Case Studies From the Network for Oncology Communication
and Research
Mark Pegram, MD
A 58-year-old postmenopausal attorney develops
a 3 cm infiltrating ductal cancer of the left breast. She is treated
with lumpectomy and axillary lymphadenectomy. The tumor is found
to be poorly differentiated, aneuploid, ER 0%, PR 0%, and HER-2
positive by FISH. One of 12 axillary nodes is found to be positive.
Two years after completion of adjuvant chemotherapy with AC and
radiation therapy, she develops multiple symptomatic bone metastases
and
bilateral pulmonary nodules….
Andrew Seidman, MD
A 57-year-old postmenopausal advertising executive
is diagnosed with a 5 cm infiltrating lobular carcinoma of the
right breast. She is treated with modified radical mastectomy and
immediate TRAM reconstruction. Pathology reveals a tumor that is
poorly differentiated, ER 0%, PR 0%, and FISH negative. Seven of
20 lymph nodes are positive. She receives adjuvant TAC (docetaxel,
doxorubicin, cyclophosphamide) for six cycles. Twelve months following
completion of her chemotherapy, she develops metastatic disease
involving an ipsilateral
supraclavicular node, has small (less than 1.5 cm) bilateral pulmonary nodules,
and three space-occupying lesions
involving the right lobe of the liver…
Robert Fine, MD
A 58-year-old police sergeant presents with epigastric
pain, fatigue, and a 10lb weight loss over the past two months.
CT scan of the abdomen reveals a 4 cm mass in the body of the pancreas
and three hypodense lesions in the liver. Needle biopsy of the
liver reveals poorly differentiated adenocarcinoma consistent with
a pancreatic primary. CA-19-9
is markedly elevated…
John Kavanaugh, MD
A 47-year-old chemist is diagnosed with stage
III ovarian cancer. TAH, BSO, omentectomy, and tumor debulking
are performed. At the conclusion of surgery there is extensive
peritoneal involvement and the largest residual tumor mass is 2.5
cm. She receives Carboplatin and Taxol for six cycles and achieves
a complete remission. Nine months after completing treatment, she
presents
with abdominal pain and ascites…
Joan Schiller, MD
A 50-year-old NASA flight director has a three-month
history of a cough with occasional blood-tinged sputum, which prompts
a medical visit. A chest x-ray reveals a 5 cm mass in the left
lower lobe. CT scan of the chest reveals mediastinal adenopathy.
Bronchoscopic biopsy of the left lower lobe lesion
reveals poorly differentiated large cell
carcinoma. CT scan of the abdomen
reveals four hypodense lesions involving
the right lobe of the liver along with a
right adrenal mass. CT-directed liver
biopsy confirms metastatic disease…
David Ilson, MD
A 64-year-old bus driver presents with a three-month
history of fatigue, early satiety, epigastric pain, and a 7 kg
weight loss over the past three months. Over the past two weeks,
he has noted intermittent nausea and occasional hiccups, but no
vomiting, black tarry stool, or bloody bowel movements. CBC and
biochemical profile are within normal limits, with the exception
of a mildly elevated alkaline phosphatase. CT of the abdomen reveals
a distal gastric mass, enlarged upper abdominal lymph nodes, and
multiple liver metastases involving both the right and left lobes,
with the largest measuring 3 cm. Upper endoscopy confirms a mass
in the gastric antrum…
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