Tumor board 소화기

Case C.C.) For anemia evaluation P.I.) 고혈압으로 본원 순환기내과 F/U 중인 자로 routine lab 상 Hb 13.1g/dL('08 년 4 월 ) ==> 10.9g/dL 감소 동반한 anemia 소견 확인되어 EGD & CFS 등 GI evaluation 위해 내원 PMHx.) DM/HTN/TB/Hepatitis(-/+/-/-) Medication : Aspirin 100mg Candesartan 8mg Amlodipine 5mg Personal history) Smoking (-) Alcohol : Social ( 소주 1 병 X 주 1 회 ) Family history ) None 김 O 기 (M/49) Adm via OPD

Case 1 Review of systems –Weight loss (-), Night sweating (-) –Epigastric pain (-) –A/N/V/D/C (-/-/-/-/-) –Hematemesis (-), Hematochezia (-), Melena (-) Physical examination V/S) 110/80 mmHg – 78/min – 20/min – 36.8 ℃ –Soft and flat abdomen –Abdomen Td/rTd/MG (-/-/-) –Normoactive bowel sound –No hepato-splenomegaly

Initial lab findings CBC/DC 6460/mm(55%) – 10.7 g/dL – 32.9% - 324k PT/INR 1.05 aPTT 13.7 PBS : RBC – Microcytic hypochromic, anisocytosis +1 Chesmistry –Prot/alb 7.20/4.2 TB/DB 0.52/0.20 mg/dL –AST/ALT 12/145 U/L ALP/γGT 52/34 U/L –BUN/Cr 8/0.8 mg/dL LDH 247 U/L –Na/K/Cl 141/4.1/104 mEq/L Uric acid 5.1 mg/dL Tumor marker –CEA/CA19-9 : 1.40ng/ml/5.9U/ml

Case 1 OP : Lap. Rt. Hemicolectomy ( )

Colonoscopy( )

OP : Lap. Rt. Hemicolectomy ( )

Pathology Biopsy at CFS Op. specimen

Ann Surg 2004;240:44-50

Treatment Plan Surgery `  Provide important prognostic information –Definitive staging –Chance for cure –Prevent complication (Bleeding, obstruction, perforation)

Leukemia & Lymphoma 2004;45:

5-year survival rate : 88.9% 5-year disease free survival rate 83.1% Leukemia Research 2007;31:

Treatment Plan Surgery  Provide important prognostic information –Definitive staging –Chance for cure –Prevent complication (Bleeding, obstruction, perforation)  Post-operative treatment? Surgery only? Combination Therapy –Systemic chemotherapy alone? –CT with RT? –R-CHOP x3 plus RT (45Gy) Vs extended CT (R-CHOP x8)

Case 2 C.C.) Epigatric pain P.I.) ‘10.5 stomach ca (AGC B4) 진단 후 본원 혈액종양 내과에서 FOLFOX #1(6/1~6/3) 시행받은 자로 내원일 오전부터 한차례 vomiting 과 동반된 Epigastric pain 으로 응급실 방문 PMHx.) DM/HTN/TB/Hepatitis(-/-/-/-) OP Hx(+) : '03.11 hystrectomy d/t mymoma Personal history) Smoking (-) Alcohol (-) Family history ) None 유 O 숙 (F/43) Adm via ER

Gastroscopy

Case 2 Review of systems –Fever/chill (-/-) Weight change (-) –Abdominal pain (+ : Epigastric & RUQ area) –A/N/V/D/C (-/-/+ : 복통과 함께 1 회 /-/-) –Hematemesis (-), Hematochezia (-), Melena (-) Physical examination V/S) 110/80 mmHg – 78/min – 20/min – 36.8 ℃ –Chronic ill-looking appearance –Soft and flat abdomen –Abdomen Td/rTd/MG (+ : Epigastric & RUQ area/-/-) –Murphy sign (+)

Initial lab findings CBC/DC 9410/mm(57%) – 13.1 g/dL – 38.9% - 124k PT/INR 1.03 aPTT 25.7 Chesmistry –Prot/alb 8.4/4.4 TB/DB 2.32/1.49 mg/dL  (0.9/0.2) –AST/ALT 38/46 U/L ALP/γGT 2097/457 U/L  (1479/97) –CRP 1.69 mg/dL Amylase/lipase 2600/1468U/L  (62/36) –BUN/Cr 9/0.7 mg/dL Na/K/Cl 141/5.1/104 mEq/L Tumor marker (‘ ) –CEA/CA19-9 : 25.9ng/ml / 2.0U/ml

Case 2

Abdomen CT ( )

Liver & pancreas US (6/14)

ERCP (6/14)

PTGBD (6/15)