《国际医疗首诊病例》胃癌手术发现肝转移

《国际医疗首诊病例》胃癌手术发现肝转移

（原创）美国希望之光医疗，欢迎转载，请注明出处。

前2周，躺在加拿大多伦多某医院莫先生，原本是做胃癌切除手术，谁知外科医生打开一看，发现肝转移，手术无法进行。全家人非常担忧。回到家莫太太上网谷歌搜索，寻求美国医学专家会诊，美国希望之光医疗核心团队这行字醒目的出现在她眼前。抱着试一试的心情，立即拨通了美国希望之光医疗中心国际免费电话：95040351892

美国希望之光医疗中心得知莫先生的病情后，首席医务官极为重视，3天后安排了美国肿瘤专家戴教授和莫先生进行远程医疗视频会诊。

诊断：转移性胃癌

病史小结：

Middle age male with recently diagnosed distal gastric cancer (presumably adenocarcinoma), found to have hepatic metastasis during planned open distal gastrectomy which was aborted. Now has J-tube and feeding. Planned for palliative radiotherapy to gastric outlet obstruction, followed by ramucirumab, capecitabine, and cisplatin.

咨询建议：

1. Outlet obstruction- consider stenting by gastroenterologist.
2. Chemo- ramucirumab is approved for 2nd line therapy, would treat first with FOLFOX (add trastuzumab if HER2 positive), if progress, use ramucirumab plus paclitaxel as 2nd line, or look for clinical trial.
3. the clinical trial I mentioned is for HER2 negative patients, but there is no site in Canada. This immunotherapy trial is as following:

KEYNOTE-059  is recruiting patient like him, please contact following center to see if he is eligible and there is a spot for him:

https://clinicaltrials.gov/ct2/show/study/NCT02335411?term=pembrolizumab+gastric&rank=5&show_locs=Y#locn

4. if patient's biopsy sample is enough for more test, recommend immunohistochemistry staining for DNA mismatch enzyme expression. If expression is deficient, it's likely he will benefit from immunotherapy such as anti-PD1 (nivolumab or pembrolizumab, currently available only on clinical trial for gastric cancer).

美国希望之光医疗服务宗旨，为全球华人利用世界最优秀的医疗资源开启了最完整便捷的快速通道，让国际最权威的医学专家用世界最先进的诊疗设备、最新颖的特效药物和最有效的治疗手段，为您的生命带来新的希望之光！

温馨告示：如果国际患者病情需要美国医学专家开处方药，根据美国的有关法律，国际患者必须通过与美国医学专家的远程医疗视频咨询后，医生才能开药。