How is gastric cancer managed in diabetic patients?

Question

Hello doctor,

I am 58 years old and weigh about 85 kg. I am an insulin-dependent diabetic patient. I have been diabetic for the last 20 years and insulin-dependent for the last ten years. I take 1000 mg of Metformin after breakfast, and I take Linagliptin 5 mg of Linagliptin at dinner.

In the morning, I take a tablet of Trinexovas 20, Rosuvastatin 10 mg, and Fenofibrate 145, and at night, Aspirin 75. As my mind wanders a lot at night, I take 0.25 mg Trika as self-medication and 30 IU Glulisine and Glargine each morning and night with occasional shots of Glulisine whenever I physiologically feel that my sugar count is high of late.

I have many indigestion problems, so I was given some prebiotics and probiotics. It gave some relief, though, but it started again after it was stopped subsequently. I have prescribed Domperidone as and when required, but it has become a regular affair with Aciloc 300 mg and PAN D added to it as self-medication.

Today I had many problems with my stomach due to gas and indigestion. I also felt that I was either unable to pass urine or urine was not getting generated, and I was worried about my kidneys because I am an alcoholic on weekends. I drink six pegs of vodka with soda and water.

I went to my company's pathologist to get my blood tested, and the reading given is:

HbA1c = 7.5%.
Random sugar = 175 mg/dl
SGOT 49 U/L, SGPT 37 U/L.
Total bilirubin 0.71 mg/dL.
Direct bilirubin 0.38 mg/dL.
Blood urea 21 mg/dL.
Serum creatinine 1.1 mg/dL.

Being a scientist by profession, I have a steady job and carry work home. I am a workaholic like an alcoholic and do not do any exercise either. I got my endoscopy done, and the doctor diagnosed malignant growth in the stomach. The biopsy result is still awaited. Please guide me on the next course of action. I want to get myself mentally prepared.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen your endoscopy report (attachment removed to protect the patient's identity), and based on that, it is cancer of the distal part of the stomach (food storage organ). A biopsy is needed just for confirmation. Further, you must undergo a PET (positron emission tomography) scan after the biopsy report.

If a PET scan is suggestive of non-metastatic disease (not spread to other sites), then a staging laparoscopy to see inside the abdomen by scope with a small hole is advisable. Make sure it is non-metastatic because, in 15% of cases, even PET scans can miss metastasis. After that, chemotherapy is advisable to reduce the disease burden.

Based on the evidence, four cycles of chemotherapy followed by surgery (distal radical gastrectomy) and four cycles of chemotherapy should be given to complete the full treatment. This is the whole process. I suggest you accept the thing as soon as possible and start the treatment. If it is non-metastatic, then a cure is possible.

I hope this will help you.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, both smoking and alcohol are risk factors for carcinoma of the stomach.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

This tumor cannot be removed through endoscopy as it is looking a little bulky and a little advanced.

I hope this helps.

Answer 4

Hello,

Welcome back to icliniq.com.

I have seen the biopsy report (attachment removed to protect the patient's identity), and as expected based on the endoscopy report, it is adenocarcinoma. Further workup and treatment will remain the same as explained previously. Please do share the PET and CT reports.

I hope this helps.

Answer 5

Hello,

Welcome back to icliniq.com.

I have seen your PET scan film and report (attachments removed to protect the patient's identity). I am sorry to say this, but the disease has already spread to the liver and another part of the abdomen. In this case, surgery is not an option. Only chemotherapy is the option for further treatment. Chemotherapy will reduce the disease burden but will not cure it. You have to visit a medical oncologist to start chemotherapy.

I hope this helps.