PADLET 3 TUMOR BOARD DISCUSSION ON PATIENT A AND B - PROGNOSIS AND TREATMENT.PATIENT A :STAGE : Early (T1aN0M0);HER 2 : Negative; PATHOLOGIST :well differentiated; Lesion confined to mucosa, well-differentiated criteria for early gastric cancer (EGC). No lymphovascular invasion noted. ONCOLOGIST OPINION : Endoscopic mucosal resection → Surveillance .ONCOSURGEON :Surgery not required. PATIENT B: STAGE III :Advanced T3N2M1; PATHOLOGIST : HER 2 Neu :Positive (3+)Poorly differentiatedPoorly differentiated carcinoma with strong HER2 expression. No signet-ring cells. ONCOLOGIST OPINION : Trastuzumab + chemo ;ONCOSURGEON : Palliative only if obstructive by Dharma Saranya

Case discussion for treatment regarding gastric cancer

2025-07-02 14:41:04 UTC

1. What is early gastric cancer? Why is EMR appropriate for Patient A but not for Patient B?

Early Gastric Cancer (EGC):

Defined as cancer confined to the mucosa or submucosa, regardless of lymph node status.

Usually T1a or T1b stage.

Why EMR is appropriate for Patient A:

T1a stage → tumor limited to mucosa.

Well-differentiated, no lymphovascular invasion → low risk of spread.

HER2-negative, so no need for systemic HER2-targeted therapy.

EMR is minimally invasive and avoids unnecessary gastrectomy.

Why EMR is not suitable for Patient B:

T3N2M1 → tumor has invaded beyond muscularis propria + distant metastasis.

Poorly differentiated, higher risk of spread.

Not localized → EMR not curative in this stage.

Needs systemic therapy, not local endoscopic treatment.

2. Why is surgery not considered as an option for Patient B?

Stage III advanced cancer (T3N2M1) with distant metastasis (M1).

Curative surgery is not effective in metastatic disease.

Patient already has significant tumor burden.

Focus is on systemic therapy (trastuzumab + chemo).

Surgery reserved only for palliation, e.g., in case of gastric outlet obstruction or bleeding.

3. If Patient B were HER2-negative, will the systemic therapy plan change or can you still use Trastuzumab?

Yes, the systemic therapy plan would change.

Trastuzumab is a HER2-targeted monoclonal antibody. It is only effective in HER2-positive tumors. If HER2-negative, Trastuzumab would not be used.

The patient would instead receive standard chemotherapy regimens like:

ECF (Epirubicin, Cisp

latin, 5-FU)

FOLFOX (5-FU, Leucovorin, Oxaliplatin)

2025-07-02 14:44:17 UTC

Early gastric cancer is carcinoma confined to mucosa and submucosa of stomach regardless of presence or absence of lymphnode metastases. EMR is suitable for patient A because tumor is limited to mucosal layer,small, well differentiated without lymphovascular invasion while in patient B metastases is present so it is not appropriate
Patient B has locally advanced and metastatic gastric cancer so surgery is not curative, if needed palliative surgery for symptomatic relief can be done.
Trastuzumab can be used only in Her 2 positive cancer, here if it is Her 2 negative alternative chemotherapy regimens like platinum based agents can be used

2025-07-02 15:15:16 UTC

1 Early gastric cancer is defined as carcinoma confined to mucosa and submucosa of stomach irrespective of lymph node metastasis

EMR suitable for patient A because it is limited to mucosa and well differentiated

and without lymphovascular invasion but in patient B metastasis is present so EMR is not appropriate

2 patient B has stage 3 (T3 N2 M1) advanced cancer with distant metastasis so surgery is not preferred

If needed palliative surgery can be done

3 If patient is Her2 negative systematic plan therapy will change like ECF regimen(epirubicin,cisplatin,5 fluorouracil)Since trastuzumab is Her2 targeted monoclonal antibody

reagustheinvictus — 2025-07-06 01:46:57 UTC

Early gastric carcinoma: cancer limited to mucosa and submucosa with or without lymph node involvement, it can be superficial, protruding or excavated
Why EMR for patient A: because tumor confined to mucosa and no lymph node spread and no metastasis
Why EMR not for patient B : in T3 involve subserosa, lymph node and metastasis involved, so no use in EMR ( EMR is nothing but resection of mucosa)
Why surgery is not considered for patient B

Presence of distant metastasis, stage 4 ( m1), poorly differentiated tumor are factor for not suitable for surgery, palliative surgery - symptomatic relief ( any obstruction)

If patient B were HER 2 negative, therapy will change or still use trastuzumab
Trastuzumab - works by targets HER2 PROTEIN receptor on cancer cells, if negative means no use of trastuzumab
HER 2 negative: fluoropyrimidine + platinum + Docetaxel.