This is the case of a 27 year-old male who was diagnosed to have thymoma. Two months prior to admission, patient experienced on and off chest pain associated with occasional cough. Pain relievers prescribed by a doctor on private consult gave temporary relief for a month. The symptoms persisted accompanied with a gradual weight loss . He was confined in a private hospital in Manila where he had CT scan that revealed mediastinal mass. Biopsy revealed thymoma and was advised to have thoracic surgery hence the admission to our institution.
The contemplated surgery was put on hold as the attending wants clearance from the oncologist. The oncologist wants the patient to undergo chemotherapy.
Thymoma is a type of cancer that begins in the thymus. The thymus is located in the upper chest just below the neck. It is a small organ that produces certain white blood cells before birth and during childhood. These white blood cells are called lymphocytes and are an important part of the body’s immune system. Once released from the thymus, lymphocytes travel to lymph nodes where they help to fight infections. The thymus gland becomes smaller in adulthood and is gradually taken over by fat tissue.
Cancer begins when normal cells begin to change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body).
Although rare, thymomas are the most common type of thymic tumor. The term thymoma traditionally refers to a non-invasive, localized (only in the thymus) type of thymic tumor. Thymomas arise from thymic epithelial cells, which make up the covering of the thymus. Thymomas frequently contain lymphocytes, which are non-cancerous. Thymomas are classified as either noninvasive (previously called benign) or invasive (previously called malignant). Noninvasive thymomas are those in which the tumor is encapsulated and easy to remove. Invasive thymomas have spread to nearby structures (such as the lungs) and are difficult to remove. Approximately 30% to 40% of thymomas are of the invasive type. (Healthline.com)
Thymoma is generally a slow-growing tumor that does not usually spread outside of the thymus. Occasionally, it can spread to the lining of the lung, called the pleura. Less often, it can spread to other parts of the body. (Cancer.net)
The symptoms in 60% of patients with Thymoma are caused by pressure from the enlarged thymus on the windpipe (trachea) or blood vessels which explains the difficulty breathing or pain being experienced by the patient.
Other symptoms of thymoma may include:
• shortness of breath
• swelling of the face
• coughing
• chest pain
• muscle weakness (especially in the eyes, neck, and chest, causing problems with vision, swallowing, and breathing)
• weakness
• dizziness
• shortness of breath
• fatigue
Of these, Mr. P. only manifested the chest pain and coughing.
Thymoma is categorized into four stages (I, II, III, and IV) which may be further subdivided (A and B) based on the spread of cancerous tissue. The Masaoka staging system is as follows:
• Stage I. The thymoma lies completely within the thymus.
• Stage II. The thymoma has spread out of the thymus and invaded the outer layer of the lung (pleura) or nearby fatty tissue.
• Stage III. The thymoma has spread to other neighboring tissues of the upper chest including the outer layer of the heart (pericardium), the lungs, or the heart’s main blood vessels.
• Stage IVA. The thymoma has spread throughout the pericardium and/or the pleura.
• Stage IVB. The thymoma has spread to organs in other parts of the body.
• The treatment for thymoma cancer depends on the stage of cancer and the patient’s overall health. Because thymomas are so rare, there are no defined treatment plans. Options for treatment include surgery, radiation therapy, and/or chemotherapy. Surgical removal of the tumor is the preferred treatment. Surgery is often the only treatment required for stage I tumors. Treatment of thymoma often relieves the symptoms caused by paraneoplastic syndromes.
• A treatment that is intended to aid the primary treatment is called adjuvant therapy. For instance, chemotherapy may be used along with surgery to treat thymoma. Stages II, III, and IV thymomas are often treated with surgery and some form of adjuvant therapy. However, in the case of Mr. P, the oncologist prefers chemotherapy.
Also, since the patient is already immunocomprmised or has low level of immune system, I have advised the patient and the visitors to wear mask. The patient has been place on reverse isolation or protective environment.
Source: Healthline.com

My rotation in the ward for my BST at the LCP has started last Monday and although sleep has been elusive, I still feel the adrenalin rush through my vein.

It is like I am an energizer bunny.

My feet are still swollen and although this signals me to follow the red light, I have no intentions of taking leave of absence. Although we are allowed to have 6 absences for the entire training period, I feel that it is just proper to maximize my training fee by taking the opportunity to be in the ward and learn new things about bedside care.

Aside from the bedside care, we are expected to perform admission and discharge procedures and to carry out doctor’s orders. If you want to excel in something you must not stop at just learning the 411 but you have to progressively learn the craft.

While I feel so pumped up in my training days, there are instances that sadness sucks the joy in my highly cholesteroled heart.

After every endorsement and rounds, I usually review the patient’s chart to check on the diagnosis, doctor’s progress notes, medications and everything I could wrap my mind around.

Last night, I managed only two patients.  One has so many medications needed to be given at certain intervals. The other has just prn (pro re nata) or as needed medications.  It was for pain.

The doctors made their rounds so I was not able to scan the charts of my patients.

At past 6:00 pm, I was asked by the charge nurse to assist the attending – an oncologist in medicating my patient (who only has prn med).  He was given Etoposide – a chemotherapy drug.

After regulating the drug, I looked for the patient’s chart and found out that he has bronchogenic cancer with non small cancer cells.  The cancer has metastatized in his brain.

He is undergoing 6-cycle chemotherapy.  I was really surprised because he looked healthy, not experiencing alopecia and he kept on playing tricks on me every time I entered his room.

I am imagining, If were in his bed, would I still be the same bubbly person that I used to be? Chemo is a very scary and horrible experience based on people who have undergone it.

I know that as a medical practitioner, emotion should not get in the way of my profession.  I was supposed to handle three patients that day but my third patient who had a DNR order expired. It is sad when you are in the room with the relatives to witness the doctor to pronounce the patient dead.

Every training day is a tiring and edematous day but at the end of the day, I do not feel exhausted.

This is what I wanted to do. Screw the odds, Death is not an option.

All I need now is my Trodat so that my hands will be spared from scribbling my complete name and license number on each page of the patient’s chart.