Linitis plastica is a rare and aggressive form of stomach cancer characterized by a thickening and stiffening of the stomach wall. This condition presents significant challenges in diagnosis and treatment, often leading to a poor prognosis. This article discusses linitis plastica’s nature, progression, complications, and end-of-life care considerations.
Understanding Linitis Plastica
Linitis plastica is a subtype of diffuse gastric cancer, often associated with signet ring cell carcinoma. These cancer cells infiltrate the stomach wall, leading to a rigid, non-distensible organ, often described as having a “leather bottle” appearance. This differs from more common stomach cancers that form localized masses.
Early diagnosis is difficult because initial symptoms are often non-specific, and the cancer primarily affects the submucosal layer, often sparing the superficial mucosal layer. Diagnostic methods include endoscopy with multiple biopsies, which can be challenging due to deep infiltration. Imaging techniques like CT scans, PET scans, and endoscopic ultrasound (EUS) are also used to identify wall thickening and assess disease extent.
How the Disease Progresses and Its Complications
The progression of linitis plastica is marked by thickening and stiffening of the stomach wall. This rigidity prevents the stomach from expanding to hold food or contracting to move it into the intestines. This leads to several complications.
Nutritional impairment is a significant complication. Patients experience difficulty eating, leading to early satiety even after small amounts of food. This results in severe weight loss, malnutrition, and dehydration. The stomach’s reduced capacity and impaired emptying can also cause frequent and sometimes bloody vomiting.
The stiffening can also lead to obstruction, particularly at the stomach outlet (pyloric stenosis), which further exacerbates vomiting and prevents food from passing into the digestive tract. As the disease advances, cancer cells can spread to other organs, such as the peritoneum, liver, and lungs, a process known as metastasis. This spread can cause organ dysfunction and failure, leading to a decline in health. Managing pain becomes an increasing concern as the disease progresses and involves surrounding tissues and organs.
Prognosis and Life Expectancy
Linitis plastica is known for its aggressive nature and poor prognosis. The median overall survival for patients is around 6 to 14 months, particularly in advanced stages. One-year survival rates are low, reported at 33%, and five-year survival rates are even lower, 5% to 29%, even after surgical interventions.
This outlook is due to the cancer’s aggressive biological behavior and challenges in early diagnosis. It often presents at an advanced stage, making curative treatments difficult. Factors influencing prognosis include the disease stage at diagnosis, extent of metastasis, and the patient’s overall health. Complete surgical resection, when feasible, can improve survival, but this is often not possible due to the widespread nature of the disease at diagnosis.
End-of-Life Care and Support
When curative treatments are no longer effective or desired, palliative care becomes central to managing linitis plastica. This approach focuses on improving the patient’s quality of life by addressing distressing symptoms rather than attempting to cure the disease.
Symptom management is a primary focus, including strategies to alleviate pain, nausea, vomiting, and fatigue. Nutritional support is also a significant concern, given the severe weight loss and difficulty eating. This might involve liquid diets or, if appropriate for comfort, feeding tubes. Emotional and psychological support for both the patient and their family is also provided, helping to address anxiety, depression, and grief associated with the illness.
Hospice care offers specialized support during the final stages of the disease, emphasizing comfort, dignity, and quality of life. Hospice services can be provided at home, in dedicated hospice centers, or in other healthcare settings. Advance care planning is also an important aspect, encouraging patients to discuss and document their wishes for future medical care, ensuring their preferences are respected as the disease progresses.