Oncology & Cancer Case Studies | Medical Professionals

Oncology Case Studies

ONCOLOGY CASE STUDIES

Renal Cell Carcinoma Patient with Liver Mets

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…

63-Year-Old Man with Arthritis, Recurrent Infections, and Pancytopenia

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…

Advanced NSCLC: Best Treatment Option

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…
The bone marrow aspirate is replaced by hypergranulated abnormal promyelocytes (MacNeal Tetrachrome 100x).

A 47-Year-Old Woman with Pancytopenia After Treatment with Radioiodine Therapy

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…

A 52-Year-Old Man With a Lesion in His Nose

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…

A 64-Year-Old Man with a Chronic Rash

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…

Heart Failure During Breast Cancer Management: A Case Study

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…

Managing Neutropenia in a Patient with Abdominal Pain Following Chemotherapy

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…

A 59-year-old With Unresectable Gastrointestinal Stromal Tumor

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…

A 54-Year-Old Male With Fever and Diarrhea After HSCT

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…

A 71-Year-Old Male Presents with Androgen-Deprivation Therapy (ADT) Resistance

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 =…

54-Year-Old Man Presents With Increasing Right-Sided Facial Swelling

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…

A 58-year-old with Stage IV Pancreatic Adenocarcinoma

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 •…

A 55-year-old Woman with Breast Cancer and Shortness of Breath

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…

Case Study: What’s Causing this Linear Rash in a Patient with Hodgkin Lymphoma?

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…

A 70-Year-Old Woman With Oral Pain and Otalgia

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.•…

Case Study: A Patient with Breast Cancer and mTor-induced Stomatitis

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…

Drug Interaction in a 64-Year-Old with ALL

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)…

72-year-old Woman with Cystic Mass

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…
Example of an acneiform rash

Cetuximab-Induced Rash in a 54-Year-Old with SCC

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…

Elevated Troponins in a Patient with Colorectal Cancer

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 3, post FOLFOX…