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The stomach is positioned in the upper belly and is essential for food digestion. When food is ingested, it travels down the esophagus, a muscular tube that connects the throat to the stomach. The food then enters the stomach. The stomach mixes the food and secretes gastric secretions that aid in the breakdown and digestion of the food. The food is subsequently digested further in the small intestine.
STOMACH CANCER TYPES
Stomach cancer, also known as gastric cancer, develops when healthy cells in the stomach become aberrant and proliferate uncontrollably. A tumor might be malignant or noncancerous. A malignant tumor is one that can grow and spread to other regions of the body. A benign tumor is one that can develop but does not spread. Cancer can start anywhere in the stomach. It can also spread to surrounding lymph nodes and other organs, including the liver, bones, lungs, and ovaries in women.
Adenocarcinoma is the most common type of stomach cancer. This indicates that the cancer began in the glandular tissue that lines the interior of the stomach. Lymphoma, gastric sarcoma, and neuroendocrine tumors are rare kinds of malignant tumors that originate in the stomach.
SYMPTOMS AND SIGNS OF STOMACH CANCER
Stomach cancer is rarely detected at an early stage since it frequently lacks particular symptoms. When symptoms do appear, they can be ambiguous and include the ones described below. It is crucial to remember that similar symptoms can be caused by a variety of other conditions, including a stomach infection or an ulcer.
- Heartburn or indigestion
- Abdominal pain or discomfort.
- Vomiting and nausea, particularly vomiting up solid meals quickly after eating.
- Constipation or diarrhea.
- Stomach bloating after eating.
- Appetite loss.
- While eating, the sensation of food becoming caught in the throat.
Advanced stomach cancer symptoms may include:
- Weakness and exhaustion
- Vomiting blood or passing blood in one's feces.
- Unknown cause of weight reduction.
Please with your doctor if you are concerned about any changes you are experiencing. In addition to other questions, your doctor will inquire as to how long and how frequently you have been experiencing the symptom(s). This is done to assist in determining the cause of the condition, which is referred to as a diagnosis.
STAGES OF STOMACH CANCER
Staging describes where the cancer is present, whether or not it has spread, and whether or not it is impacting other sections of the body. Doctors utilize diagnostic tests to determine the stage of cancer, therefore staging may not be complete until all of the tests are completed. Knowing the stage assists the doctor in determining the best course of treatment and can help estimate a patient's prognosis, or possibility of recovery.
Distinct forms of cancer have different stage descriptions. The staging of adenocarcinoma, the most frequent kind of stomach cancer, is covered in this section. Gastric lymphoma, sarcoma, and neuroendocrine tumors are staged differently.
TNM system of staging
The TNM system is one technique that clinicians use to describe the stage. Doctors use diagnostic test and scan results to address the following questions:
Tumor(T): How far into the stomach wall has the initial tumor spread?
Node(N): Has the cancer spread to your lymph nodes? If so, where are they and how many are there?
Metastasis(M): Is the cancer in other parts of the body?
The results are aggregated to establish each person's cancer stage. There are five stages: stage 0 (zero), stages I through IV, and level V. (1 through 4). The stage provides a common language for doctors to describe the cancer so that they can collaborate to determine the best treatments.
More information on each component of the TNM system for stomach cancer can be found below:
The "T" plus a letter or number (0 to 4) in the TNM system is used to represent how far the tumor has progressed into the stomach wall. The size of a tumor is measured in millimeters (cm). A centimeter is approximately the width of a normal pen or pencil.
Stages can also be subdivided into smaller groups to assist define the tumor in greater depth. The following information about tumor stages is provided:
TX: The primary tumor is inoperable.
T0: There is no evidence of a primary stomach tumor.
Tis: This stage refers to a condition known as carcinoma (cancer) in situ. The cancer has only been identified in cells on the surface of the stomach's inner lining, known as the epithelium, and has not migrated to any other layers of the stomach.
T1: The tumor has spread to the stomach's lamina propria, muscularis mucosae, or submucosa, which are the inner layers of the stomach wall.
- T1a: The tumor has spread to the lamina propria or the muscularis mucosae.
- T1b: The tumor has infiltrated the submucosa.
T2: The tumor has spread into the muscularis propria, the stomach's muscle layer.
