Tuesday, June 17, 2014

One Case to struggle with...

A 60 year old smoker presents with Dysphagia, mid epigastric pain and weight loss
cutting through the chase, a work-up suggested an obstructing Adenocarcinoma of the G-E junction.
there was no local nodes or mets in the liver....The patient has a PEG for nutrition

WELL NOW WHY AM I INTRIGUED?

There is a palpable 2 cm Left retro-mandibular hard node, an additional node is in the vicinity with SUV 3
and the lung show small nodules (largest 0.5cm) in the Right lung

A PET scan showed the retromandibular adenopathy with an SUV of 15
but none of the lung lesion had an uptake to make my life difficult
there is suggestion of an uptake in the parotid although the SUV here is very low also
an asymetry of the base of the tongue did not pick-up PET dye

A biopsy of the retro-mandibular nodule is pending
A radiation input is also pending!

Now you tell me what chemotherapy to use
EOX, ECF  or Taxotere-Carbo

and please speak loudly back!
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