Cancer
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21648
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Browsing Cancer by Author "Bowman, Paul"
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Item Challenges of Medical Decision-Making in an Autistic Pediatric Patient with Retinoblastoma and Osteosarcoma: A Case Study(2018-03-14) Rapisand, Stefanie; Hamby, Tyler; Bowman, Paul; Shum, KathyBackground: In oncology, one of the most crucial decisions is whether it is appropriate to discontinue chemotherapy before the full course of treatment. Medical professionals must consider the risks versus the benefits, the patient’s quality of life, the appropriate role of chemotherapy, and the patient’s preference. The decision is difficult in pediatric patients who have encountered multiple malignancies while suffering from the untoward effects of chemotherapy. It is especially difficult in malignancies such as osteosarcoma where successful treatment involves the full course of systemic chemotherapy. Case Information: A 9-year-old autistic male with a history of retinoblastoma presented with pain in the right leg and an abnormal gait. A biopsy confirmed the diagnosis of high grade osteosarcoma. Neoadjuvant chemotherapy (protocol AOST 0331) was initiated with the administration of Cisplatin and Adriamycin, but was complicated by nausea, vomiting, febrile pancytopenia, and multiple life threatening infections. Nausea and vomiting was so severe that a feeding tube was placed for feedings and medication administration. After hip disarticulation amputation, chemotherapy was resumed, but was suspended at week 15 of treatment due to multiple life-threatening complications such as nephrotoxicity, endocarditis, and staphylococcus and streptococcus mitis infections. Discussion: The decision to discontinue chemotherapy early was not an easy one. The patient suffers from severe autism, is non-verbal, blind, intellectually disabled, and suffered many complications from his first and second pediatric malignancies. After considering the patient’s long battle with two pediatric malignancies and the numerous challenges he has had from undergoing chemotherapy, the patient’s parents and physicians agreed to discontinue chemotherapy. The patient is now receiving palliative care. Conclusion: Our case illustrates the importance of an individualized treatment plan when working with complicated patients. When physicians are faced with challenging medical decisions, it is important to remember, that with the help of their medical team and open communication with patients and their family members, making these decisions may not be as difficult and may be beneficial to everyone involved.Item Slow-growing benign tumors with potential for functional disability in Neuroblastoma: a case study.(2018-03-14) Rapisand, Stefanie; Bowman, Paul; Finger, NicoletBackground: Neuroblastoma (NBL) is the most common malignant extracranial tumor in pediatrics and may mature into ganglioneuroma (GN). Though GN is benign, it has the potential to cause severe symptoms related to adjacent structures or organs. Cases of GN causing complications such as scoliosis and hydronephrosis have been reported. We report a rare case of stage IV neuroblastoma which, over the course of 19 years, has presented as numerous GN tumors causing a striking number of complications. Case information: A 7 month-old male presented with stage IV NBL disseminated to his face, groin area, and testicles. The primary tumor was resected after chemotherapy treatment. Despite treatment efforts, disease spread to the bone marrow and numerous tumors appeared throughout the body. At the current age of 19, the patient has endured a lifetime of complications due to tumors in the face, spine, intestine, groin, and testicles. These complications include scoliosis, bowel obstruction, severe abdominal pain, hydronephrosis, varicocele, and neurologic symptoms. Conclusions: In more than half of patients, NBL is widely metastatic by the time it is diagnosed. Recurrence of NBL or GN is infrequent with complete tumor excision. However, due to the invasive character of NBL, it is difficult to ensure complete elimination of tumor cells. It is possible that the recurrent GN tumors appearing in this patient are the result of the maturation of what was initially metastasized, microscopic NBL lesions. Due to the rarity of such extensive GN dissemination, the pathology and management strategy of this condition is still being understood. Treatment of patients with NBL requires long-term, multidisciplinary management by experienced providers. Emphasis should be placed on quality of life. In addition, transfer of these patients from pediatric care to adult care requires extensive communication and education between the patient, family members, and all involved medical providers.