Abschlussbericht des Onkologen

Donnerstag, 13. Juli 2023

Ich habe den Abschlussbericht des Löwener Onkologen, dr. Sabine Tejpar, vor meiner Entlassung zurück nach Hause, bekommen. Das Original ist in Flämisch. Ich übersetze ihn nach Englisch, denn ich werde ja in Estland einen Onkologen finden müssen, der mich übernimmt.

I got the final medical report of my Belgian oncologist, dr. Sabine Tejpar. The original is written in Dutch, but I translated it to English for my future oncologist in Estonia.

Summary

During our consultation on July 6, dr. Tejpar explained me the situation as follows:

The scan on July 3 revealed that a few new hypermetabolic glands have developed after the surgery.

This is, as she feels, just a side effect of the Nivolumab therapy, so there is no reason to worry.

But because of this she wants to see me once more in October 2023 in order to confirm her feeling. Until confirmation, her work with me cannot be considered „done“.

This is no reason to wait three more months before returning to Estonia. Anyway I will need to find an oncologist in Estonia who takes over my case. And that oncologist should be willing to communicate with Dr. Tejpar about my case.

English translation

Dear Colleague

We saw your patient SAFFRE LUC JOHANNES at the digestive oncology and prevention consultation on 2023-07-06.

History:

  • 2022-09-21: external diagnosis of adenocarcinoma of the cardia cTNM? molecular?

  • 2022-12-06: Startup FLOT

  • 01-2023: Admission in Eupen due to bleeding from tumor requiring clipping of visible vessel in ulcer distal to cardiac tumor.

  • 03-2023: partial esophagectomy, partial gastrectomy, gastric tubulation with intrathoracic anastomosis with 2-field gland revival via left thoracophrenola parotomy.

ypT3N0 (0/48 lymph nodes positive, including 2 with response to therapy). Advice MOC: FLOT or possibly nivo to be discussed with the patient. Molecular: IHC MLH 1 and PMS2 loss. MSI PCR 5/5. 26% methylation of the MLH1 promoter demonstrated. The BRAF p.V600E absent. Germline: not deployed, SeqCap NGS: ND, HER2 IHC score 1+, CISH Ratio Her2/CEP17 = 10.6/3.1 = 3.42; CPS = (# for PDL-1 staining cells / # viable tumor cells) x 100 = 33.

  • 04-2023: Given the MSI high, there is an indication for adjuvant treatment with Nivolumab (via compassionate use) with new bialn by means of PET/CT after 3 months.

Allergy:

No known allergies

PET/CT post adjuvant nivo 07-2023

Compared to previous research (2023-02-14):

  1. Development of multiple slightly to intensely hypermetabolic glands mediastinally, bilaterally hilar, as well as one discrete hypermetabolic gland at the height of the left internal mammary chain (tv 148): possibly still inflammatory/sarcoid-like reaction to Nivolumab.

  2. New discrete hypermetabolic nodule anterior in the middle lobe (tv 168): DD still inflammatory (cfr. point 1), DD metastasis.

  3. New moderately hypermetabolic focus at the same level. The left supra-umbilical abdominal wall (tv 230): possibly also non-specific inflammatory focus under Nivolumab, DD malignant peritoneal implant (to be interpreted depending on APO thoracic glands).

Therapy on admission:

  • Dafalgan, 1 g, 4/d, 8h 14h 20h 2h

  • Durogesic (patch 25 mcg/h), 1 patch, TRANSDERM, 1 time every 3 days, 20h

  • Erythrocin, 250 mg, 3/d, 8h 12h 17h

  • Esomeprazole eg, 40 mg, 1/d, 8h

  • Innohep, 4500 E, SC, 1/d, 20h

  • Motilium, 10 mg, 3/d, 8h 14h 20h

  • Movicol (sol ud sachet 25 ml (=13.8 g)), 1 sachet ># in case of constipation (max 1)

  • Ms direct, 10 mg ># no PCEA, pain&PO possible (max 6)

  • Novalgin, 1000mg ># in case of pain every 4 hours (max 3)

  • Sv isocal (1 kcal/ml) (1 l), 1 l, Jejunostomy tube, 1/d, 20h

Anamnesis:

feels good. slightly decreasing weight

DECISION:

  1. Status after distal esophagectomy, partial gastrectomy and gastric tube reconstruction after neoadjuvant treatment with FLOT for MSI high node metastatic GEJ adenocarcinoma (cT3N1M0). Clinicoanamnestically and biochemically favorable evolution. Given the MSI high, there is an indication for adjuvant treatment with Nivolumab (via compassionate use) with the new bialn via PET/CT after 3 months.

  2. bilan 07-2021: Compared to previous research (2023-02-14):

    1. Development of multiple slightly to intensely hypermetabolic glands mediastinally, bilaterally hilar, as well as one discrete hypermetabolic gland at the height of the left internal mammary chain (tv 148): possibly still inflammatory/sarcoid-like reaction to nivolumab.

    2. New discrete hypermetabolic nodule anterior in the middle lobe (tv 168): DD still inflammatory (cfr. point 1), DD metastasis.

    3. New moderately hypermetabolic focus at the same level. The left supra-umbilical abdominal wall (tv 230): possibly also non-specific inflammatory focus under Nivolumab, DD malignant peritoneal implant (to be interpreted depending on APO thoracic glands).

  3. Planning: patient now back to Estonia. Will be available 10-2023 for new PET/CT and repl. quid reactive glands then progression anyway, then start combination immunotherapy

Yours sincerely

Original reports

Here are some of the PDF files generated by mynexuzhealth app.