Mr. Xiao Was Diagnosed with Advanced Gastric Cancer, Neoadjuvant Chemotherapy Laid the Foundation for Surgery
A 45-year-old man, Mr. Xiao, experienced symptoms including nausea, abdominal pain, and acid reflux, prompting him to seek medical attention. After a series of diagnostic tests, he was preliminarily diagnosed with gastric adenocarcinoma. Upon further evaluation, the medical team confirmed a diagnosis of advanced gastric cancer. Instead of proceeding directly to surgery, the treatment plan included four cycles of neoadjuvant chemotherapy. Following this approach, the tumor showed signs of regression, allowing for a successful radical gastrectomy. Post-surgery, the patient continued with adjuvant chemotherapy. The combined treatment strategy resulted in complete tumor removal, with no signs of recurrence or metastasis during follow-up.
Patient Profile: Male, 45 years old
Type of Disease: Advanced Gastric Cancer
Hospital: Zhongnan Hospital of Wuhan University
Date of Treatment: April 2021
Treatment Plan: Neoadjuvant chemotherapy (fluorouracil, oxaliplatin) followed by radical gastrectomy and postoperative chemotherapy
Treatment Duration: Four cycles of pre-surgery chemotherapy, 12 days of hospitalization, six cycles of postoperative chemotherapy, and regular follow-up visits
Treatment Outcome: Successful tumor removal with no recurrence or metastasis observed
Initial Consultation and Diagnosis
Mr. Xiao, a 45-year-old male, reported experiencing high work-related stress and irregular eating habits in recent months. Three days before his visit, he began suffering from nausea, stomach pain, and acid reflux, which progressively worsened. He came to the hospital seeking relief. During the physical examination, his vital signs were stable, and while his abdomen was soft and without palpable masses, there was noticeable tenderness in the gastric area. Blood tests showed no significant abnormalities, ruling out infection as the cause. However, tumor marker tests revealed elevated levels of CA72-4 and CEA, indicating the possible presence of cancer. A gastroscopy was recommended, and the patient agreed. The procedure revealed thickening of the gastric wall and a 2.8×1.9cm ulcer. Biopsy results confirmed adenocarcinoma, leading to a preliminary diagnosis of gastric cancer.
Development of the Treatment Plan
To better understand the stage and spread of the disease, a PET-CT scan was performed. The results showed irregular thickening of the gastric wall with increased FDG uptake, suggesting malignancy with serosal invasion. Additionally, three groups of enlarged lymph nodes were found in the abdominal cavity, indicating possible metastasis. Based on these findings, the cancer was classified as T3N2M0—Stage III gastric cancer. Given the advanced stage, immediate surgery was not recommended. Instead, a multidisciplinary team of oncologists and surgeons advised four cycles of neoadjuvant chemotherapy using fluorouracil and oxaliplatin to reduce tumor size and potentially downstage the cancer. After completing the chemotherapy regimen, tumor markers decreased and a follow-up CT scan showed tumor shrinkage and improved lymph node status. At this point, the patient was cleared for surgery, and a radical gastrectomy was successfully performed. He then underwent six additional cycles of adjuvant chemotherapy using the same drug regimen.
Response to Treatment
During the neoadjuvant chemotherapy phase, Mr. Xiao experienced only mild nausea and vomiting, with no severe side effects or bone marrow suppression. After four cycles, the tumor had visibly regressed, and lymph node involvement had improved, confirming the effectiveness of the treatment. He was then transferred to the surgical department and underwent a successful gastrectomy. He was discharged on the 12th day of hospitalization. During the six cycles of postoperative chemotherapy, his condition remained stable with good tolerance to the medications. Regular follow-up visits showed no abnormal test results, and there was no evidence of tumor recurrence or distant metastasis.
Post-Treatment Recommendations
As the patient's condition improved, I emphasized several lifestyle and health management strategies to support long-term recovery:
Adopt a light, easily digestible diet rich in protein and vitamins to meet daily nutritional needs.
Maintain emotional well-being and approach recovery with a positive mindset.
Monitor for any unusual symptoms and seek medical attention promptly if needed.
Attend regular follow-up appointments to monitor for potential side effects such as gastrointestinal discomfort or bone marrow suppression.
Clinical Insights and Reflections
In the past, advanced gastric cancer was often associated with poor surgical outcomes. However, modern oncology has introduced neoadjuvant chemotherapy as a valuable strategy to improve resectability and long-term survival. This case illustrates how a well-planned combination of chemotherapy and surgery can significantly benefit patients with Stage III gastric cancer. Mr. Xiao's successful outcome highlights the importance of a multidisciplinary approach and personalized treatment planning in managing complex cancer cases.