Stomach cancer

So sorry to hear that your father in law has been diagnosed with stomach cancer. I can’t comment on the time it took to receive his diagnosis as my own was diagnosed within 2 weeks although that was as much information as could be provided at that time following the biopsies taken during the endoscopy. However, over the course of the next 4 weeks I too had scans and other tests before chemotherapy started. This was to see whether the cancer has spread to other organs and to determine the size of the tumour. This will help the specialists decide what options there are for treatment. Everyone is different and you will see from posts on this site that treatment varies depending on the type of cancer, the grading and spread amongst other factors. 

There are a number of chemotherapy treatments which of course are determined by the things mentioned above and the frequency, timing and number of cycles vary from patient to patient. For example, I was not given a staging at diagnosis but the tests and scans suggested FLOT chemo was appropriate for me followed by surgery then more FLOT. The original plan was to perform a total gastrectomy but the chemo was successful in reducing the tumour sufficiently that although most of my stomach was removed, I was able to retain a very small part. My chemo is and was administered for 4 cycles every 2 weeks before surgery and now the same post surgery. Mine was stage 3 but there was no spread. 

Please be assured that your father in law will have a multiple discipline team who will review all of the results and determine the best options for treatment. Do you have a McMillan nurse assigned? These wonderful people will be more than happy to discuss any issues you have. A dietician should also be assigned to your father in law, particularly given his current issues with eating and weight loss and they will provide the appropriate guidance and probably something like Fortisips to help him. Do contact them. 

This website might also help answer some questions for you as well as providing information to help manage eating https://www.opa.org.uk/

Karen Thankyou for this information it has been very helpful x

Hi Eva,

I'm really sorry to hear about your father in law and how long it's taken to get a diagnosis.

I have to say that it seems very unusual to be told that stage II is inoperable - I don't know where he is being seen, but might it be worth requesting a second opinion elsewhere, perhaps from a surgeon? This can be arranged, I believe, through one's existing oncologist (they ought not to take offence or feel bad about it) or through one's GP.

There are different chemo regimens available and they take different lengths of time as each regimen has different recommended cycles. These days, FLOT is generally regarded as the global gold standard chemo (5-FU, oxaliplatin and taxol) for potentially operative cases and for those in good health. It is available on the NHS, Generally people would have 4-6 cycles of this pre-op and another 4 post-op. Many doctors, however, still use older protocols like EOX.

Hope this helps, and wishing you all the best,

SDH xx

Thankyou for your response. Yes i thought it was odd too not to operate however he said becouse its spred its abit tricky. We get a proper plan on Tuesday so fingers crossed they will come up with something. It's heart breaking watching him go through this. Xx

Hi Eva,

I'm still confused as to why they would say that and what 'a bit tricky' actually means. Stage II can mean spread into local lymph nodes and it's true that it's not equally easy to remove all lymph nodes based on their location.

That said, there is a lot of variance between surgeons in their skill levels and training when it comes to lymph node removal. For example, the average 'acceptable' lymph node removal in the UK according to NHS guidelines is 15 and on average only 75% of operations manage that. In Japan, average node removal is in the 50s. My dad's surgeon, Professor Hanna at St Mary's removed 76 nodes for my dad who was stage IV. There are other surgeons who routinely remove 'trickier' lymph nodes in other parts of the country.

I suppose I'm saying that a 'bit tricky' for one team might be routine for another. You're entitled to ask for a second opinion so if you're not happy with your current team's plan.

Feel free to message me if you like,

SDH x