ONCOLOGY CASE STUDIES
A 74-year-old man presents to the oncology infusion center 1 week after receiving an intravenous dose of enfortumab vedotin-ejfv. His right arm has a large erythema and blister. Can you make the correct diagnosis?
A patient with a history of HIV presents to the ED with a 3- to 4-week history of vomiting and testicle pain. Can you make the diagnosis?
The patient first noticed a firm, nontender, moveable hard mass while conducting a routine breast self-examination in the shower.
By: Paul Bowlin, MD; E. David Crawford, MD A 72-year-old male presents with fatigue and shortness of breath. On initial laboratory evaluation, he is found to have a hematocrit level of 55%. His past medical history is significant for hypertension, hyperlipidemia, coronary artery disease, and gastroesophageal reflux disease. Surgical history is only notable for cardiac…
By: C. Andrew Kistler, MD, PharmD, RPh A 63-year-old man presents to the hospital with a history of recurrent infections that include cellulitis, pneumonias, and upper respiratory tract infections. He reports subjective fevers at home along with unintentional weight loss and occasional night sweats. The patient has a remote history of arthritis, which was diagnosed…
By Sandra Cuellar, PharmD, BCOP A 63-year-old male is referred by his primary care physician for work-up of possible lung cancer. The patient has a history of shortness of breath and persistent cough (with no accompanying hemoptysis) and a chest x-ray is suspicious for malignancy. The patient has not experienced any weight loss. Past medical…
By Justin M. Watts, MD; Peter Maslak, MD; Martin S. Tallman, MD A 47-year-old woman presented for evaluation of pancytopenia. She had been diagnosed with papillary thyroid cancer 18 months earlier and underwent total thyroidectomy followed by radioiodine (I-131) ablation for nodal and small pulmonary metastases. Cumulative dose of radioactive iodine was 312 mCi. She…
By Barbara Ann Burtness, MD A 52-year-old man who lives in the Midwest presents with a lesion in his nose. He has an extensive history of sun exposure and a 35 pack-year smoking history. The patient sought attention from an otolaryngologist, who cultured the lesion in the right upper medial nasal vestibule but noted “no…
Chief Complaint AG, 64-year-old gentleman of Greek descent, presents with a 6-month history of rash that started on his upper extremities and now includes his lower extremities. Physical Examination • Rash apparent on arms and legs; it appears raised and red in color, and is more pronounced on his legs, which contains red and blue…
Byline: Sandra Cuellar Puri, PharmD, BCOP Chief Complaint During a routine follow-up visit, WM, a 48-year-old female, complains of ongoing fatigue since the beginning of cytotoxic chemotherapy, 6 months after initiating trastuzumab. Physical Exam • At 6 months following initiation of single-agent trastuzumab, a multigated acquisition (MUGA) scan revealed left ventricular ejection fraction (LVEF) dropped…
Chief Complaint MP is a 38-year-old woman who comes to the clinic with a temperature of 101F and complains of abdominal pain approximately 14 days after her last chemotherapy treatment. Results of Last Visit During her last appointment, MP denied fevers, chills, or other signs/symptoms of infection but, due to laboratory results, was initiated on…
Case Study: Chief Complaint M.T., a 59-year-old female patient with unresectable malignant gastric gastrointestinal stromal tumor (GIST) presents to discuss treatment options. Relevant Medical History Hypertension Depression Clinical Presentation/Laboratory Tests Diagnosed in 2015 when she experienced abdominal pain Tumor was KIT exon 9 mutation-positive She was initiated on imatinib 400 mg orally daily At 3…
Chief Complaint DC, a 54-year-old male diagnosed with multiple myeloma, develops a low grade fever and some mild diarrhea 10 days after receiving a successful autologous hematopoietic stem cell transplant (HSCT). Physical Exam • Low grade fevers persists for several days • All other vital signs remaining stable• His physical exam is benign with no…
This case study explores the clinical presentation and treatment plan for a man with stage 4 colon cancer with disease progression.
