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AMPULLA

Ampulla of Vater adenocarcinoma,(W/D), pT3N1(3/15)M0, stage IIB (AJCC 7th), invade duodenal wall and pancreas, negative washing cytology s/p Whipple and feeding jejunostomy on ___/___/___, LVI+, perineural invasion -, post op complicated with gastroparesis, UGIB

• LNs (3/15 totally): positive for metastasis [3/15 (peri-tumoral LN: 2/5, peripancreatic LN: 1/3, perigastric LN: 0/3, CBD LN: 0/1, SMA LN: 0/1, LN8+9: 0/1, LN12P: 0/1, LN12A: 0/0)] with extracapsular spread.
• Initial presentation: ___
• Treatment plan: adjuvant chemotherapy will be started post op 4~6 weeks
• Feeding: jejunostomy tube ___/___/___
• Follow up parameter:
  • abdominal CT scan ( ___/___/___
  • and tumor marker

Explain on ___/___/___

• adjuvant_chemotherapy_purpose: to prolong disease-free survival and overall survival, and decrease the risk of recurrence and distant metastases, but not 100%.
• adjuvant_chemotherapy_regimen options:
  • 5FU_LV:
    • regimen: “5FU D1-D5 (425mg/m2) IV, LV (20mg/m2) Q4W for 6 cycles”
  • gemcitabine: (out-of-pocket)
    • regimen: “Self-paid gemcitabine 1000mg/m2 IVF 30 min QW for 3 weeks on, 1 week off for 6 cycles”
    • mortality_reduction: “Reduce risk of mortality by 30%“

treatment_start_considerations

• admission_arrangement: “Consider start treatment, arrange admission for 5FU D1-D5 (425mg/m2) IV, LV (20mg/m2), check lab and tumor marker.”
  • assessments before chemotherapy:
    • Vascular
    • Nutritional