20161013 Oncology D4 + Hospice D1

Morning meeting: liver cirrhosis

Hospice pre-exam

A story

MiniCEX

42M, ABC
oral ulcer
tissue proof
CT, bone scan, abd echo, CXR for staging (Head and neck staging system)
adjuvant CCRT for 2 months (CCRT or RT, CT has no role in adjuvant therapy)
          CCRT 適用於有ECS or positive margin after surgery
thyroid papillary cancer(popular): wait 6 months
disease progression: symptoms, examination
CT again,
use PET to prove because biopsy not feasible
recurrence staging 4a(可以開) 4b(不能開) 4c(?)
PEG creation + fluconazole
palliative treatment: RT not suitable(resistant), choose CT+target therapy

RECIST

PD=增加20%以上, progressive disease
SD介於PD~PR之間, stable disease
PR=減少30%以上, partial response

Morphine 

通常Q4H給以穩定baseline劑量 避免peak attack
口服 : SC : IV = 6 : 3 : 2
fentanyl 25ug/hr = 口服 60mg/day

腫六點

(1)Initial presentation
(2) Definite diagnosis
(3) Disease extend
(4) Effects/side effects of previous treatments
(5) Treatment plan
(6) Ongoing problems

TKI

(1) Gefitinib/Erlotinib: EXON19del
(2) Afitinib: EXON19del+Wildtype: 容易產生嚴重副作用
(3) Osimertinib: EXON10del+T790M
副作用: rash/diarrhea/hepatotoxicity/interstitial lung

Cisplatin

副作用: Nephrotoxicity/Neurotoxicity/Hearing loss/GI
唯carboplatin無腎毒性

5FU continuous injection

副作用: hepatoencephalopathy/消化道炎症
比較不會有骨髓抑制