Case Presentation

Fikadu

Pt. Info..

Age: 64! Sex: Female! Treated at the James Cancer Hospital

Pt. Medical History..

Sinus Trouble! Bronchitis! Hypertension! GERD! Deviated Septum! Hemangioma! Degenerative joint disease! Rib Fracture

Pt. Social History..

Married! Smoker! Currently: smokes some days! Smoked: 0.5-1 pack/day for 30yrs! Alcohol user! 0.5 oz/week & 1 shot/week

History of Present Illness..

Pt. went to see primary Dr. with complaints consistent with sinus infection. !
She received antibiotics!
Symptoms of sinus infection depend upon which of the sinuses are affected, but, may include: pain or pressure in different areas of the face or head that may get worse when coughing, sneezing, bending over, lying down or sitting upright headache of varying degrees, depending on which sinuses are infected nasal discharge visual disturbances fever sore throat

History of Present Illness..

She experienced recurrent upper respiratory symptoms! Later, she developed a persistent cough.! Chest x-ray showed a shadow in the left upper lobe.

History of Present Illness..

History of Present Illness..

Pts symptom went away, so she went on living her normal life for months.! During a follow-up CT of the chest! 1.4cm LUL nodule was noted.

History of Present Illness..

History of Present Illness..

Given the result of her CT Scan, what other diagnostic studies would you recommend/order as her physician? Why would you order each?

History of Present Illness..

1. PET/CT ! Used to see the extent of malignancy for staging. ! 2. MRI! To check for brain mets as lung ca. tends to metastasize to the brain. ! Lymphatics & Hematologic are the two main routs of spread for Lung ca.

History of Present Illness..

History of Present Illness..

PET/CT impression:! the increased FDG uptake in this lesion was concerning for malignancy! Therefore, needle biopsy was done. ! The result revealed! ???

Review..
What are the two types of lung Cancer?

Review..
What are the two types of lung Cancer?!
!

Small Cell !
!

Non-Small Cell

Review..

Given her history, which of the two types would you guess?

Review..

Small Cell !

Pathology Result..

Needle biopsy did reveal ! Limited Stage SCLC.

Review..
About 10% - 15% of Lung cancers are small cell.! Heavily associated with smoking! Staging ! Limited -- RT with Chemo, maybe surgery! Extensive -- Chemo or Clinical trial

Question..

What is another common name for Small Cell Lung Cancer?

Answer..

Oat Cell ca.

Lung..
Respiratory organ.! Air passes through! Trachea! L&R Main-stem bronchi! Secondary bronchi! Tertiary bronchi! Bronchioles! Alveoli

Lung Ca..
Lung cancer is the 1st cause of cancer death in men and women.! 2nd in incidence in men and women. ! Can be any where in the lungs.! Can directly invade Mediastinal structures as! Esophagus, Trachea, Blood Vessels! Estimated new cases: over 200,000 in 2013! Estimated death from Lung ca: over 150,000 in 2013

Lung Ca..
Staging! Small Cell! Limited: confined to 1 lung and Neighboring lymph nodes! Extensive: 1 or both lungs and any # of lymph nodes including distant! Non-Small Cell! Stage I: no lymph node involvement ! Stage II: confined to a small area and surrounding lymphs! Stage III: involving lymph nodes in the middle of the chest! Stage IV: Mets

Lung Ca..
Risk Factors:! Tobacco ! Secondary smoke! Chemicals! Pollution! Asbestos

Lung ca..
More common in men than women! More common in urban areas! More common in areas with! lower socioeconomic status! less educated people! Common with African-Americans

Etiology..

Mortality..

Lung ca..

Lung ca..
Presenting Symptoms include! A persistent cough! Chest pain! Hoarseness ! Weight loss or loss of appetite ! Coughing up blood ! Shortness of breath ! Feeling tired or weak ! Chronic bronchitis or pneumonia!
Wheezing

Lung Ca..
Diagnostic tests include! CT! PET! MRI! Lymph node biopsy -- excision of lymph nodes for further examination! Endoscopic study --- using an endoscope! Mediastinoscopy -- endoscope inserted into the mediastinum after incision to see lymph nodes! Pulmonary function test -- to see how well the lungs are functioning

Lung Ca..

Lymph node include

Lung ca..
Treatment options!
Surgery!
Only 1/5th of patients are candidates.! Pneumonectomy, Lobectomy, Wedge resection & Sleeve resection (Bronchi)! RT: prescribed 7000cGy @200cGy/fx.! Chemo : had Cisplatin/etoposide, Carboplatin

Lung Ca..
Patient treated at the James.! Set-up ! Supine on a wing board,! Arms overhead, ! Knee sponge.! She always asked for warm blanket.

Lung Ca..

Lung Ca..
! ! ! ! ! ! !

Lung (1/3- 4500cGy)! Heart (3/3- 4000cGy) ! Esophagus (1/3- 6000cGy)!

Lung Ca..

AP.

Lung Ca.

G125

Lung Ca.

305

Lung Ca.

PA

Lung Ca.

Side effects! She had trouble sleeping.! Using magic mouthwash for lower esophagial irritation.! Fatigue!

!
Chemotherapy Agents

Carboplatin: IV over 1 hour on Day 1 of each 21-day cycle.

Side effects: Moderate nausea/vomiting, myelosuppression, and fatigue.

!
Etoposide: On days 3, 4, & 5 (seperated from carboplatin for concern of allergic reaction), at home she takes Etoposide 50 mg capsules as prescribed.

Side effects: myelosuppression, fatigue, hair loss.

References
! American Cancer Society. Lung Cancer. http://www.cancer.org/

cancer/lungcancer-non-smallcell/detailedguide/non-small-celllung-cancer-what-is-non-small-cell-lung-cancer. Reviewed 12 July 2013. Accessed 15 September 2013. " ! American Cancer Society. Lung Cancer(Small Cell). http:// www.cancer.org/cancer/lungcancer-smallcell/detailedguide/smallcell-lung-cancer-what-is-small-cell-lung-cancer. Reviewed 12 July 2013. Accessed 15 September 2013. " ! American Lung Association. Lung Cancer Fact Sheet. http:// www.lung.org/lung-disease/lung-cancer/resources/facts-figures/ lung-cancer-fact-sheet.html. Accessed 15 September 2013. " ! National Cancer Institute. Lung Cancer. http://www.cancer.gov/ cancertopics/types/lung. Accessed 15 September 2013.