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Adcon Admitting Conference PowerPoint Presentation

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Description : This is about a patient with a stage IV Gastroesphageal Adenocarcinoma that is poorly differentiated.

Tags : Oncology

Published on : Sep 15, 2020 | Views : 1964 | Downloads : 0

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Admitting Conference By Moses Isaiah Koh
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Identifying Data Patient N.P. 52/M Married, Roman Catholic, Filipino Gastroesophageal Carcinoma; Poorly differentiated s/p Feeding Jejunostomy (10.02.19)Cerebrovascular S/p 3rd Cycle of FOLFOX 4 (11.11.19) 5th admission in UERM
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Chief Complaint Difficulty of swallowing ??
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History of Present Illness Admitted 4 months PTC swallowing solids that progressed to liquids vomiting of previously ingested foods after eating Sought consult and was diagnosed with Tonsillopharyngitis Given unrecalled antibiotics which provided no relief
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3 months prior Symptoms persisted Associated with weight loss of 10kg Constipation Prompted consult and underwent endoscopy Fungating mass at GE Junction CT Scan Bone islands vs metastasis at left femoral head andd vertebral bodies
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In the interim, Symptoms persisted, 2 months PTA First cycle of FOLFOX 4 and Underwent insertion of feeding jejunostomy 1 month PTA Second cycle of FOLFOX 4 and was subsequently discharged 2 weeks PTA 3rd cycle of FOLFOX 4 and was subsequently discharged
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Review of Systems
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Past Medical History MAJOR ILLNESSES Gastroesophageal Carcinoma; Poorly Differentiated (2019) SURGERIES s/p Feeding Jejunostomy (10.02.19) ALLERGIES No known allergies to any food or medication
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Unremarkable Smoker (40 pack years) Alcohol beverage drinker averaging 4 bottles per day Denies illicit drug use Family History Social History
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Physical Examination
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Salient Features Patient is a 52/M known case of gastroesophageal carcinoma; Poorly Differentiated, s/p Feeding Jejunostomy (10.02.19), S/p 3rd Cycle of FOLFOX 4 (11.11.19), This is his fifth admission in UERM. Patient complains of difficulty of swallowing History: Previously admitted for treatment with FOLFOX 4 Past Medical History: Gastroesophageal carcinoma; Poorly Differentiated, s/p Feeding Jejunostomy (10.02.19) Family History: Unremarkable Previous smoker and previous heavy drinker
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Differential Diagnosis Achalasia Most commonly presents with dysphagia, regurgitation Barium Swallow: Bird’s Beak Sign Esophageal Leiomyoma Causes dysphagia Weight loss Muscle wasting Barium: Smooth concave mass underlying intact mucosa Endoscopy: Mobile submucosal masses
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Working Impression Gastroesophageal Carcinoma; Poorly differentiated, s/p Feeding Jejunostomy (10.02.19), S/p 3rd Cycle of FOLFOX 4 (11.11.19)
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Diagnostics CBC Chest X-ray Serum Electrolytes CT Scan EUS Biopsy
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Laboratories
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Chest X-Ray Clear lung fields True cardiac size cannot be ascertained Aorta is unremarkable Other chest structures are not remarkable
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Gastroesophageal Carcinoma; Poorly differentiated Alcohol Smoking Nitrosamine GERD Male Obesity Red meat Zinc deficiency Folate deficiency Alcohol + Smoking + GERD+ Obesity  Barrett’s Esophagus  Metaplasia  Adenocarcinoma Mutation of TP53 gene Alcohol + Smoking  Cell damage  Inhibition of detoxification and promotion of oxidation Esophageal epithelium mutation Risk Factors Pathophysiology
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Signs and Symptoms Dysphagia Weight loss Bleeding Pain Hoarseness Persistent cough Respiratory symptos
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NCCN Staging- Tumor Size Tis- abnormal cells in esophagus. Could turn to cancer T1a- lump of cancer cells started growing on the esophagus. Tumor hasn’t grown far from the esophageal wall T1b- tumor has grown through the first layer of esophageal wall to the second layer T2- tumor has entered the third layer of the esophageal wall T3- tumor has reached the last and outermost layer of the esophageal wall T4a- tumor has grown through the esophageal wall and into the lining of nearby body parts T4b- means that the tumor has grown through the esophageal wall and into the nearby body parts
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NCCN Staging- Node NX- it is unknown if there are any lymph nodes with cancer N0- there are no nearby lymph nodes with cancer N1- 1-2 lymph nodes with cancer N2- 3-6 lymph nodes with cancer N3- 7 or more lymph nodes with cancer
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NCCN Staging- Metastasis MX- Uncertain if there’s a metastasis M0- There’s no metastasis M1- Cancer has spread to the blood stream and to other areas of the body
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NCCN Staging- Grade GX- Grade can’t be determined. Sample may not be big enough G1- Cancer cells look similar to healthy cells G2- Cancer cells somewhat different from healthy cells G3- Cancer cells barely look like healthy cells
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SQUAMOUS CELL CARCINOMA STAGE IVB The tumor is any size and in any location The cancer is in any number of lymph nodes The cancer has spread to areas of the body far from the esophagus
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Treatment Palliative FOLFOX 4 (Folinic Acid, 5-FU, Oxaliplatin)