My best friend, my little bro has stage 4 cancer

by Gia
(PA)

My little brother is 33 years old and was just diagnosed two weeks ago with stage 4 stomach cancer (poorly differentiated adenocarcinoma). He is in otherwise in good health. I don't understand why he has been given a 4% chance of survival. His cancer has only metastasized to one lymph node outside the stomach. The oncologist has not given my brother much hope but is still going to treat him as if it's stage 3 cancer and curable. They are going to give him 8 weeks of chemotherapy and then radiation. And if survives all that then maybe he will have stomach removal. I understand statistics are against us but since the cancer has not spread to any other organs yet why is the prognosis still so grim?

Peters Reply - Hi Gia, sorry to hear about your brother’s stomach cancer. He is very young to have developed this condition. It’s possible there maybe a genetic reason for this and you can read more about heredity gastric cancer in the prognosis section of this website. You and other family members may need to be tested for the cadherin 1 gene mutation to check for your risk of developing this condition.

As for the grim prognosis, we know that this condition needs to be picked up early. His oncologist is right in being honest with him about the current stage and prognosis for his stomach cancer. Any spread of the disease to lymph glands or beyond carries a worse prognosis because it’s spread. There are likely to be something called micrometastasis present. This is where single cancer cells spread, but are undetectable at this stage on any scans or tests that we currently have available to us. An enlarged gland shows that this has been infiltrated by lots of cancer cells (although there are other reasons for enlarged lymph glands, but assumptions have to be made when doing the staging of these tumours. Stomach cancer does respond to chemotherapy, but after a while it can stop working. This is for many different reasons, but the important thing is to achieve a window in which your brothers treatment can become curative.

If your brothers chemotherapy is successful (and we are all rooting for him), when his stomach is removed, the surgeon will remove the surrounding lymph glands. These will be analysed in the lab for cancer involvement. They will also be able to test his tissue to see if he carries the CDH1 gene which is the cause for hereditary diffuse gastric cancer.

If you have any further questions or concerns, do let me know. I am sure you will find lot’s of information and advice helpful on this site. Also if you have time (and I know how difficult that is when you are providing support for your brother), do keep us informed of your his progress as we will all be thinking of him as well as you and your family. I would just like to wish your brother well on his current journey.

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