T3: The tumor has spread through all of the muscle layers and into the connective tissue outside the stomach. It has not spread to the lining of the abdomen, known as the peritoneal lining, or to the serosa, the stomach's outer layer.
T4: The tumor has spread through all of the muscle layers and into the connective tissue outside the stomach. It has also spread to the peritoneal lining, the serosa, and the organs that surround the stomach.
- T4a: The tumor has encroached on the serosa.
- T4b: The tumor has spread to the organs that surround the stomach.
Node (N)
The “N” in the TNM staging system is for lymph nodes. These small, bean-shaped organs help fight infection. Lymph nodes inside the abdomen are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. The overall prognosis for patients with stomach cancer is based on how many regional lymph nodes show signs of cancer. If 2 or fewer have cancer, the prognosis is better than if more than 3 to 6 or 7 or more lymph nodes contain cancer cells.
NX: Regional lymph nodes cannot be evaluated.
N0: The cancer has not spread to the regional lymph nodes.
N1: Cancer has spread to one or two regional lymph nodes.
N2: Cancer has progressed to three to six regional lymph nodes.
N3: Cancer has spread to at least seven regional lymph nodes.
- N3a: Cancer has progressed to seven to fifteen regional lymph nodes.
- N3b: Cancer has progressed to at least 16 regional lymph nodes.
Metastasis (M)
The letter "M" in the TNM system indicates if the cancer has moved to other parts of the body, a condition known as distant metastasis.
MX: It is impossible to assess distant metastases.
M0: The cancer has not spread to the rest of the body.
M1: Cancer has spread to another portion of the body or sections of the body.
Cancer stage grouping
Doctors determine the cancer stage by integrating the T, N, and M classifications.
Stage 0: This is sometimes referred to as cancer in situ. The cancer is exclusively located on the epithelium's surface. The cancer has not spread to the stomach's other layers. This is a stage of cancer that is thought to be in its early stages (Tis, N0, M0).
Stage IA: The cancer has spread to the inner layer of the stomach wall. There has been no metastasis to lymph nodes or other organs (T1, N0, M0).
Stage IB: In either of these two circumstances, stomach cancer is referred to as stage IB:
- The cancer has spread to the inner layers of the stomach wall. It has progressed to one or two lymph nodes but not further (T1, N1, M0).
- The cancer has spread to the outer muscle layers of the stomach wall. It hasn't spread to the lymph nodes or any other organs yet (T2, N0, M0).
Stage IIA: Stomach cancer is classified as stage IIA if any of the following criteria exist:
- The cancer has spread to the inner layer of the stomach wall. It has spread to 3 to 6 lymph nodes but not to the rest of the body (T1, N2, M0).
- The cancer has spread to the outer muscle layers of the stomach wall. It has progressed to one or two lymph nodes but not further (T2, N1, M0).
- The cancer has spread across all of the muscle layers and into the connective tissue outside the stomach. It has not spread to any lymph nodes or nearby organs, nor has it developed into the peritoneal lining or serosa (T3, N0, M0).
Stage IIB: Stomach cancer is classified as stage IIB if any of the following criteria exist:
- The cancer has spread to the inner layers of the stomach wall. It has spread to 7 to 15 lymph nodes but not to the rest of the body. (T1, N3a, and M0).
- The cancer has spread to the stomach's outer muscle layers. It has spread to 3 to 6 lymph nodes but not to the rest of the body (T2, N2, M0).
- The cancer has spread through all of the muscle layers and into the connective tissue outside the stomach, but not into the peritoneal lining or serosa. It has progressed to one or two lymph nodes but not further (T3, N1, M0).
- The cancer has spread across all of the muscle layers and into the connective tissue outside the stomach. It has spread to the peritoneal lining or serosa, but not to the lymph nodes or adjacent organs (T4a, N0, M0).
Stage IIIA: Stomach cancer is classified as stage IIIA if any of the following criteria exist:
- The cancer has spread to the stomach wall's outer muscle layers. It has spread to 7 to 15 lymph nodes but not to the rest of the body (T2, N3a, M0).
- The cancer has spread through all of the muscle layers and into the connective tissue outside the stomach, but not into the peritoneal lining or serosa. It has progressed to three to six lymph nodes but has not migrated to other organs (T3, N2, M0).
