Surgical Oncology: Day 10-11

Yesterday was 6a-6:30p, today was 6a-5p.

Yesterday was another clinic day. I saw the craziest case of breast cancer...this woman has 3 nipples and 4 breasts. I was definitely a little excited to see such a rare case, but once I got in with the patient and examined her, I immediately felt concerned. One nipple had retracted and dimpled, giving a so-called "cauliflower appearance". Near to that nipple, there was a reddish, shiny, blanchable, and growing spot on her skin. Behind the red spot and the nipple, there was a large, hard, immobile lump. Just upon examination, I could tell it was going to be cancer. So a biopsy was done of the 2 areas (the red lesion and the lump), and we are awaiting the results. She was a person that did not go to a family doctor regularly, did not get annual exams. She also, having such irregular anatomy, did not know the signs of what is irregular but not harmful versus what is irregular and alarming. I will be following her until my time on the oncology service finishes; I hope things turn out better than we anticipate. The thing is, she knew that something was going on with her breasts, but it took her over a year to make an appointment with a physician to get it looked at professionally. I pray that it is not too late, we will definitely offer her every opportunity we have available to us, let's just hope that the treatments are successful.

Today, I watched a right hepatic lobectomy on a patient with metastatic carcinoid. Carcinoid is a type of tumor that secretes serotonin, and causes symptoms such as flushing and diarrhea to occur as a result of the excess serotonin secretion. This patient had the primary carcinoid in the small intestine; I had met another patient with carcinoid, which had its primary in the ileo-cecal junction. In medical school, carcinoid is synonymous with a tumor of the appendix, which is the most common tumor of the appendix, but is not the most common place for the primary carcinoid tumor to develop. Anyway, the patient had radioablation to the liver mets previously, as well as a slight resection. So when we went in to try and resect half the liver, we met a lot of fibrous scar tissue that was adherent to the liver capsule and overlying muscle, fascia, fat and skin...so it was really difficult to mobilize the liver. After several hours, we finally got the liver free from adhesions, we microwaved it to transect the liver, and pulled out the right lobe. This should prolong the patient's life and the quality of life (it should lower the symptoms), but it is not a cure. Luckily, carcinoid is fairly slow-growing, so the prolongation of life should be quite significant.

Tomorrow is another day in the OR from dawn til dusk...1 more week left of surgical oncology then its off to a new hospital for a few weeks!! :)