Info

🌱 來自: inpatient oncology

prompt of inpatient oncology

Goal: Be like oncologist, summarize the provided information by following formate, with markdown title h2 each points

• 1. patient info (age, gender, past history)
• 2. cancer type(Anatomical, Histologic),
• 3. cancer grade(high, intermediate, or low),
• 4. cancer stage(TNM)
• 5. genetic mutations,
• 6. disease course and aim of treatment, first points will be ”- Initial presentation (YYYY-MM-DD): ” for each course or event, start with date formate as ”- (YYYY-MM-DD):”, in bullets points
• 7. reason for hospitalization

informations:

  Miss Wu is → a 51 year-old lady with medical history of mitral valve prolapse, hypertension and hyperlipidemia under medications and monitory. Additionally, she has had ovarian cancer s/p hysterectomy and left oophorectomy in 2005. She initial presented of tenesmus, small -caliber stools for six months. then → she was diagnosed with sigmoid colon adenocarcinoma (M/D) s/p lap. AR on 2018/6/29, pT3N1(3/15) s/p mFOLFOX6 x12(2018/12/18-2019/02/14), with liver metastasis s/p Lap. Lateral segmentectomy+ S5+ S7 hepatectomy+ hilium LN dissection on 2020/04/16, s/p mFOLFOX6(II) x12(2020/05/27~2020/12/07), with liver metastases recurrent at ↣ left lobe s/p laparoscopic left lobectomy+ cholecystectomy + LN biopsy(2022/01/04), s/p Xeloda x5(2022/02~05), with multiple liver mets s/p Avastin/FOLFORI x12(2022/07/06~12/15) then → Xeloda(II)x3(2023/01/05~2023/03/19). Mainly of the above chemotherapy side effect is → 5-FU related skin pigmentation.

   In early April. 2023, she presented appetite decreasing, general malaise and fever accompanied with acute hyperbilirubinemia caused generalize icteric. Blood draw showed leukocytosis and empirical antibiotic ceftriaxone was administrated for favor cholangitis. CT scan on 4/11 revealed liver metastases progression with IHD dilatation. Tumor compression of common hepatic duct was suspected. Though we informed the resolve choice might be PTCD or ERBD, but she hesitated and decided to have targeted combined chemotherapy. Thus, attending physician planned her treatment as dose adjusted Avastin/FOLFIRI(II) (Irinotecan 125 mg/m2, 5FU 1000 mg/m2 2 days, leucovorin 400 mg/m2, maintain Avastin at ↣ 5 mg/kg), started on 2023/04/12. The bilirubin level declined after cycle 1.

    The last CT scan disclosed stable disease on 2023/06/28. The schedule chemotherapy arranged on 2023/07/17 but she defer because of personal reasons. In the recent 2 weeks, she developed progressive decrease appetite, nausea, vomiting, epigastric region tenderness followed with yellowish skin change,  tea color urine, gray-colored stool as well as asymptomatic fever (Tmax 38.2℃).

    Today, she was admitted for schedule chemotherapy but hyperbilirubinemia was note. According to the above symptoms, suspended chemotherapy and arrange admitted patient for further assessment.