- The cancer has spread across all of the muscle layers and into the connective tissue outside the stomach. It has expanded to 1 to 2 lymph nodes and has developed into the peritoneal lining or serosa, but not to other organs (T4a, N1, M0).
- The cancer has spread across all of the muscle layers, into the connective tissue outside the stomach, and into neighboring organs or structures. It has not spread to lymph nodes or other regions of the body (T4b, N0, M0).
Stage IIIB: Stomach cancer is classified as stage IIIB if any of the following criteria exist:
- The cancer has spread to the inner layer of the stomach wall or to the outer muscle layers of the stomach wall. It has spread to at least 16 lymph nodes but not to other regions of the body (T1 or T2, N3b, M0).
- The cancer has spread through all of the muscle layers and into the connective tissue outside the stomach, but not into the peritoneal lining or serosa. It has expanded to 7 to 15 lymph nodes but has not infiltrated any nearby organs (T3, N3a, M0).
- The cancer has spread through all of the muscle layers, into the connective tissue outside the stomach, and into the peritoneal lining, or serosa. It has progressed to 7 to 15 lymph nodes but not further (T4a, N3a, M0).
- The cancer has spread across all of the muscle layers, into the connective tissue outside the stomach, and into neighboring organs or structures. It may or may not have spread to 1 to 6 lymph nodes, but it did not migrate to other regions of the body (T4b, N1 or N2, M0).
Stage IIIC: Stomach cancer is classified as stage IIIC if any of the following criteria exist:
- The cancer has spread through all of the muscle layers and into the connective tissue outside the stomach, and it may have spread to the peritoneal lining or serosa. It has spread to at least 16 lymph nodes but not to other regions of the body (T3 or T4a, N3b, M0).
- The cancer has spread across all of the muscle layers, into the connective tissue outside the stomach, and into neighboring organs or structures. It has progressed to at least seven lymph nodes but has not moved to other regions of the body (T4b, N3a or N3b, M0).
Stage IV: Stage IV stomach cancer is defined as a cancer of any size that has spread to other sections of the body in addition to the stomach area (any T, any N, M1).
Recurrent cancer: Cancer that returns after therapy is referred to as recurrent cancer. It could be a limited recurrence, which means it has returned to the same location where it began. It could also be a distant metastasis, which means it has returned in another section of the body. If the cancer returns, more tests will be performed to determine the degree of the recurrence. These tests and scans are frequently identical to those performed at the time of the first diagnosis.
Japanese system of staging
Stomach cancer is far more common in Japan and other Asian and South American countries than in the United States. In Japan, stomach cancer is staged differently dependent on where the cancerous lymph nodes are positioned around the stomach. This differs from the US approach, which counts the number of lymph nodes rather than their location.
The Japanese system can be used to describe stomach cancer surgery. The type of surgery is distinguished by the removal of lymph nodes in addition to the stomach.
D0: There were no lymph nodes removed.
D1: The lymph nodes near the stomach were removed.
D2: Lymph nodes were removed from a larger area.
DIAGNOSIS OF STOMACH CANCER
Many tests are used by doctors to detect or diagnose cancer. They also perform tests to see whether the cancer has spread to another place of the body from where it began. This is referred as as metastasis. Imaging tests, for example, can reveal whether or not the cancer has spread. Images of the inside of the body are produced via imaging tests. Doctors may also conduct tests to determine which treatments are most likely to be effective.
A biopsy is the only guaranteed way for a doctor to know if a part of the body has cancer in most cases of cancer. During a biopsy, the doctor extracts a small sample of tissue for laboratory testing. If a biopsy is not possible, the doctor may recommend alternative tests to aid in the diagnosis.
This section discusses the many methods for diagnosing stomach cancer. Not all of the tests described below will be administered to every individual. When selecting a diagnostic test, your doctor may take the following variables into account:
- The type of cancer that is suspected.
- Your symptoms and signs.
- Your age, as well as your overall health.
- The outcomes of previous medical tests.
The following tests, in addition to a physical examination, may be used to identify stomach cancer:
Biopsy: A biopsy is the removal of a small sample of tissue for microscopic examination. Other tests can indicate the presence of cancer, but only a biopsy can provide a definitive diagnosis. The material is next examined by a pathologist (s). A pathologist is a medical professional who specializes in interpreting laboratory tests and assessing cells, tissues, and organs to identify disease.
