted for a low-dose combination chemotherapy regimen. Over time, the results were nothing short of remarkable. See the detailed imaging findings that illustrate the patient’s dramatic response to treatment, including follow-up PET scans indicating no evidence of metastatic cancer and the disappearance of previously localized disease.
SLIDE LEFT: SEE CANCER BEFORE TREATMENT
SLIDE RIGHT: SEE REMISSION AFTER TREATMENT
Clincal Notes
Here are notes I received from the attending physician on the case (as supported by the scans above):
- 5.0 x 2.3 cm area of FDG uptake with SUV max of 12.3 in the cardia of the stomach. Abnormal FDG uptake in the distal esophagus which appears to be contiguous with the hypermetabolic activity seen
in the cardia. - Extensive FDG avid right lower cervical, mediastinal and hilar, paraesophageal, retrocrural, retroperitoneal and mesenteric lymphadenopathy, compatible with lymph node metastasis.
- Multiple foci of abnormal FDG uptake in the spine, in the ribs and in the pelvis, compatible with skeletal metastases.
- 1.1 x 0.4 cm left upper lobe nodule extending from the pleuia with mild FDG avidity, pulmonary metastasis cannot be excluded. Attention on follow-up exam is suggested.
- A focus of abnormal FDG uptake in the segment 6 of the liver, suspicious for hepatic metastasis.
- Small foci of increased FDG uptake in the soft tissue Jf the torso, indeterminate, however, soft tissue metastasis cannot be excluded. Attention on the follow-up exam is suggested.
The Psychological Journey
I think it is particularly important to highlight the psychological journey of the patient, who entered the program feeling deeply despondent following the unfavorable prognosis he received elsewhere. I cannot emphasize enough the importance of providing hope and cultivating a positive mindset in the medical setting. Through encouragement and a tailored treatment plan, the patient’s health steadily improved, marked by decreasing tumor markers and progressively favorable scans. The resolution of his pain and the lifting of his spirits underscore the holistic impact of effective cancer treatment.
Remission
A year later, the patient’s ongoing remission from metastatic gastric cancer, which is uncommon in such advanced cases, sheds light on the potential for life-saving interventions even in challenging diagnoses. Our program at Hirschfeld Oncology is holistic. We have created a comprehensive approach to cancer management, intertwining medical intervention with psychological support, reinforcing the critical role of clinician-patient relationships in overcoming despair and fostering resilience in the face of serious illness. More on Gastric Cancer.
This case serves as a powerful example of how tailored chemotherapy strategies can lead to unexpected and significantly positive outcomes in patients facing dire circumstances.
