What is the treatment for adenocarcinoma found in marrow biopsy?

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.

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.

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.

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.