Surgical Oncology: Day 13-14

Was in Saturday from 6-9:30, just doing rounds. My resident told me I didn't have to come in early when I was about to leave for the day...I could have slept in!! Shoulda told me sooner!! ;)

Today I was in from 6a-6p, and it was a full clinic day, which I love. I get to see so many different patients, and I am starting to feel more comfortable and relaxed with each encounter. I'm starting to enjoy sitting down and talking with the patient about his/her problem(s). It is so much fun to be able to give my advice on things, even if it's as simple as how to treat constipation and why each laxative is different, I am loving being able to give my opinions. I try to teach something to each patient...Since I learn so much from them, I think it's only fair to try and share some of my knowledge with them.

The types of patients I saw today include: Invasive breast cancer (invading the skin of the breast), colon cancer in a 50-something patient, carcinoid syndrome, liposarcoma, thyroid cancer, and a really REALLY rare case: a man with malignant pheochromocytoma of the organ of Zuckerkandl. The Organ of Zuckerkandl is a chromaffin body derived from embryonic neural crest tissue and is located at the bifurcation of the aorta at the origin of the inferior mesenteric artery. This little bit of tissue at the aortic bifurcation can become cancerous and release excess catecholamines into the blood stream. Catecholamines, such as Dopamine, Norepinephrine, and Epinephrine, are known as the "fight or flight hormones"...they cause increased heart rate, increased blood pressure, and increased blood glucose. In order to counter-act these effects, a patient is given an alpha-blocker, which blocks the alpha receptors from vasoconstricting, and thereby decreases the effects of the catecholamine release on blood pressure...In short, it keeps the blood pressure from rising too high. I palpated his umbilical region and felt the tumor; it was big enough to feel through the abdomen, even though the aorta is pretty much right on top of the spine. That was really cool. He's had this tumor for several years, and we are controlling its growth by inhibiting its ability to establish a bigger blood supply; We are suppressing angiogenesis ("growth of new blood vessels") by giving the patient a drug called Thalidomide. You might remember this drug in its relation to birth defects that it causes... It prevents the limb buds from developing fully, and children who were born to mothers who took thalidomide during pregnancy were born with deformed extremities...so we don't often see a patient on this drug, but it can still be very useful in certain situations (this patient is a great example).