Sarah Henretta/Dr. Cristofanilli - Week 4

This week I continued working with Dr. Cristofanilli in his clinic. I was unable to work with the breast surgeon because of a change in schedule, so I look forward to working with her next week. Patients that I saw this week highlighted the interplay between oncology and other specialties. One patient presented with breast cancer all throughout their bones. The cancer was so extensive that their femur was on the verge of fracture. Before starting treatment, Dr. Cristofanilli had to consult with an orthopedic surgeon and refer the patient to them because they could not risk a fractured femur in the middle of cancer treatment. Additionally, I saw a patient who presented with osteomyelitis, resulting in an emergency situation. Though not cancer related, Dr. Cristofanilli had to explain the severity of the situation to the patient and work with the emergency department and infectious disease to get the patient seen quickly.

Furthermore, this week I was especially struck by the extent to which Dr. Crtistofanilli’s uses cutting edge diagnostic tests to understand individual patient’s diseases. The way he utilizes diagnostic tests and the type of tests he uses are not the standard, and I am thankful to be able to observe it. To me, cancer used to appear like a disease filled with a lot of unknowns. However, with the way Dr. Cristofanilli approaches diagnosis and treatment, nothing is left up to question. I really appreciate this approach because it is similar to thinking through a research question in the lab. For example, a patient presented with the pathology of an ER+, HER2- tumor. In seeing this, Dr. Cristofanilli ran a blood test to investigate the tumor DNA further and fully understand the tumor. Based on the pathology and an unremarkable blood test result, the obvious course of therapy was a treatment which targeted the estrogen receptor. However, the patient stopped responding to the ER therapy and started progressing. Instead of switching to a therapy blindly, Dr. Cristofanilli took a step back and re-ran the blood test to investigate the tumor DNA again. Notably, the results for the blood test this time showed that the tumor had five mutations in the estrogen receptor gene, something that rarely happens and an obvious answer for why the tumor had become resistant. With this new information, we were able to pick a therapy that would be effective despite the many mutations in the estrogen receptor gene. Before working with Dr. Cristofanilli, I believed that doctors had a binary approach to diagnosis and treatment (if this diagnosis, then prescribe this treatment). However, over the past four weeks I have grown to appreciate and enjoy the thought process and decision making associated with determining the best treatment plan for patients. Additionally, this week in the clinic we received new diagnostic tests that measure tumor cells in the patient blood.  The tests have just been approved by most insurance companies which was significant because it expanded the amount of patients we could use them on and improved our ability to understand the stage and progression of the patient’s disease. I am looking forward to seeing the results of some of these tests come back in a few weeks. 

Lastly, I continued to make progress on my research project. I updated the image analysis pipeline to improve the accuracy of the images and worked to optimize the presentation of the results, so it was easy to understand for anyone regardless of their background. I also discussed starting a second project focused on analyzing the genetic history and social history of a subset of our patients to determine if there is an unidentified factor predisposing them to breast cancer and a young age. 

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