By Michael A. Maccini, MD, and E. David Crawford, MD Introduction Mr. G is an active 71 year old male referred to our second opinion clinic in June 2011 due to persistently elevated prostate-specific antigen (PSA) levels following robotic radical prostatectomy 2 months prior. Surgical pathology was notable for Gleason grade 4 + 3 =…
By C. Andrew Kistler, MD, PharmD, RPhChief Complaint 54 year old man presents to the emergency department with progressive right-sided facial swelling. He first noticed it approximately two months ago however more people in his family were commenting on it recently, therefore he decided to go to the emergency department. He denies dysphagia, new or…
Chief Complaint R.M. is a 58-year-old male recently diagnosed with stage IV pancreatic adenocarcinoma (Slide 1). He is a mechanical engineer and intends to continue to work from home during his treatment. He is 10 days from a stent placement for hyperbilirubinemia (Slide 2). Relevant Medical History • Hypertension • Diabetes (well-controlled) • Hypercholesterolemia •…
Chief Complaint J.W. is a 55-year-old woman recently admitted to the hospital for worsening shortness of breath (Slide 1). Relevant Medical History • Stage 4 estrogen receptor/progesterone receptor–positive breast cancer. Current Treatment Regimen • Nab-paclitaxel 100 mg/m2 on day 1, 8, and 15, repeated every 28 days. and denosumab every 28 days for her bone…
A 23-year-old patient with Hodgkin lymphoma was seen as an inpatient consultation for a pruritic rash that had been present for two days. The man was being treated with the ABVD chemotherapy regimen (doxorubicin, bleomycin, vinblastine, dacarbazine [DTIC-Dome]). Family history was noncontributory. A review of systems was negative for fevers but positive for chills and…
Author: Barbara Ann Burtness, MD Chief Complaint H.R. is a 70-year-old woman who presented to her dentist with a 2-year history of ill-fitting dentures and oral discomfort, and right-sided otalgia (Slide 1). Relevant History • H.R. experienced a 20lb weight loss, attributed to pain with eating.• Past medical history was notable for sarcoidosis and hypertension.•…
Byline: Sandra Cuellar Puri, PharmD, BCOP Chief Complaint E.O. is a 53-year-old African-American female who complains of mouth pain after 4 weeks of therapy with exemestane plus everolimus. Relevant Medical History • Recurrent metastatic estrogen receptor/progesterone receptor-positive, HER2/neu-negative breast cancer that has progressed• Cancer has metastasized to her bones (according to previous scans). • Eastern…
Author: Sandra Puri Cuellar, PharmD, BCOP Chief Complaint Upon laboratory testing, SL, a 64-year-old female diagnosed with Philadephia chromosome–positive (Ph+) ALL, was found to be anemic (Hgb=7 g/dL) (Slide 2) and neutropenic (ANC=600 cells/mcL) after her second course of maintenance therapy. Relevant Medical History • Currently, SL is taking vincristine, prednisone, methotrexate, and mercaptopurine (POMP)…
Byline: Alan A. Thomay, MD; Matthew T. Then, MD; and Jeffrey M. Farma, MD Chief Complaint H.G., a 72-year-old obese woman, presents with a 6-month history of infrequent upper abdominal pain and nausea, along with non-specific gastrointestinal symptoms. Relevant Medical History • Hypertension• Four uncomplicated vaginal deliveries (G4P4)• Appendectomy Physical Exam • A central, nodular…
Chief Complaint MJ, a 54-year-old male diagnosed with squamous cell carcinoma (SCC) of the oropharynx (T4aN2bMx), develops grade 3 acneiform rash (Slide 1) after receiving an investigational treatment containing cetuximab. History and Physical • MJ is currently enrolled in a clinical trial with therapy consisting of continuous infusion 5-fluorouracil, carboplatin, and cetuximab. • After receiving…
Author: C. Andrew Kistler, MD, PharmD, RPh Chief Complaint JW, a 64-year-old woman, complains of chest pain that is not entirely associated with exertion 5 days after hospital admission for the administration of FOLFOX chemotherapy to treat colorectal cancer (CRC). Relevant Medical History • Hypertension • Hyperlipidemia • Recent diagnosis of CRC • On Day…
This patient, who had an increasing PSA level, was found to have abnormal PCA3 urine test results.
A 65-year-old male patient with a high PSA level and a bone scan showing new lesions requires a recommendation for the next treatment step.
A woman with Stage III breast cancer who is about to undergo adjuvant chemotherapy needs a recommendation to maintain her bone health.
A patient undergoing treatment for NSCLC presents with disorientation and nausea/vomiting. Can you guess the cause?
Dr. E. David Crawford, Head Urologic Oncology at the University of Colorado, presents his case study on renal cell carcinoma (RCC).
Although there are new therapies for M1CRPC patients and others pending, ideal sequencing regimen is still not certain.
Although prevalence of cytogenetic abnormality in tumor biopsy is low, finding one or more abnormalities can expand the patient’s treatment options.
