A chief physician of the Cancer Hospital affiliated to Sun Yat-sen University received a patient with gastric cancer in the outpatient department. After careful examination, the doctor found a distant abdominal metastasis. But CT examination failed to find metastasis. The doctor told the patient that it was not suitable for surgery and needed chemotherapy. The patient was dubious and later went to another well-known hospital in China to see an expert. Experts say it can be operated after inspection. After the abdominal cavity was opened, it was found that the gastric cancer had metastasized and could not be surgically removed, so the abdominal cavity was heated and perfused. Later, the patient's condition gradually deteriorated and his physique was not as good as before.
This is a typical case of delayed treatment due to wrong treatment decision. So when treating gastric cancer, what should we do first, surgery or chemotherapy? How should I choose?
Advantages and disadvantages of preoperative chemotherapy for gastric cancer preoperative chemotherapy for gastric cancer is also called neoadjuvant chemotherapy. Let's first look at the advantages and disadvantages of neoadjuvant chemotherapy.
There are three advantages:
1, chemotherapy may shrink the tumor and improve the surgical resection rate.
2. Eliminate potential micrometastasis and reduce the possibility of postoperative metastasis and recurrence.
3. Understand the reaction of tumor to drugs through preoperative adjuvant chemotherapy, and guide postoperative treatment.
There are three disadvantages:
1. If chemotherapy is ineffective, the tumor may grow further and even delay the operation.
2. If the chemotherapy response is large, it will reduce the patient's physique and immune function and affect the surgical treatment.
3. Cases with effective chemotherapy sometimes bring difficulties in judging the scope of surgery, and whether patients with effective chemotherapy can prolong their survival time is still controversial.
At present, there have been many clinical studies around the world to explore whether preoperative chemotherapy for gastric cancer is effective, but there is still no consistent conclusion. Especially for patients from Asia, it is more controversial.
In fact, it is difficult to draw a universally applicable conclusion on clinical problems, especially those involving surgery. Most cases still need front-line doctors to analyze according to the specific situation of each patient.
Does the treatment of gastric cancer choose surgery or chemotherapy? The main treatment of gastric cancer is surgery, but the effective rate of preoperative chemotherapy for gastric cancer is about 50%. The most basic basis for deciding whether chemotherapy is needed before gastric cancer surgery is as follows:
1, gastric cancer examination should be comprehensive and detailed.
The staging of gastric cancer has great influence on the choice of treatment methods. Comprehensive and meticulous examination is helpful to judge the staging of gastric cancer more accurately. In addition to ct and other imaging examinations, doctors' direct physical examination of patients is also very important, especially rectal finger examination, which can often find many metastases that CT can't find. So as to avoid blind operation. So some people say that "one finger is worth a thousand dollars". (Digital rectal examination can also directly find most cases of rectal cancer. )
2. If distant metastasis has been found before operation or laparoscopic exploration, and the operation cannot be completely removed, systemic chemotherapy should be chosen. (Except for severe bleeding and obstruction)
3. Surgery is the first choice for patients in the early and middle period before operation. Many of these patients can be cured directly by surgery, even without chemotherapy for life.
If locally advanced gastric cancer is diagnosed, there is no distant metastasis. At this time, the surgeon should judge whether it can be completely removed according to his own experience and level. Generally speaking, for the cancer focus in the antrum of the stomach, it is recommended to actively remove it first, mainly because the tumor is easy to cause obstruction, and the operation has little effect on the quality of life of patients. However, if the surgeon is not sure about the complete resection of the tumor, he can consider chemotherapy first.