Case Oncology 1

7/26/2019 Case Oncology 1

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1

1. Subjective data Objective data

- Subjective data

65

CC : Non small cell lung cancer stage IV with bone andliver metastasis """#

FH : "$%""&'("$&"'

SH : )%&*+(""$, *" 1 , !" 1 ,

-*"."

- Objective data

65#5 $g * 166 cm (ECOG 1)

H%I : 1/8/57 (/ 1 &- &'(&"'

("0&ltrosound : 'ulti(le h)(o*h)(erchoic lesion !*5

cm at right lateral nec$ + l)m(homa re-er

./50 Fine Needle io(s) 2+ight cervical

l)m(h node 1/563 In4ammator) cell C+:

+ight hilar mass with right u((er lung atelectasis

%: C7N 8 at right u((er 9ugular

1"/50 C chest* ; cm +&7 mass encasing +&7 bronchus


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about ! cm distal to carina multi(le

mediastinal and i(silateral su(erior hilar

l)m(hadeno(ath) * vidence o- obstructive

(neumonia +&7

15/50 C+ : +ight u((er lung mass with

in


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6 hrs be-ore (aclitael

!. ,a$ 1;" min be-ore (acitael

!#1 Beamethasone !" mg IV !#! Chlor(heniramine 1 am(IV !#; +anitidine 5" mg IV !#E ndansetron / mg IV;# ,a$ ;" min be-ore carbo(latin ;#1 ndansetron 16 mg 8deamethasone

/ mg in NSS 5" cc IV dri( 15mins ;#! +anitidine 5" mg IV

Che'!thara"$ Order1. ,a$ 1 %aclita&el 'g/'in 5B

5""cc IV dri( in ; hours 2useglass s)ring, s(ecial IV set3

!# +ecord % D 15 min E whenstarting and then D ;" min ! i-stable ma) o= record

E. ,a$ Carb!"lati 0C 5in

5B !"" cc IV in ! hours5# >-ter com(letion o- Carbo(latin,give B5N!

1""" cc IV /"*1"" cchr

!# me(raGole2!"mg3Sig# 1 ca( (o B ac

;# 7oraGe(am 21mg3Sig 1 tab % hs

E# %aracetamol25""mg3Sig 1 tab oral (rn -orm)algia or arthralgia

5# 'etoclo(ramide

Sig 1 tab oral tid ac

!'e 'edicati!1# 'V 1! (c!# 'etoclo(ramide21"31; ac;# 7oraGe(am213 11 hs2# me(raGole2!"3 11

ac

Lab *Hb 11, Hct ;; C .,"""

%latelet !5",""" Neutro(hil 6" Scr "#6


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.

&""#- %alliative care &0-"$

"$" ""&" 1$&0%230%

3. !" #$%&

""$&%3$"&"&

* %er-ormance status : C@ J ! 2" C@ 13

* Com(lete blood count

1# +C K HbK1", HctK;" 2" Hb 11,Hct ;;3

!# C K CK;,""", >NCK1,5"" 2"C .,""", >NC 5,E""3

;# %lateletK (latelet K1"",""" 2 " %lt !5","""3

"*"&"""#&

2. '! (&

)# &' NSC7C stage IV with bone and liver

metastasis cell t)(e 1 !-#4ua'!u# cell

(ade!carci!'a)(>7? rearrangement 1$ @F+

negative ""#&$*-

* Boublet chemothera() 2%latinum based3 "-


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evaciGumab 8 chemothera() 6 c)cle

ir#t-lie1

*"""# "1 ""#

&$*-

Carbo(latin >&C 5*6 da)1 D !1 d 1$ %aclitael !""mgm!da)1 D !1 d

""#"&$*&-"

0" 1$""-*&&$

*

E6cac$ '!it!rig

"$&%"10""$&,4$&"', "*

""# "&-/!&icit$ '!it!rig

* Carbo(latin : nauseavomiting, m)elosu((resion,


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alo(ecia

* %aclitael : h)(ersensitivit), m)elosu((ression,

brad)cardia, h)(otension

5. (*)$+)% (

$,()')

""$&%&*&*

" "&%"-*& 0 carbo(latin

&*;"*."L 2moderate emetic ris$3

*(aclitael

&* M ;"L 2low emetic ris$3 /"

1 moderate emetic ris$

,a$ 1 ,a$ -3%alonosetron "#!5 mg IV

Beamethasone 1! mg IV%

Beamethasone / mg % B

,5*H; antagonist 21st

gen3e# ndansetron

Beamethasone 1! mg IV%

5*H; antagonist 21stgen3 e#

ndansetron ,Beamethasone / mg % B

$"er#e#itivit$ "aclita&el- Beamethasone !" mg ; dose KK 1! hr be-ore, 6

hr be-ore and " hr be-ore (aclitael

* H1 and H! antagonist use be-ore (aclitael

. '-$%%))%

1# "&"

!# 0&00

;# "#*$"1$1 "


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/*%&"-&"** &'("%

E# ""$""* *$1$"$(4("

1$+&'* "&'". "-"* ""$.1""$$"-*& *

1$* &- -$ !*; %"

5# *&"%%&* &'

1*&**$ &0 "- -* & 1

1040

7. ' %'!

