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HomeAnswersRadiation OncologyadenocarcinomaA 55-year-old woman has adenocarcinoma. Please help.

What is the treatment for adenocarcinoma in a 55-year-old?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At May 5, 2018
Reviewed AtMay 15, 2024

Patient's Query

Hello doctor,

The patient is 55-year-old female weighing 121 pounds and suffering from adenocarcinoma as found in marrow biopsy. She is on ventilator now.

Hi,

Welcome to icliniq.com.

The following are the questions which come to my mind, which is not provided by the information you provided: What were the complaints of your patient? Why is she on a ventilator? What is the working diagnosis of the doctors? Have the doctors informed you that the cancer has spread to the lungs? Has cancer spread to the brain? My guess is you want to know if she will get better. Even in the best of hands, such patients usually do not do well. If the doctors are discussing about withdrawal of care, it may probably be the best course of action. Please reply as to what your specific query is, and any other blood reports, scan reports and X-rays which could be attached so I could assist you better.

Thank you.

Patient's Query

Thank you doctor,

The patient had complained of shortness of breath. She was earlier diagnosed with miliary tuberculosis two months back and was recovering well with an increase in weight but last month she got unconscious at morning 4.30 AM and we rushed to the hospital where doctors took her to ICU and took biopsy and bone marrow test.

Hi,

Welcome back to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity). The CT scan reports were not attached. If they are available, please send them also. Your patient is suffering from probable disseminated malignancy with unknown primary (means cancer has spread throughout the body, the original site of the cancer is not apparent). The reports are suggestive of disease in the lungs as well as in the liver or bone. She also has a secondary bacterial infection, the probable focus is in the lungs. She may also have co-existent miliary tuberculosis which prevented the quick diagnosis of cancer and may have fooled even the best of doctors.

If her condition is improving with therapy and her ventilator parameters are improving with the antibiotics and other supportive care (I assume her doctors will be giving high-end antibiotics such as Piperacillin, Tazobactam, and Amikacin or similar drugs), and she is able to be weaned off the ventilator, then she can be advised palliative chemotherapy after two weeks, after doing some blood tests called tumor markers, which would guide to as the possible location of the primary. If her ventilator parameters are not improving even after 72 hours to 96 hours, I would not advise further escalation of therapy, and it would be better to get discharged against medical advise and take her home to have a peaceful death at home. There is nothing much that can be done at that point. A palliative care physician or oncologist with experience in palliative care can be consulted before getting discharged so that she can be kept comfortable at home. This may be difficult to accept but is probably the best that can be done for the patient.

I hope I have been able to help you make an informed decision and give appropriate advice.

Patient's Query

Thank you doctor,

I have attached the CT scan report. Kindly advice.

Hi,

Welcome back to icliniq.com.

I said I wanted the CT (somputed tomographjy) scan report. I meant the written report of the scan films which is given by the radiologist. It will detail the individual findings and the final impression of the radiologist. I have already seen these scan films as you had already attached them.

Patient's Query

Thank you doctor,

I have attached the file of CT scan report.

Hi,

Welcome back to icliniq.com.

I saw the report (attachment removed to protect the patient's identity). It is suggestive of disease in the liver also as well as lung. She needs an oncologist to review her at the bedside to determine the best course of action. It is difficult to say when it started, maybe three to six months ago. She could have had mild symptoms or no symptoms in the early stages. That is why it was difficult to detect it early.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Andrew Chellakumar Fenn
Dr. Andrew Chellakumar Fenn

Radiation Oncology

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