TY  - CHAP
M1  - Book, Section
TI  - Surgery for Upper Gastrointestinal Cancer in a Morbidly Obese Patient with Diabetes and Renal Impairment
A1  - Alrifai, Doraid
A1  - Shipway, David
A1  - Ngan, Sarah
A2  - Ring, Alistair
A2  - Harari, Danielle
A2  - Kalsi, Tania
A2  - Mansi, Janine
A2  - Selby, Peter
Y1  - 2018
N1  - 
T2  - Problem Solving in Older Cancer Patients
AB  - An  81-year-old  man  presented  with  a  4  month  history  of  nausea,  epigastric  discomfort  and  unintentional  6  kg  weight  loss.  He  was  found  to  have  mild  anaemia  (Hb  98  g/l,  mean  corpuscular  volume  92  fl)  and  low  iron  indices.  His  baseline  creatinine  was  144  µmol/l  and  estimated  glomerular  filtration  rate  (eGFR)  47  ml/min.  He  underwent  gastroscopy,  during  which  an  ulcer  was  detected  at  the  gastro-oesophageal  junction  (GOJ).  Histopathology  confirmed  an  undiff  erentiated  adenocarcinoma.  CT  staging  demonstrated  tumour  invasion  into  the  gastric  subserosa  and  two  enlarged  perigastric  lymph  nodes.  His  tumour  was  clinically  staged  as  T3N1M0.His  past  medical  history  included  type  2  diabetes  mellitus,  diabetic  nephropathy  (stage  3  chronic  kidney  disease)  and  obesity  (BMI  35.2  kg/m2).  He  suffered  from  painful  osteoarthritis  of  the  hips  and  knees  and  had  an  exercise  tolerance  of  100  m.  He  struggled  to  climb  two  flights  of  stairs  without  resting,  mainly  because  of  arthritic  symptoms  rather  than  because  of  dyspnoea  or  chest  pain.He  was  an  ex-smoker  who  drank  minimal  alcohol.  He  lived  in  a  first  floor  flat  with  his  wife,  who  had  had  a  stroke  and  suffered  from  reduced  mobility.  He  was  independent  in  his  activities  of  daily  living  and  required  no  support  from  social  services.  His  medication  at  presentation  included  amlodipine,  ramipril,  metformin,  gliclazide,  and  ibuprofen  as  and  when  required.What  are  the  current  evidence-based  treatment  options  for  managing  this  tumour  type?What  other  information  might  influence  treatment  decisions?What  is  the  relevance  of  morbid  obesity  to  perioperative  management?How  will  stage  3  chronic  kidney  disease  affect  his  management?What  is  important  specifically  about  diabetes  in  this  context?Patient  outcome  
SN  - 
PB  - Clinical Publishing
CY  - New York, NY
Y2  - 2021/03/06
UR  - hemonc.mhmedical.com/content.aspx?aid=1152358306
ER  -