Metastatic Cancer Case Study

Sakeenah is 14 years old African american girl, she comes to the University of Michigan Pediatric Gastroenterology clinic on 5/22/2018 complaining of abdominal pain. She is accompanied mom and dad today and she provides the interval medical history, She states that the pain started month ago, epigastric, and occasionally radiate to right side, described as squeezing or burning pain. She states that the pain is on/off, in scale of 7-8/10, occur more in the morning. The pain lasts few hours several time a day. She feels that "food sits in my stomach and doesn't digest." Sakeenah states that pain is worse when she eating a grassy food, she stop eating it for a while and the pain seems

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At todays visit she is accompanied by her husband. She is awake, alert and oriented. She complains of chronic pain in her hips and legs that radiate down to her feet. She describes her pain as as shooting, dull, ache. “she states, sometimes its like

At today’s visit, she is accompanied by her caregiver from senior bridges. She is awake, alert and oriented. Affect is flat. She denies pain at this time. She states that she suffers from chronic abdominal, dull, wave like, abdominal pain. She states that she takes her pain pill every other pain because her pain seems to occur every other day. She reports that she is feeling depress because she had an appointment schedule recently to remove skin cancer from her face and her daughter cancel the appointment. The care giver report that the patient has daily agitation, but taking the Ativan helps. The patient reports a fair appetite and having regular bowel movements.

A review of her medical records indicates that she was recently admitted to MMH from 2/28/17 to 3/3/17 and treated for pneumonia and UTI. Her recently labs that was done in February indicated a BNP of 861. She continues to suffer from chronic UTI and had her indwelling Foley catheter discontinued on 3/19/17. She continues to suffer from chronic anemia and chronic kidney disease. She is legally blind.

Metastatic disease may be an incidental finding in asymptomatic patients. It may present with nonspecific symptoms such as malaise or weight loss, and it may present with symptoms and signs related to the metastatic site as dyspnea, lymph node enlargement, bone tenderness, or signs of increased intracranial tension.

Patient History: my patient is a 79 y/o female. She weighs 71.7 kg and is 165.1 cm tall. She has a history of colon carcinoma and hypertension. She has had a previous cholecystectomy, appendectomy, and removal of a uterine polyp. She has no history of bleeding disorders. She was a smoker, but quit 30 years ago. She smoked a half pack per day for 10 years; rare alcohol use. She is status post right-hemicolectomy. She is allergic to penicillin.

A 17-year old female presents to the office with a history of abdominal pain, distension, and diarrhea for the last ten days. She

Cancer is given to a whole collection of related diseases. Cancer cells begin to divide unregulated and spread into surrounding tissues. Scientists have proposed that lots of SP2 protein may transform to normal cells into cancer cells. In addition, the deprivation of specific co-stimulated molecules can impair the natural killer cells ability and lead to the cancer. Cancer occurs almost anyplace in the human body. Cells become old and become more abnormal or cells, which are damaged when they should die, divide without stopping and may constitute growths called tumors. Also cancer cells are less specialized than normal cells. The first and original tumor is called primary tumor. Primary tumor may spread to other parts of the body and create new tumors.

S.R. is a 63-year-old Caucasian female currently working as an operating room nurse. She has a significant past medical history consisting of Breast Cancer, Depression, Fall, Diverticulitis of the Colon, Follicular Lymphoma (stage 3), Irritable Bowel Syndrome, Osteoarthritis and Sciatica. Currently S.R. is going through chemo with Rituximab for recurring lymphoma, gastritis and atrial fibrillation. S.R came to the emergency department presenting with shortness of breath and dizzy from having intractable nausea and coffee ground emesis overnight. Her chief complaint was of feeling dizzy and weak at home after vomiting with chills and sweating. The client knows her history and the fact that she needs to be on proton pump inhibitors twice a day,

reported that her abdominal discomfort started about eight days ago, after eating Chinese food. She described the discomfort or pain as “ aching and it comes and goes ” and it is located in the right lower abdomen, which is aggravated after attempting to drink fluids of even food. She denies taking alcohol nor illicit drugs. She also denies having any fever or chills in the past eight days. No allergies to medication, as well as to the food, was disclosed.

Review of the medical record indicates that she was diagnosed with stage 3 rectal cancer with Mets to bones in 2013 for which she was treated with radiation treatments. She is followed by Dr Lederman in New York and locally by Dr patel- oncologist. After her radiation therapy she developed lymphedema to left lower extremity. She is follow by healthy lymphatics agency and was been followed by Dr DeBonet for pain.

There have been 3 cases of untreatable cancer in my family. The first time I had was aware of cancer is when my grandfather was diagnosed with bone cancer. My grandfather was a very happy man with such joy that being sad around him was almost impossible especially after his passing. Grandpa Ken was what I called him. losing my grandfather made life very difficult for my grandmother who has several physical troubles. He died when i was very young, but even at a young age his death impacted me heavily.

At today’s visit she is accompanied by her husband. She is awake, alert and oriented times one. She denies pain, chest pain, and shortness of breath. The husband reports that the patient appears stable at this time, but she is not eating as much as she used to. She reports that she is able to dress herself, feed herself and shower herself. The husband reports that it is increasing difficulty to get her to her doctor appointment and that she wonder at time. No acute distress noted. KPS 50%.

Neurologic care remains a concern for the Department of Medicine, the Residency Program (IMC), and Summa Health Medical Group (SHMG). After two years, we are back to one Summa Physician for stroke call.