Sorry for taking so long to respond. I kept meaning to come back to gastric and lung cancer topics, but then would get sidetracked. Anyways, let’s talk about each individually.
Gastric Cancer is a very aggressive and fast growing cancer. Most people who have symptoms of gastric cancer are already in the advanced stages and are incurable. It is not standard practice to screen for gastric cancer and only about 25% of people with gastric cancer are eligible for surgical resection (meaning removal of the tumor). The single biggest determinate of developing gastric cancer is being infected with H. pylori. H. pylori is a bacteria which causes gastric ulcers and is more common in developing countries than in the USA or Europe. Although the incidence of gastric cancer has declined in the USA, it is still a common cancer, and reasonable for anyone to develop, including young men, with a rise in 25-39 year olds in recent decades.
The most common symptoms of gastric cancer are weight loss and mild, vague abdominal pain which gets progressively worse and more persistent with time. People will sometimes report that they don’t feel hungry or complain of nausea and difficulty swallowing. One of the earliest signs of gastric cancer is mild anemia (low red blood cell count), which a primary care provider (PCP) would notice during routine yearly blood work. However, anemia is nonspecific for cancer and not always concerning, so most providers won’t think to look for cancer.
Gastric cancer is diagnosed by CT or endoscopy (when a gastroenterologist puts a camera down your esophagus and looks into the stomach directly). During a endoscopy, the physician can also take a biopsy of the tumor, which is important for determining what type of tumor a patient has. Treatment for gastric cancer most commonly involves surgical removal of the tumor sometimes followed by chemotherapy. However, over 75% of patients are inoperable at time of diagnosis. At that point, we almost universally recommend hospice.
There are too many types of chemotherapy for gastric cancer to list, and most patients will receive a combination of different types individualized to them based on physician preferences and their tumor morphology. However, of note, some patients who have incurable gastric cancer are started on a chemotherapy called trastuzumab, because it can alleviate difficulty swallowing which is associated with gastric cancer and extend life after diagnosis by approximately 3 months. Which brings me to prognosis for gastric cancer: it’s bad. Most people will die within a year of diagnosis, some in less than 6 months. One common way people die is by aspiration pneumonia which is when a patient swallows food into their lungs and develops an infection.
Lung Cancer is the leading cause of cancer related deaths worldwide. Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancers and is associated with smoking. Smokers and other high-risk patients over the age of 50 are regularly screened for lung cancer with chest x-rays by PCPs.
The most common signs of lung cancer are cough, difficulty breathing, and chest pain, but many people with lung cancer also suffer from chronic lung diseases like COPD, so they may not realize anything out of their norm is happening. Coughing up blood is another, less common, sign of lung cancer, but is a red flag for PCPs to check for lung cancer. Although you can see tumors on X-ray, follow-up CTs are usually performed to see tumors dimensions and look for metastasis of the cancer to other areas of the body, which is very common. A bronchoscopy is a necessary diagnostic procedure in which a physician inserts a camera into the patient’s airway and take a sample (biopsy) of the lung tissue.
NSCLC is an incredibly fast growing tumor which usually will double in size over the course of 4-8 weeks. Treatment of lung cancer is surgeon removal, which offers the best chance of survival. As crazy as it sounds, people can actually have an entire lung removed and live with just one lung. Radiation therapy is the next choice for people who can’t be operated on, (usually stage II lung cancer). Chemotherapy and radiation is used for patients with stage III cancer and patients with stage IV are referred to hospice. Stage III patients are rarely candidates for surgery, but this depends on the patient’s baseline condition. Atezolizumab is the chemotherapy used most commonly for lung cancer and is given once every three weeks through a vascular access port, usually for a year.
Prognosis for lung cancer is very complex. It all depends on how early we catch the cancer. However, even with surgical removal of the tumor, recurrence and metastasis of lung cancer is still very common. If the “cancer comes back” it will usually be within the first year after surgery and median life expectancy after recurrence with 8 months.
Bottom line? Both these types of cancer are super sad and unpleasant, but I think you’re headed in the right direction with your symptoms. Just remember that as soon as someone starts experiencing the effects of these cancers, time is everything. These cancers aren’t like HCL. They will kill you within a year or less if not promptly treated.