Week 5 of Summer Immersion

This week I have seen more outpatients than usual in Dr. Rohit Chandwani's clinic. There were two follow-up cases and four new cases. The follow-up visit of a patient who had the Whipple procedure a month ago exhibited some shooting pain periodically in the abdomen and down foot syndrome, though the incision wound healed up nicely and no more draining of fluid from the wound. There are potentially some nerve damages, and the patient may need further examination and physical therapy.

Another patient who had originally scheduled surgery two weeks ago has been postponed to next week due to delayed CT scans. The patient has a benign tumor in the pancreatic head, which needs to be surgically removed. Though the patient is not jaundiced, the dilated bile duct and abdominal pain experienced by the patients led to the clinical decision for surgery.

The third patient who had liver cirrhosis five years ago was experiencing nausea and vomiting caused by the gastrointestinal stromal tumor (GIST). GIST is also causing enlarged spleen and portal hypertension. The patient's stomach has a 2~3 cm, slow-growing mass characterized by Ki67. A surgical operation was highly recommended despite the high risk for operation due to low platelet count. The patient will be given a laparoscopic gastrectomy, in which part of the stomach will be removed, through a small opening at the belly button and 2 to 3 openings for the laparoscope.

The fourth patient has multiple cysts in the liver, kidney, and pancreas. The patient had blood in the stool occasionally. Although cysts in the liver and kidney are mostly benign, those in the pancreas have a higher likelihood of developing cancer. Due to the patient's family history of cancer, an MRI in three months is given to monitoring the development of the cysts.

The fifth patient had the Whipple surgery two weeks ago. The last measurement gave a 400 mL drain from the surgical site, which is less than the 500 mL limit to worry about. The patient will keep the drain tube until less than 300 mL draining. The good news is that the patient has complete response to chemotherapy.

The final patient is a more complicated case. The patient has ovarian cancer and a hepatic lesion of 1.1-1.2 cm in size. It was hard to tell if the lesion in the liver is caused by metastasized ovarian cancer (this will also determine whether the cancer stage is T2 or T3). The original MRI and CT scans were not done for the study, so it is hard to tell. Normally, ovarian cancer might metastasize to the liver, but it is rarely the other way around. The cyst in the liver looks benign and develops within the liver itself because it would be on the surface lining of the liver if metastasizing from the ovaries. The final clinical decision is to perform a biopsy while performing the major surgery for ovarian cancer and PET scans to search for hotspots for cancer in the liver and other parts of the body.