Oncology Day One - Viet

My preceptor for this rotation is Dr. Hsu. From 9-10:30am I attended a meeting about nasopharyngeal carcinoma (npc)...

In almost 100% of NPC cases, the Epstein Barr Virus is found and is used as an indicator of how much the cancer has progressed. TNM staging is used to describe the tumor.

T1 = less than 2cm
T2 = greater than 2cm, less than 4cm
T3 = greater than 4 cm
T4 = progressed to neighboring regions

The top three causes of NPC are: smoking, betel nut, and alcohol. Treatment plan for NPC is usually CCRT (Concurrent Chemoradiotherapy).

Dr. Hsu briefly talked about his research. He is currently trying to elucidate the structure of the androgen receptor. In prostate cancer, the cancer cells require the androgen receptor for uptake of growth factors. His work then, has important implications for the future of prostate cancer treatment and prevention.

From 11-12:00pm Dr. Hsu showed me the charts and lab results of his patients. He had 17 patients and about 15 were terminally ill. All that could be done for them is pain management.

From 12:00pm-12:30pm I attended rounds with Dr. Hsu.
Notes from 4 patients:

Patient 1
- Recurrent tumor
- Segmental = 90%, Myelocyte = 0.5 (Mature, Chronic process)
- Had bone metastasis, L5 destruction, Leg pain
- CT scan showed many tumors in the lung fields
- Treatment included Erbitux + Chemo + Morphone pain management

Patient 2
- Squamous cell carcinoma of the Tonsil
- Metastasis to pelvis
- Need to treat with morphine.
- Hopice care, patiend has poor prognosis

Patient 3
- Esophageal cancer
- Dysphagia (47kg very thin!!)
- Must recover body weight first
- CT scan shows tumor obstruction in the middle to lower 1/3
- Tumor obstruction created a fistula and pused the trachea to the side.
- A Jejunum tube was used.
- Broncosopy shows bumps but still smooth.
- Bone scan is negative.

Patient 4
- 30yo female was diagnosed with NPC 2 yrs ago and refused treatment
- She is a non-smoker so tumor was caused naturally
- The tumor is now malignant and has metastasized to the bone and liver.

From 1:30-2:30pm I was pimped along side 4 interns.