Expert: Claes-Gustaf Nordquist, M.D. - 3/6/2007

Question
I was seeking your medical expertise and advice on my mother's current condition. She is 79 years old and suffered from a stomach ulcer but did not respond to medication for a month and was later diagnosed with “gastric” signet ring carcinoma of the stomach. Her surgeon performed a total gastrectomy procedure on January 29, 2007 to remove the tumor. She is recovering very well thank God and now started to eat normal food after taking certain medications 30 minutes prior to each meal and B-12 vitamin shots every other day for another 2 months. The surgeon also removed 8 lymph nodes, part of the pancreas, and the spleen. The biopsy report showed that part of the pancreas, the spleen and 6 of the lymph nodes to be cancer free but 2 of the lymph nodes were malignant. She also had her thyroid removed 30 years ago and has been on thyroid and 2 high blood pressure medications for decades now.

I was wondering from your expert opinion what would you recommend to be done next? An oncologist suggested a 4 session chemotherapy each consisting of using Xeloda 3 times every 12 hours for 2 weeks then a week rest. Another oncologist agreed adding a recommendation of radiation in the middle or towards the end of her 12 week overall chemotherapy sessions. A third one mentioned that because of her age even if any cancer is still remaining after the surgery the possibility of it spreading is very low because of all her blood capillaries are getting very narrow so the blood would not carry much cancer with it and even if they discover cancer in the next test after 3 months they may start treatment then.

All of the 3 oncologists want to do base line abdomino-pelvic CT and markers now and in 3 months. I am really worried that it will be very difficult for her to handle the chemotherapy which she has not started yet so I was seeking your advice as to what to do next and what type/frequency of cancer testing do you recommend. Finally, do you suggest any type of diet (what and what not to eat) and/or natural remedies that will help in this case.

Thank you very much in advance for your anticipated reply and thanks for all the similar replies you did for the other patients and their loved ones.

Answer
I'm sorry to read about her - and your - problems! I can not in good concience recommend any diet or "natural" remedy since I regard them as completely useless in a case like this - apart from the obvious dietary considerations you must take when dealing with a case involving a gastrectomy (what is an "unnatural" remedy?). Gastric cancers - unless caught VERY early, unfortunately not the case here - usually have such a serious prognosis that even though I agree on the difficulties of giving such therapy to a 79 year old lady I must recommend chemo therapy in some form if at all possible! I fear that if we wait and she has a relapse of her cancer disease it will prove to be too late for any real treatment. Furthermore. Gastrointestinal tumors are not usually good candidates for radiation therapy. Given these facts and considerations I can only recommend  the first alternative with chemo therapy alone. However unfortunately I can not offer you any guarantees. I also agree with her drs. with regards to future tests etc. Please do keep me posted! Good luck!