Endoscopy: An endoscopy allows the doctor to view within the body using a gastroscope or endoscope, which is a narrow, illuminated, flexible tube. As the tube is introduced via the mouth, down the esophagus, and into the stomach and small bowel, the patient may be sedated. Sedation is the administration of drugs in order to become more relaxed, tranquil, or sleepy. During an endoscopy, the doctor can take a biopsy of tissue and examine it for symptoms of cancer.
Endoscopic ultrasound: This procedure is similar to an endoscopy, except that the gastroscope has a small ultrasonic probe on the end. An ultrasound creates a picture of the interior organs by using sound waves. An ultrasound scan of the stomach wall can help doctors identify how far the cancer has gone into the stomach and adjacent lymph nodes, tissue, and organs like the liver or adrenal glands.
X-ray: An x-ray is a technique that uses a small amount of radiation to create a picture of the structures inside the body.
Barium swallow: A barium swallow is a procedure in which a person drinks a liquid containing barium and then undergoes a series of x-rays. Because barium coats the lining of the esophagus, stomach, and intestines, tumors and other abnormalities are more visible on x-ray.
Molecular tumor testing: Your doctor may advise you to undertake laboratory testing on a tumor sample to discover specific genes, proteins, and other tumor-specific components. The results of these tests can help you decide on a treatment plan.
In the case of stomach cancer, testing for PD-L1 and high microsatellite instability (MSI-H), also known as a mismatch repair deficit, may be performed. Testing can also be done to see if the tumor is producing too much of a protein called human epidermal growth factor receptor 2 (HER2), which is especially important if the disease is progressed. The findings of these tests assist doctors in determining if immunotherapy is a viable therapeutic option.
Computed tomography (CT or CAT) scan: A CT scan uses x-rays captured from various angles to create images of the inside of the body. A computer combines these images to create a detailed, three-dimensional image that identifies any anomalies or malignancies. A CT scan can be performed to determine the size of the tumor. To improve image detail, a specific dye known as a contrast medium is sometimes administered before to the scan. This dye is typically administered as a beverage to be swallowed as well as an injection into a patient's vein.
Positron emission tomography (PET) or PET-CT scan: A PET scan is frequently coupled with a CT scan (see above), resulting in a PET-CT scan. However, your doctor may refer to this technique simply as a PET scan. A PET scan is a technique for creating images of organs and tissues within the body. A radioactive sugar compound is put into the patient's body in modest amounts. This sugar molecule is absorbed by the cells that consume the most energy. Cancer absorbs more radioactive stuff because it aggressively uses energy. The material is then detected by a scanner, which produces images of the inside of the body.
Magnetic resonance imaging (MRI): An MRI produces detailed images of the body by using magnetic fields rather than x-rays. The tumor's size can be determined via an MRI. To provide a crisper image, a special dye known as a contrast medium is administered before to the scan. Typically, this dye is injected into a patient's vein.
Laparoscopy: A laparoscopy is a small surgical procedure in which the physician inserts a thin, illuminated, flexible tube known as a laparoscope into the abdominal cavity. It is used to determine whether the cancer has progressed to the lining of the abdomen or the liver. Cancer that has progressed to these locations is frequently undetected by a CT or PET scan.
TREATMENT OF STOMACH CANCER
Different types of specialists frequently collaborate in cancer care to develop a patient's overall treatment plan, which mixes many sorts of therapy. This is referred to as a multidisciplinary team. This team may include the following doctors for stomach cancer:
Gastroenterologist: a physician who specializes in the digestive tract, especially the stomach and intestines
Surgeon or surgical oncologist: a surgeon who specializes in the surgical treatment of cancer
Medical oncologist: a physician who specializes in the use of drugs to treat cancer
Radiation oncologist: a physician who specializes in cancer radiation therapy
Pathologist: a physician who specializes in the interpretation of laboratory tests and the evaluation of cells, tissues, and organs in order to diagnose disease
Radiologist: a physician who specializes in the use of imaging technologies to diagnose disease
Other health care professionals on cancer care teams include physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others.
Surgery, radiation treatment, chemotherapy, targeted therapy, or immunotherapy can all be used to treat stomach cancer. The following are descriptions of the most prevalent types of stomach cancer therapies. Treatment for symptoms and side effects, which is an important element of cancer care, may also be part of your treatment plan.
