Acute Arterial Thrombosis Following Chemoterapy in Patient with Oral Cavity Carcinoma- Importance of Decision Making in Family Medicine Practice- A Case Report

Abstract

Oral cancer is most common in developing countries, but is also seen in the rest of the world. In more than 90% of cases, squamous cell is found. Treatment is surgical with or without subsequent adjuvant therapy. Patients with tumors have a higher risk of thrombosis, assuming that the underlying pathophysiological mechanism is endothelial dysfunction. The presented case describes the development of acute thrombosis of the right common femoral artery in a patient with late diagnosed carcinoma of the floor of the oral cavity after a consecutive treatment with cisplatin, 5-fluorouracil and cetuximab. A 62-year-old man was diagnosed with squamous cell carcinoma of the floor of the oral cavity, with subsequent surgical resection and radiotherapy. Due to recurrence, a laryngectomy was performed and 6 courses of chemotherapy with cisplatin, 5-fluorouracil and cetuximab were followed. 2 days after the last infusion, acute peripheral arterial thrombosis was developed. Cancer and applied antitumor therapy exert a synergistic effect on coagulation activation. The exact mechanisms by which thrombotic complications occur are not fully understood. They suggest a toxic damage to the vascular endothelium, which leads to a decreased expression of nitric oxide synthetase and, accordingly, vasodilation, a decrease in anticoagulants and an increase in the levels of procoagulants such as tissue factor, which activates coagulation and induces the activation of platelets. The general practitioner occupies a central role in the health care system in a number of countries. In order to be able to perform its complex activities and successfully solve diverse health problems it is necessary to possess specific knowledge and skills from various fields of medicine.

Keywords

• Squamous cell carcinoma
• Thrombotic complications
• General practitioner
• Primary care

Ağız Kavitesi Karsinomlu Hastada Kemoterapi Sonrası Akut Arteriyel Tromboz-Aile Hekimliği Uygulamasında Karar Vermenin Önemi-Olgu Sunumu

Abstract

Ağız kanseri en çok gelişmekte olan ülkelerde görülmekle birlikte dünyanın geri kalanında da görülmektedir. Altta yatan patofizyolojik mekanizmanın endotel disfonksiyonu olduğu varsayıldığında, tümörlü hastalarda tromboz riski daha yüksektir. Sunulan olguda, geç tanı alan karsinomlu bir hastada ardışık kemoterapi sonrasında gelişen akut vasküler tromboz anlatılmaktadır. 62 yaşındaki bir erkeğe ağız boşluğu tabanında skuamöz hücreli karsinom tanısı konuldu ve ardından cerrahi rezeksiyon, radyoterapi ve sisplatin, 5-florourasil ve setuksimab ile kemoterapi uygulandı. Son infüzyondan 2 gün sonra akut periferik arter trombozu gelişti. Kanser ve antitümör tedavisi pıhtılaşma aktivasyonu üzerinde sinerjistik bir etki gösterir. Vasküler endotelde olası bir toksik hasar, nitrik oksit sentetaz ekspresyonunun azalmasına ve buna bağlı olarak vazodilatasyona, antikoagülanların azalmasına ve pıhtılaşmayı aktive eden ve trombositlerin aktivasyonunu indükleyen doku faktörü gibi prokoagülanların seviyelerinde artışa yol açar. Pratisyen hekim birçok ülkede sağlık bakım sisteminde merkezi bir role sahiptir. Karmaşık faaliyetlerini gerçekleştirebilmek ve çeşitli sağlık sorunlarını başarıyla çözebilmek için tıbbın çeşitli alanlarından özel bilgi ve becerilere sahip olmak gerekir.

Keywords

• Skuamöz hücreli karsinom
• Trombotik komplikasyonlar
• Pratisyen hekim
• Birinci basamak sağlık hizmeti

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