"!&.,

" ",/ % &"'""0 cre(itation 1$ chest *

ra) 0inNCM5"" cellmm; 2E""3 ,/&&264%%7"

&' +ebrile eutr!"eia(1%&-"$

&% (" 1$ chest *ra) & (neumonia &-"$&%&* '>SCC

criteria10 $1 ,/ high ris$ "

"#/""#1 1$IV antibiotics

E'"iric treat'et# (&1# Ce-e(ime ! g IV D / hr -or 1E*!1 da)s or until


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neutro(enia resolves

!# Vancom)cin !*; gd IV -or 1E*!1 da)s

1. Subjective !bjective data

9 Subjective data

8%6!


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CC : ""%%7&'("$&"'&"

&

FH : "$%""&'("$&"'SH : )%&*+(""$ *" -*"

Objective data

H%I : 1"/56:"$&-155 "

""$ mammogram 0

&,'ammogram : mass at le-t breast siGe 1*!

cm 2I+>BS 5315/56 Core needle bio(s) : Invasive ductal

carcinoma!.56 7e-t breast lum(ectom) with sentinel

l)m(h node and aillae) l)m(h node

dissection :* Invasive ductal carcinoma grade II

* umor siGe 1#5 cm

* Free surgical margin

* Sentinel 7N bio(s) : (ositive metastasis ;

out o- 5 nodes

* >illar) 7N dissection : (ositive

metastasis 1 out o- !" nodesStaning : + staining /"L, %+ staining "L, ?i*

60 !5L, H+! IHC ;815.56 C chest include u((er abdominal

* No lung mass or in


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%h)sical eamination :

60 $g * 165 ,#@> : > woman loo$ed well, good conscious,

C@ "VS : %1!"/", ;0#" AC, H+ 0" b(m, ++ !1

t(mHN : Not (ale, no 9aundice, Cervical 7N

negativeCVS : %'I at 5th ICS in 'C7, normal S1S!, no

murmurChest : surger) lesion at le-t breast

2lum(ectom)37ung : Clear>bdominal : so-t, not tender, 7"S", s(leen

dullness negative7ab :

Hb 1!#" Hct ;5C 0,"""

%lt ;"",""" Neutro(hil 5" Scr "#0

.

&""# - tend li-e &0--

/

3. !)" #$%& ""$&%3$"&"&

* %er-ormance status : C@ J ! 2" C@ "3* Com(lete blood count

1# +C K HbK1", HctK;" 2" Hb 1!,Hct ;53


11/14

!# C K CK;,""", >NCK1,5"" 2"C 0,""", >NC ;,5""3

;# %lateletK (latelet K1"",""" 2 " %lt ;"","""3

"*"&"""#&

2. '! (&

))% ""%%7&' breast cancer %

Invasive ductal carcinoma 2IBC3( 7e-t breastlum(ectom) with sentinel l)m(h node and aillar)

l)m(h node dissection( tumor - 1#5 ,#

"$&-"%&2& ! 1$metastasis organ -. "$&%N' staging

0 stage II> 21c, N1, '"3

hormone status 0 + (ositive ,P1L 2 /"L3, %g+ negative, P!"L

2"L3 1$ ?I*60 * 5 !"L 2!5L3 " H+! (ositive

"$&% (rognosis St# @allen criteria

7uminal ""# 1Surger) ,/ """#1,

+adiation 1$ S)stemic treatment 2Conventional

chemothera(), Hormonal thera() 1$argeted thera()3


12/14

""#&$* 1$""$(4-

+adiation 1$ S)stemic thera()

1. Radiati! * standard 5" @) in !5 -ractions. S$#te'ic thera"$Conventional chemothera()8 Hormonal thera() 8

argeted thera() *"1$- >C Q E D ; w$ -ollowed b) %aclitael 8 trastuGumab

Q1! wee$l) then trastuGumab -or 1 )r and >Is -or 5

)r* Boorubicin 6" mgm! IV da)1* C)clo(hos(hamide 6"" mgm!IV da)1

: c$cle +!r 1 da$(3 ;


13/14

brad)cardia, h)(otension

E# rastuGumab : In-usion related e=ect, cardiac toicit),

interstitial (neumonitis

5. (*)$+)% (

$,()')

""$&%&*&*

" "&%"-*& 0

""Boorubicin8 c)clo(hos(hamide

&*."L 2High ris$3 ""

,a$ 1 ,a$ -2=-1 atag!i#t

>((re(itant 1!5 mg %

"-

Fosa(re(itant 15" mg IV5- 3 atag!i#t

1stgen B "- %alonosetron "#!5 mg IV

B

,e&a'etha#!e

1! mg IV%

!" mg IV% 2 N?*13

=-1 atag!i#t

>(re(itant /" mg B!*;

,e&a'etha#!e

/ mg % B!*E 2-or

a(re(itant3 / mg % B! then / mg bid

B;*E

2-or -osa(re(itant 3

/ mg bid 2w" N?*13

$"er#e#itivit$ ' %aclita&el- Beamethasone !" mg ; dose KK 1! hr be-ore, 6

hr be-ore and " hr be-ore (aclitael

* H1 and H! antagonist use be-ore (aclitael


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e'!rrhagic c$#titi#

H)dration : IV 1#5 R ! 7d "- oral !*; 7d

$ee( urine out(ut K 1""mlhr 2!#E 7d3

. '-$%%))%

1# *&"0/"$*4"

!# "$%""&%" &-&*

3$"$ ;# """ *"-(0

&0-

E# 0&00 % &"

Case Oncology 1

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