The type and stage of cancer, potential side effects, and the patient's preferences and overall health all influence treatment options and recommendations. To treat stomach cancer, a combination of therapy is frequently employed. Stomach cancer can be difficult to treat since it is typically not discovered until it has progressed to an advanced stage.
Take the time to learn about all of your treatment options, and don't be afraid to ask clarifying questions. Discuss the aims of each treatment with your doctor, as well as what you can expect during treatment. These discussions are known as "shared decision making." When you and your doctors collaborate to choose therapies that meet the goals of your care, this is referred to as shared decision making. Because there are various treatment choices for stomach cancer, shared decision making is especially crucial.
Surgery
During a surgery, the tumor and some healthy tissue surrounding it are removed. The sort of surgery done is determined by the stage of the cancer.
Some clinicians may prescribe an endoscopic mucosal excision for very early stage (T1a) malignancy. This is the removal of the tumor using an endoscope.
When the cancer is in its early stages (stages 0 or I), surgery is utilized to remove the cancerous portion of the stomach as well as any adjacent lymph nodes. This is known as a subtotal or partial gastrectomy. In a partial gastrectomy, the surgeon joins the remaining portion of the stomach to the esophagus or small intestine.
If the cancer has spread to the outside stomach wall, whether or not it has migrated to the lymph nodes, surgery, chemotherapy, or radiation therapy may be employed. A partial gastrectomy or a total gastrectomy, which involves the removal of the entire stomach, can be performed by the surgeon. During a total gastrectomy, the surgeon connects the esophagus to the small intestine directly.
Gastrectomy is a major surgical procedure that might have substantial side effects. Following this procedure, the patient will be able to eat only a limited amount of food at a time. A typical adverse effect is "dumping syndrome," a collection of symptoms that includes cramps, nausea, diarrhea, and disorientation after eating. This occurs when food enters the small intestine too quickly. The doctor can advise you on how to avoid this and provide medicine to assist regulate your symptoms. The symptoms normally subside or fade after a few months, but for some people, they may be persistent. Patients who have had their entire stomach removed may require vitamin B12 injections on a regular basis since they may no longer be able to absorb this important vitamin through their stomach. Before undergoing surgery, consult with your health care team about the potential adverse effects of the procedure.
Because the cancer may have migrated to those lymph nodes, regional lymph nodes are frequently removed during surgery. This is known as a lymphadenectomy. The number of lymph nodes that should be excised is currently being debated. More lymph nodes are removed in Europe, particularly in Japan, than in the United States.
When cancer is discovered in Stage IV, surgery is usually not advised as the primary treatment. Other forms of treatment will be suggested instead.
Radiation therapy
The use of high-energy x-rays or other particles to eliminate cancer cells is known as radiation therapy. A radiation therapy regimen, or schedule, typically consists of a predetermined number of treatments administered over a predetermined time period. External-beam radiation treatment, which delivers radiation from a machine outside the body, is commonly used to treat stomach cancer. Radiation therapy can be performed either before or after surgery to diminish the size of the tumor or to eradicate any leftover cancer cells.
Radiation therapy side effects include fatigue, moderate skin responses, upset stomach, and loose bowel motions. The majority of negative effects fade quickly after treatment is completed. Discuss with your radiation oncologist the potential side effects you may face as well as your recovery time.
Chemotherapy
Chemotherapy is the use of medications to eradicate cancer cells, typically by preventing the cancer cells from growing, dividing, and proliferating.
A chemotherapy regimen, or schedule, typically consists of a predetermined number of cycles administered over a predetermined time period. A patient may be administered one medicine at a time or a mixture of drugs at the same time.
Chemotherapy can be used to kill cancer that remains after surgery, limit tumor development, or alleviate cancer-related symptoms. It can also be used in conjunction with radiation therapy. There is currently no single standard chemotherapy treatment regimen that is used globally. However, the majority of chemotherapy therapies for stomach cancer are based on medication combinations such as:
- Cisplatina (available as a generic drug).
- The drug oxaliplatin (Eloxatin).
- Fluorouracil (fluorouracil) (5-FU, Efudex).
Other medicines that are utilized include:
- Capecitabine (Xeloda).
- Docetaxel (Taxotere).
- Epirubicin (Ellence).
- Irinotecan (Camptosar).
