From Dr. Strong
At Memorial Sloan-Kettering, we operate on more than 100 patients with gastric (stomach) cancer each year.
The team approach is the key aspect of gastric cancer treatment at Memorial Sloan-Kettering. From our dedicated gastrointestinal cancer pathologists, who review each patient's slides; to our radiology specialists who review imaging studies, specifically looking for cancer sites that may affect treatment; to our talented and experienced gastroenterologists, who evaluate hundreds of patients with stomach cancer each year and are of critical importance in assessing the stage of the cancer -- our specialized team allows us to come up with the best plan to treat patients with the goal of cure.
Caring for Allen Wang
Mr. Allen Wang was quite stunned by the news of his diagnosis of gastric cancer. He naturally wanted to move forward as quickly as possible to treat his cancer. He was an otherwise healthy man who had not had many prior abdominal surgeries. These factors made him a good candidate for a minimally invasive, laparoscopic approach to stomach cancer surgery.
Mr. Wang responded well to his surgery and recovered without difficulties. His response to treatment was typical and what we normally see for patients who undergo this type of surgery.
Mr. Wang, like many of the cancer patients we see at Memorial Sloan-Kettering, had a strong and positive outlook that helped tremendously. The process of testing and then treatment can be rigorous. But when the patient knows that there is a whole team working toward the goal of cure -- all of whom share the knowledge of how to achieve this goal -- then it is all worth it.
His long-term prognosis is excellent, and although the term "cure" must be used carefully, it is likely that he has been cured. He will, however, be watched carefully through visits with me and periodic testing to monitor that the cancer does not come back.
Working at a place like Memorial Sloan-Kettering is a privilege and it is clear that the patients are very special and expect the very best from their physicians. It is a wonderful feeling to know you have helped a cancer patient through a part of their treatment and that you may have helped cure them. The hope is to allow people to return to normal life as soon as possible. Patients like Mr. Wang are the reason I enjoy my profession so much, and I hope for his continued health and happiness.
From Dr. Meng
Dr. Strong referred Allen Wang to us for consideration of adjuvant chemotherapy to try to reduce the risk of recurrence of his stomach cancer. We examined the pathology report completed shortly after surgery to get clues if he was at risk for recurrence. Fortunately, the report showed that all of Mr. Wang's lymph nodes were negative. The only "high-risk" feature of his cancer was the size of his tumor, a T3. Size for stomach tumors is classified from T1 (smallest) to T4 (largest).
Based on the tumor size and the fact that he was a relatively young patient, we advised that Allen have the standard regimen following stomach cancer surgery, which consists of a combination of 5FU chemotherapy and radiation therapy. This regimen was developed as a result of clinical studies conducted by Memorial Sloan-Kettering medical oncologist David Kelsen.
Mr. Wang, however, was adamant about not receiving any type of chemotherapy, which he considers to be toxic and unhealthy for his body. Certainly, if he had positive lymph nodes, I would have pressed more strongly for adjuvant chemotherapy. (We've found that patients with positive lymph nodes seem to have the greatest benefit from adjuvant chemotherapy.)
The bottom line is that we try to work with the patient to understand why we might recommend additional treatment, but ultimately, it is the patient's decision. Adjuvant treatment is intended to help improve the cure rate to eradicate any microscopic disease, but there is no 100-percent guarantee that a person receiving adjuvant therapy will be cured. We can guide patients to try and make informed decisions -- based on their own values and principles -- and if reasonable, we should abide by them.
