Info
CRC, sigmoid colon cancer, ? cm AAV (M/D) adenocarcinoma, s/p ? on 2016/00/00, pT3N2b(9/26)M1 with liver mets, RAS wild type
- Initial presentation: stool OB positive on 2014 but neglected, bloody stool since 2016/5~
- Treatment plan: palliative chemotherapy
- Follow up parameter: abdominal CT scan, and sigmoidoscope, CEA and CA199 if elevated
- 2017/00/00: The purpose of palliative chemotherapy is to control disease and prolong life and maintain quality of life but not cure. Possible late complication, if without treatment or progression despite treatment was told. i.e. liver mets progression, then jaundice, BTI, altered mentation… even life threatening hepatic failure… i.e. lung mets progression, then cough, dyspnea, infection… even life threatening respiratory failure…
- 2017/00/00 Explain palliative chemotherapy treatment options. Sequential lines of treatment to maximize efficacy/minimize toxicity of each line treatment to control disease for as long as possible. Explained choices of adding target agent including to increase the response of chemotherapy. But the effect might last months only. Regimens such as avastin (NHI reimbused in 1st line oly)+ FOLFIRI in KRAS mutation/wild type or cetuzimab (NHI reimbursed in 1st and 3rd line only) + FOLFIRI in RAS wild type only. Chemotherapy will be started postop 4~6 weeks. @ consult NS for port A implantation @ Start palliatve chemotherapy, explain treatment options, after discussion, patient prefer ? discuss next time @ Apply for avastin, add >6 weeks from surgery @ Arrange admission on for #1 FOLFIRI treatment and check lab (90% dose reduction and omit 5FU bolus) on ? @ Check RAS, HER2-neu, BRAF, and MSI status @ Check UGT1A1 (3ml in EDTA) for irinotecan. @ vascular assessment, nutritional assessment, dental assessment before chemotherapy, pharmacist education