- Paclitaxel (Taxol).
Chemotherapy side effects vary depending on the individual and the dose used, but they can include exhaustion, infection risk, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These adverse effects normally fade away once the treatment is completed.
Immunotherapy
Immunotherapy, also known as biologic therapy, is intended to increase the body's natural defenses against cancer. It employs components created by the body or in a laboratory to enhance, target, or restore immune system activity.
When chemotherapy fails, pembrolizumab (Keytruda) may be an option for individuals with advanced stomach cancer who have PD-L1 or have MSI-H.
Different forms of immunotherapy might result in a variety of adverse effects. Skin rashes, flu-like symptoms, diarrhea, and weight fluctuations are all common adverse effects. Consult your doctor about the potential adverse effects of the immunotherapy that has been prescribed for you.
Targeted therapy
Targeted therapy is a type of cancer treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This method of treatment inhibits cancer cell growth and spread while limiting damage to healthy cells.
The targets of all cancers are not the same. Your doctor may order tests to determine the genes, proteins, and other variables in your tumor in order to find the most effective treatment. This enables clinicians to provide the most effective treatment to each patient whenever possible. Furthermore, research studies are continuing to learn more about specific molecular targets and new treatments aimed at them.
Targeted therapy for stomach cancer comprises the following treatments:
HER2-targeted therapy: Some tumors may produce an excessive amount of a protein known as human epidermal growth factor receptor 2. (HER2). This is referred to as "HER2-positive cancer." Trastuzumab (Herceptin, Herzuma, Ogivri, Ontruzant) in combination with chemotherapy may be an option for patients with advanced HER2-positive stomach cancer.
Anti-angiogenesis therapy: Anti-angiogenesis therapy aims to halt angiogenesis, or the process of forming new blood vessels. Because tumors require the nutrients given by blood vessels to develop and spread, anti-angiogenesis medicines aim to "starve" the tumor. The medicine ramucirumab (Cyramza) may be an additional option for people whose tumor has grown while taking first chemotherapy.
Discuss with your doctor the potential side effects of a certain medicine and how to manage them.
Metastatic stomach cancer
Doctors refer to cancer that has spread to another place of the body from where it began as metastatic cancer (also called "stage IV"). If this occurs, it is advisable to consult with specialists who have treated similar cases in the past. Different doctors may have differing views on the optimal conventional treatment strategy. Clinical trials are another possibility.
Because metastatic stomach cancer is not curable, the goal of treatment at this stage is primarily to extend a patient's life and manage cancer symptoms. Palliative therapy includes any treatment, including chemotherapy or radiation therapy. Surgery is rarely performed, and chemotherapy is usually the primary treatment. It's worth noting that studies demonstrate that using palliative chemotherapy for stomach cancer can improve both the duration and quality of life.
A diagnosis of metastatic cancer is extremely stressful and challenging for the majority of people. You and your family are encouraged to express your feelings to doctors, nurses, social workers, and other members of the health care team. It may also be beneficial to speak with other sufferers, such as through a support group.
Remission and the possibility of recovery
When cancer cannot be identified in the body and there are no symptoms, the patient is said to be in remission. This is often known as having "no evidence of illness," or NED.
Remission can be either temporary or permanent. Many people are concerned that the cancer will recur as a result of this uncertainty. While many remissions are durable, it is vital to discuss the potential of the cancer returning with your doctor. Understanding your recurrence risk and treatment options may make you feel more prepared if the cancer returns.
Recurrent cancer occurs when the cancer returns after the initial treatment. It may return in the same location (called a local recurrence), nearby (called a regional recurrence), or elsewhere (distant recurrence).
When this happens, a fresh round of testing begins to discover as much as possible about the recurrence. Following the completion of this testing, you and your doctor will discuss treatment choices. The treatments outlined above, such as surgery, chemotherapy, and radiation therapy, are frequently included in the treatment plan, but they may be administered in a different mix or given at a different pace. Your doctor may recommend that you participate in clinical studies that are looking for new ways to treat this sort of recurring cancer. Palliative care will be essential for reducing symptoms and side effects regardless of the treatment plan you choose.
People suffering from recurring cancer frequently experience emotions such as bewilderment or anxiety. You are urged to discuss these feelings with your health care provider and inquire about support options to assist you in coping.