Carcinoma Esophagus

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Casestudies of Contents

Brief Medical History

Patient 57 years is a K/C/O Carcinoma Esophagus/GEJ – Moderately differentiated squamous cell carcinoma, Grade 2. She developed progressive dysphagia and weight loss. She was able to take only soft diet, liquids. In June, she consulted in Allopathy, she was referred to Oncology. She underwent OGD Biopsy – GE Junction which revealed moderately differentiated squamous cell carcinoma, Grade -2. PET CT done in 21st June 2021 Aster showed asymmetrical circumferential wall thickening in GEJ extending to proximal stomach—5.5 cm few nodes, no lesions in liver/lungs. She was advised Chemotherapy and Radiation therapy with CROSS protocol and IMRT 28 to 33 fractions. Hence, she approached AyurVAID Hospitals, Domlur to reduce side effects of CT-RT, improve tolerance, sensitivity and to improve the quality of life and well being.

PAST MEDICAL HISTORY:

K/C/O Carcinoma Esophagus – Moderately differentiated squamous cell carcinoma, Grade 2

COURSE AT AYURVAID HOSPITALS:

Mrs.Dakshayini M V completed the entire hospital stay in AyurVAID Hospital parallelly undergoing chemotherapy and radiation therapy from Aster CMI Hospital. She was able to tolerate the chemotherapy and radiation therapy well. She has been receiving supportive Ayurvedic care during the course of CT and RT. She underwent 4 cycles of chemotherapy.

She got admitted on 09/07/2021. Her first cycle chemotherapy was on 08/07/2021(Paclitaxel 50 mg/m2 and carboplatin AUC 2). During the initial days, she was complaining dysphagia, burning sensation in abdomen, feels always empty stomach, loss of appetite and felt nauseated on sight of food. She was mostly on fluids and soft foods(idli, dosa, kichdi). She felt aversion on sight of food. She was having vomiting 1-2 times/day. She was started with Ayurvedic treatments shiroabhyanga, naabhi-naalapoorana, kavala, gandusha and padabhyanga. Dhanwantharam gutika (0-1-1) powdered along with rice kanji was started as internal medication

On 13/07/2021, her Total WBC count dropped to 3800 cells/cumm., keeping myelosuppression, started monitoring temperature. Ensured adequate nutrition and hydration. Started internal medication Ashwagandha lehyam(1/2 tsp) at 9:00am and 5:00pm for improving WBC count, dhanyaka + shunti water for drinking to enhance digestion and appetite.

Her second CT as on 15/07/2021 (Paclitaxel 50 mg/m2 and carboplatin AUC 2). On 16/07/2021 she took solid food(4 phulkas) without difficulty.

On 17/07/2021, no episodes of vomiting, burning sensation in abdomen was absent. She was responding well to the medications.

She was taking solids and fluids on & off. To improve her sleep and overall well being ,shirodhara was started on weekends with Balaguduchyaditaila from 17/07/2021. On 19/07/2021 she passed motions 4 times (normal consistency) and her sleep was disturbed. Her Total WBC count improved to 5700 cells/cumm as on 20/07/2021.

On 20/07/2021, post radiation therapy (for 20 min) she was c/o severe abdominal pain (vas 10/10). She was given Nabhi-naalapoorana and pichu over abdomen. Her vitals were WNL. After about I hour, her pain reduced to 3/10 vas scale. Patient became stable.

Patient had her 3rd CT on 22/07/2021 (Paclitaxel 50 mg/m2 and carboplatin AUC 2). Abdominal pain and discomfort subsided. She had nausea and loose bowels 1-3 times for the next 2 days, but no vomiting.

On evaluation post radiation therapy, her Total WBC count was found too low, 1.6K/uL (dated 27/07/2021). Hence, CT and radiation therapy was on hold. She was advised Inj. Neukine 300mcg(1-0-0) for 3 days from 28/07/2021.

Her food intake reduced. She felt slight giddiness on 30/07/2021 and BP was low 90/50 mmHg. So frequency of food and fluid intake increased and advised to add more salt in her diet. She was taking apple, dosa and idlis also in small quantities.

On 01/08/2021, her Total WBC count improved to 11500 cells/cumm. and radiation therapy resumed.

On 05/08/2021, her Total WBC count again dropped to 2500 cells/cumm and Platelete count was also low, 1.06lakhs/cumm.

On 09/08/2021, her Total WBC count reduced to 2100 cells/cumm and Platelete count improved to 1.54lakhs/cumm. Her Serum Sodium was 130mEq/L and Serum Chloride was 130mEq/L. She took Inj. Neukine 300mcg for 3 days. Her dietary sodium intake was increased.

On 12/08/2021 her Total WBC count improved to 13800 cells/cumm and Platelete count improved to 1.87lakhs/cumm.

She started noticing severe hairfall from 8th August 2021. After 2 days she got her scalp hair shaved.

On 11/08/2021 she was put on Ryles tube for proper nutritional support. Food and medicines were administered through the Ryles tube. She was given fluids every 2hrly, ensuring nutrition and hydration. Her BP improved to 110/70mmHg, tiredness also reduced. She felt pain and discomfort due to the administration of NG tube for about 4-5 days which gradually reduced.

Patient had her 4thcycle of CT on 16/08/2021(20% dose reduction Paclitaxel and carboplatin) and completed her radiation therapy.

She is advised to be on high protein diet to regain muscle mass

Advised for surgery after a month.

She got discharged to home from IP on 26/08/2021. Her weight is 35 kg, height-151 cm.

Outcome

Outcome parameter Metrics Before treatment During treatment After treatment After 1 week of discharge to home

Abdominal pain

VAS(0-10)

On and off

On and off

Absent

Absent

Burning sensation in abdomen

H/M/L/Ab.

H

L

Absent

Absent

Dysphagia

H/M/L/Ab.

H (on fluid diet mostly and also soft foods like smashed kanji,dosa,idli,kichdi)

H(Only on fluid diet)

On Ryles tube (fluids every 2hrly)

On Ryles tube (intake improved)

Appetite

H/M/L/Ab.

Irregular (she feels more hunger sometimes,but not able to take food properly)

M

M

Improving

Fatigue

H/M/L/Ab.

H

H (more on the days of radiation and chemotherapy)

M

L

Sleep

P/F/G

P

F

G

G

Vitality

P/F/G

Poor

Poor

Poor

G

Weight

Kg

40.9

39.5

35

37

BP

Mm/Hg

130/80

90/70

100/70

120/80

Nausea and Vomiting

H/M/L/Ab.

H

H

Absent

Absent

Patient Reported Outcome Scale

Poor (1); Fair (2);Good (3); Very Good(4); Excellent (5);

Presenting complaints with weightage with Before treatment 09/7/2021 After treatment 26/8/2021 Upon review after 1 week of discharge to home Upon review after 1 month

Difficulty in swallowing 50%

1

3

3.5

5

Feels always empty stomach,burning sensation in stomach 50%

1

5

5

5

PET CT Scan work up before surgery

Image attached below

Plan for Palliative care at home

  1. Refer Ayurveda Prescription Below
  2. Patient is on Ryles tube. Ensure proper nutrition and hydration, feeding every 2 hourly.
  3. Avoid unnecessary exposure outside.

* Outcomes may vary from person to person

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