INTERACTIVE CASE DISCUSSION 2CHEST B

ALCARAZ, ALLEGRE, ALMORA, ALONZO, AMARO, AMOLENDA,

ANACTA, ANDAL, ANG, J.

General Data

• A.T., 78 y.o., female

• Pertinent data that should have been asked:– Occupation

Chief Complaint

• Chronic cough

History Of Present Illness

6 months PTA •non-productive cough

•no consultation

2 months PTA

•cough, becoming productive•low grade fever•loss of appetite

2 weeks PTA•productive cough•low grade fever•dyspnea•weight loss

ADMISSION

History Of Present Illness

• Pertinent data that should have been asked:– Timing

• Onset, duration, frequency– Character

• Severity– Associated events or accompanying symptoms– Relieving and aggravating factors– Quantify weight loss

Past Medical History

• No previous surgeries• No allergies• Non-hypertensive• Non-diabetic• (+) COPD

• Pertinent data that should have been asked:– Date of diagnosis of COPD

Family History

• (-) Diabetes• (-) Hypertension/Heart disease• (-) Asthma/Allergies• (+) COPD

• Pertinent data that should have been asked:– Family history of cancer or malignancies– Exposure to TB

Personal/Social History

• 30 pack year smoking history• Occasional alcoholic beverage drinker

• Pertinent data that should have been asked:– Diet and exercise– Environmental data (living condition)

Review Of Systems

• No weakness• No headache• No cyanosis• No edema

• (+) Fatigue• (+) Dyspnea• (+) Occasional chest pain

Physical Examination

• Vital Signs: BP = 120/80PR = 100bpmRR = 24cpmTemp= 37.5°C

Physical Examination• Conscious, coherent, ambulatory• Pink palpebral conjunctiva, anicteric sclera• Moist buccal mucosa, non hyperemic PPW• Supple neck, no palpable cervical lymph nodes• Adynamic precordium, apex beat 5th LICS MCL, no

murmurs• Symmetrical chest expansion, no retractions, (+)

occasional wheeze, RUL• Flat abdomen, NABS, soft, non tender• No cyanosis, pulses full and equal

Salient Features

Subjective• 78 y.o., female• Chronic cough (productive)• Occasional chest pain• Dyspnea• Low grade fever• Fatigue• Weight loss• COPD• 30 pack year smoking

Objective• Tachypnea (RR=24cpm)• Fever (37.5°C)• Occasional wheeze, RUL

TREATMENT

General Measures

• Treatment is determined by the extent of the spread

• Surgery to remove all of the lung (pneumonectomy) or part of the lung (lobectomy) may be recommended if cancer is at an early stage

• Treatment options depend upon TNM staging• Radiation may be recommended

Medications

• Chemotherapy with multiple drugs, cisplatin and topoisomerase inhibitors (with or without radiation therapy), has yielded higher survival rates than surgery particularly in patients with small cell carcinoma– Some improved results with drugs have been

reported, but studies to determine the most effective chemotherapeutic combination are ongoing

• Pain killers (narcotic analgesics) for palliation

Palliative Treatments

• May involve radiation therapy and is geared toward alleviating symptoms

• Research about alternative therapies, such as vaccines and immunotherapy, are currently in progress

Non-Small Cell Lung Cancer

• Surgery offers the best chance for curing and is recommended if the patient is a viable candidate– Only 25% of lung cancer patients are considered

to be surgical candidates at the time of diagnosis• Radiation controls local disease and is most

commonly used to palliate symptoms– 10-20% of localized disease can be cured

Non-Small Cell Lung Cancer

• Chemotherapy and/or radiation therapy may be considered after surgery for cancer that has progressed to advanced stages– Radiation plus Cisplatin-based chemotherapy are

recommended if the patient is not a surgical candidate

Small Cell Carcinoma

• Chemoterapy is the cornerstone of treatement– Regimens containing etoposide and either

carboplatin or cisplatin is belived to offer the best combination of efficacy and lack of toxicity

• Surgery is not considered helpful because small cell carcinoma has usually spread at the time of diagnosis

PROGNOSIS

Prognosis

• Without surgery, this condition is currently considered incurable, early diagnosis is critical– If lung cancer is caught in its early stages, the

survival rate is approximately 50%• Recurrence is common• The five-year survival rate for all diagnosed

lung cancers is 10-15%

References

• http://www.ecureme.com/emyhealth/data/Bronchogenic_Carcinoma.asp

• http://www.rxmed.com/b.main/b1.illness/b1.1.illnesses/Bronchogenic%20Carcinoma.html

• http://www.medstudents.com.br/pneumo/pneumo7/pneumo7.htm