Thursday, July 24, 2008

When Chemo Works

Recently, I blogged about a patient with a tumor that was difficult to diagnose. A day or two after that post, the pathologist told me the diagnosis: myoepithelial carcinoma. You can follow this link to the article that describes the largest group of patients with this diagnosis: 29. That paper brought the total number of such cases reported EVER up to 73. To put that in perspective, this is the number of women who are diagnosed with breast cancer in the US every 3 hours. To say that this diagnosis is vanishingly rare would be a tremendous understatement.

So how does one go about deciding how to treat something so rare? We reviewed all 73 case reports, and unfortunately almost none of them included any details about what chemotherapy was used. There was one exception, though. This paper describes a woman with this diagnosis who had a great response to the combination of carboplatin, taxol, and gemcitabine. Based on her experience, we offered a similar treatment regimen to my patient (and his mother, since he is a teenager). They agreed, and we all hoped for the best as the treatment started.

The main point of my prior post was how ironic it was that I was hoping the patient’s tumor was malignant, because that might make it easier to treat. Here is the patient’s CT scan the day we started his chemo and his scan from earlier this week.



You don’t need to be a radiologist to see how much the tumor shrank after just one cycle of chemotherapy.

Certainly this patient has a long way to go, and he still has more chemotherapy, radiation, and surgery in his future. But this tumor is going to be so much easier to deal with now that we know how sensitive it is to chemotherapy. Benign tumors never shrink like this after a cycle of chemo.

His outlook is very good. Sometimes malignant IS better than benign!


rlbates said...

So glad to hear it is working for him!

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Megan said...

I was a pediatric oncology nurse in tulsa a year and a half ago. The bad news seemed to outweigh the good a lot of the time. But there were successes and triumphs along the way that, combined with the indomitable spirits of the children with which I worked, made it all worthwhile.

Thank you for sharing the good here! It's nice to be reminded that good outcomes and prognoses are possible.

outre said...

that is so sweet

you should cover up the acct # too :p.

Bruce said...

Truly an amazing set of CT scans! Hope your patient continues to respond. Can you make it resectable?

Doctor David said...

Despite how awful chemotherapy can be, it's so gratifying when it works! And when the response is so dramatic... it's even more amazing. Not only is the scan much better, but the patient no longer requires pain medication and is up and active and seeing his friends and asking about going to school in the fall!

Anonymous said...

It is a great report make by the doctor.

Anonymous said...

Great scans. Made me wonder what the patient looked like before and after. It must have been a dramatic aesthetic improvement. :) I'm hoping for the best in this case.