Hematology-Oncology W1D2

Today we started out with Dr. Chen in the clinic seeing outpatients followed by rounds. We saw a total of 19 patients in a period of 3 hours. There were several cases of breast cancer, colon cancer, rectal cancer, gastric cancer and a few patients with anemia. The following are some cases that were interesting and illustrated the typical treatment plans for those types of cancers or disorders in Taiwan.

Case 1
48 year old female with left breast cancer HER2/neu 3+ (strongly positive in over expression) with liver and bone metastasis. The bone metastasis is in the mediastinal region near the sternoclavicular joints. The patient was treated with radiation therapy for the bone metastasis and was put on a chemotherapy regimen with Herceptin and paclitaxel. She is also receiving monthly treatments of Zometa, which is a bisphosphonate derivative used to decrease complications such as bone loss or bone pain produced by bone metastasis.
The patient was instructed not to consume any food products containing live cultures as they will irritate the intestinal lining and exacerbate the nausea caused by the chemotherapy. Dr. Chen mentioned that for breast cancer patients who are ER/PR negative and HER2 + the main course of treatment is chemotherapy (typically consisting of Herceptin and Paclitaxel); where as patients who are ER/PR positive, the main treatment is hormone therapy.    

Case 2
45 year old female with iron deficiency anemia. Pulse rate was 99 beats/min and she complained of dizziness also. Typical of iron deficiency anemia, she had low iron, increased TIBC and decreased ferritin. Dr. Chen said that IDA is pretty prevalent in females due to menstrual cycles. There is also about a 7% prevalence of Thalassemia in Taiwan so they need to first exclude that possibility as it is a more severe anemia than a simple IDA.
Dr. Chen gave the patient two treatment options: IV iron dextran or oral iron supplements. He explained that with IV iron dextran, it works quickly and requires a lot less number of treatments (iron levels stabilize within 2 weeks); whereas the oral form of the drug can take up to 2 months to raise iron levels. He recommends the IV treatment, but also warned the patients of possible side effects such as rash, shock, and hypersensitivity reactions.

Case 3 
72 year old male with rectal/sigmoidal cancer- T2/3 N1. This patient had a tumor that was difficult remove so he started with chemotherapy. He also received radiation therapy for the rectal sigmoidal region (It is possible to use radiation therapy because the rectum and sigmoid colon are not as mobile as compared to other sections of the colon). After radiation therapy, there is typically a 70-80% chance of tissue necrosis, which was observed in this patient. The patient's creatinin level was elevated, which may indicate kidney damage as a result of the chemotherapy. The treatment for that was a simple hydration therapy to help speed up the removal rate of the toxins.

It was a day packed with a lot of information and though I still couldn't quite understand all that Dr. Chen was trying to teach us, I felt I gained some important practical knowledge from the clinic. I also felt that I have a lot to work on with remembering drug names, cancer markers, and cancer presentations as I had some difficulty answering some of his questions.