Jonathan Go Week 2 Hematology/Oncology Day 4/5

     This post marks the end of our week in the Hematology/Oncology department with Dr. Chen.   All in all, we learned a lot about the specialty, about the universal healthcare system, and about Dr. Chen’s views on medicine and being a doctor.  As per my prior posts, I will first cover interesting cases and then cover things that I learned from the other cases.

     The first case is a 20 year old male with a desmoplastic small cell carcinoma in his abdomen resulting from a 11:22 translocation.  Although the patient is 20 years of age, he appeared to be significantly younger, which may be due to a failure to thrive.  Dr. Chen initially treated this tumor with chemotherapy; however, the tumor rapidly grew in response to therapy to the point where the abdomen was grossly distended.  Because of this, Dr. Chen switched his therapy to Pazapanib (which is currently in clinical trials).  This is a receptor tyrosine kinase inhibitor targeting VEGFR.  The medication worked very well and the tumor has shrunken greatly, although still palpable.  The treatment plan is to use Pazapanib to shrink the tumor until it is small enough to be resected.  

Some things I learned the last 2 days:

·       Dr. Chen told us to look up information about tumor cachexia:

o   Mediated by Il-1, Il-2, TNF-alpha, and IF-gamma which will lead to increased expression of transcription factors like NF-kB

§  This will lead to decreased muscle protein synthesis, muscle anabolism, and ubiquitination/degradation of proteins

o   Nutrition does not improve it and it is the main way it is differentiated from malnutrition (malnutrition gets better with proper nutrition)

o   Infliximab (TNF-alpha inhibitor) helps in 25% of the cases

o   It is a major cause of death amongst cancer patients

·       A woman had a partial resection of her breast.  Adjuvunct therapy is usually kept up 5 years past the resection to prevent recurrence.

·       A DVT will have lower leg edema extending up past the knee

·       When a patient gets a skin rash, apart from treating the etiology, the only two options for symptomatic treatment are antihistamines and steroids

·       Must always control an infection/fever before starting chemotherapy

·       Some words about medicine/national healthcare:

o   Certain services like a CT are only covered by the national healthcare system if the patient is admitted.

o   Government controls and limits treatments for patients

o   Doctors here seem to be undercompensated (I heard an IM doctor makes around 60k but this is only from word of mouth)

§  Taipei Times actually says that doctors make only around 91k NTD a month which is only approximately 36k USD a year.  I am not sure if this figure is right, but according to the paper, this is still more than professional athletes in Taiwan.

o   Some words of wisdom from Dr. Chen:  Taking notes will allow you to objectively analyze information which will lead to better patient outcomes.  Always take good notes.