What To Do If Gastric Cancer Spreads To The Pelvis After Surgery

After gastric cancer surgery, metastasis to the pelvis can occur in two primary forms: subperitoneal implantation and ovarian implantation. Each type requires a different approach for diagnosis and treatment.

Subperitoneal Implantation Metastasis

Subperitoneal implantation occurs when gastric cancer cells detach and settle in the lowest part of the body cavity—the pelvis. This can lead to symptoms such as rectal pressure, difficulty passing stools, constipation, or frequent bowel movements. To diagnose this condition, imaging tests like CT scans, MRI, and PET-CT are essential to confirm whether cancer has implanted in the pelvic region. A direct and effective diagnostic method is digital rectal examination, where an experienced physician may feel a hard mass through the rectum. The main goal of treatment is to relieve symptoms. For patients experiencing bowel obstruction, a colostomy may be necessary to allow proper waste elimination, along with systemic chemotherapy to manage the disease.

Ovarian Implantation Metastasis

Ovarian implantation, also known as Krukenberg tumor, typically presents as a large pelvic mass. Symptoms may include pelvic pressure, ascites, menstrual irregularities, and vaginal bleeding. In such cases, it's crucial to determine whether there is also metastasis within the peritoneal cavity. If no peritoneal spread is detected, surgical removal of the ovaries is often recommended. This approach, combined with systemic therapy and hyperthermic intraperitoneal chemotherapy (HIPEC), can significantly improve outcomes and prognosis for patients.