Thursday, December 15, 2016

Tumor Board

Dr. Owl: I'd like to present a patient. Can you pull him up?

Radiologist types in name and retrieves MRI for the big screen.

Dr. Owl: This guy has cancer, it ate up his entire face. Wait. What? That can't be him. Before therapy? No, oh! You have the wrong name.

Radiologist: Oh! Heh Heh. Funny how two wrong letters can do that. And the fact that the other guy also had a head MRI? Weird.

Dr. Owl: I threw chemo. And chemo. More chemo. And chemo. It kept coming back. And coming back. And coming back. And coming back.

Me: What type of cancer was it?

Dr. Owl: Squamous cell carcinoma.

Radiologist pulls up correct scan, and a collective gasp arises from the 25 or so doctors in the room.

Dr. Owl: Yes that's it! Impressive, huh? You could put a fist through that hole in his head. I started him on OPDIVO, a year ago, back before you had to do a PDL-1 to get approved. No progression. Stopped it dead in it's tracks.

The Nightingale: I'm from Texas, and a couple of years ago a Texas researcher started going on about immunotherapy, and everyone was like Pooh! But now look at this. It's amazing.

Dr. Owl: So do I just keep him on it? It's been a year. He's doing great.

The Nightingale: We don't have long term follow up studies. It's too new. I would keep going with it.

Me: I had a case like that in residency. It was basal cell carcinoma. He ignored it until it ate half his face. Went to his liver. Only time I've grossed half a face.

Swagger and Sagacity: Yes, stay on OPDIVO. And get him a bathroom scale from Sears. Better than any follow up PET or MRI. If your patient is gaining weight, you are doing the right thing. Are you going to get a plastic surgeon on that?

Dr. Owl: That's out of my hands. I'm leaving that up to Dr. ENT.

The Nightingale: Next case?

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