1. 1. MD-2204 (Respiratory System) MD-2204 (Respiratory System) PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN MD-2204 (Respiratory System) PROBLEM BASED LEARNING (PBL) Dr Tin Htay Khine Lung Cancer
2. 2. Patients History PROBLEM BASED LEARNING (PBL) 2015
3. 3. 26 year-old man Presented with : Facial swelling Lumps in axillae Chest pain on & off for 3 months Weight loss during past 6 months No medical,surgical or family history Not smoking cigarette but smoked cannabis (2 [14 years-old] 8 [18-24 years-old] joints daily) He was concious & afebrile No evidence of cyanosis He looked pale & cachexic
4. 4. Nail Clubbing
5. 5. Drumstick fingers & watch-glass nails Deformity of the fingers & fingernails Associated with number of diseases Mostly heart & lungs Idiopathic clubbing = rare
6. 6. Sign & symptoms of nail clubbing Fluctuation & softening of the nail bed ( ballotability) Loss of the normal 6month after completing first-line chemotherapy can be treated with that original first-line regimen (typically a platinum- based doublet) again, with and expected response rate of 62-100% Etoposide 50 mg/m2 PO daily for 3wk every 4wkor Topotecan 2.3 mg/m2 PO on days 1-5 every 21dor Topotecan 1.5 mg/m2 IV on days 1-5 every 21dor Carboplatin AUC 5 IV on day 1 plus irinotecan 50 mg/m2 IV on days 1, 8, and 15 every 28do
7. 89. Third-line chemotherapy for relapsed or refractory disease Stage IV disease Etoposide 50 mg/m2 PO daily for 3wk every 4wkor Topotecan 2.3 mg/m2 PO on days 1-5 every 21dor Topotecan 1.5 mg/m2 IV on days 1-5 every 21dor Carboplatin AUC 5 IV on day 1 plus irinotecan 50 mg/m2 IV on days 1, 8, and 15 every 28dor Carboplatin AUC 4-5 IV on day 1 plus irinotecan 150- 200 mg/m2 IV on day 1 every 21d] or Cisplatin 30 mg/m2 IV on days 1, 8, and 15 plus irinotecan 60 mg/m2 IV on days 1, 8, and 15 every 28d
8. 90. CISPLATIN Class: Platinum based atypical alkylator Mechanism of action: binding to DNA - disrupting its function- preventing DNA, RNA ,protein synthesis anti-tumor activity in a wide variety of cancers Cisplatin is rarely used as an individual agent
9. 91. ETOPOSIDE Drug profile Class: Topoisomerase II inhibitor Mechanism of action: inhibits specific enzyme in the cell -unravels DNA strands break -leading to cell death. anti-tumor activity in a wide variety of cancers One of component in drugs regimen to patient prior bone marrow tranplantion
10. 92. CAVE Regimen
11. 93. What CAVE is CAVE is the name of a combination of chemotherapy drugs used to treat small cell lung cancer. It is made up of the drugs C = Cyclophosphamide A = Doxorubicin (also called Adriamycin) V = Vincristine E = Etoposide
12. 94. CAVE chemotherapy as cycles of treatment. Its may have up to 6 cycles Each cycle lasts 3 weeks.
13. 95. Mechanism of Action Etoposide (Toposar, VePesid) is an effective antitumor medication. It slows or stops the growth of cancer cells in the body by causing breakage in the DNA (genetic material) strand. It may be given as an IV injection or as a pill. Cyclophosphamide (Cytoxan, Neosar) interferes with the growth of normal cells and cancer cells. It slows the growth of cancer cells and their spread in the body. It may be given as an IV injection or as a pill.
14. 96. Doxorubicin (Adriamycin, Rubex) causes destruction of DNA, which slows or stops the growth and spread of cancer cells in the body. It is an IV medication. Vincristine (Oncovin) is a plant-based compound. It causes cell death by interfering with the way genetic material (DNA) multiplies in the cell. It is only available as an IV medication
15. 97. Side Effects Tiredness and breathlessness An increased risk of getting an infection Dark marks may occur in the creases of your skin Urine may become a pink or red colour Women may stop having periods but this may be temporary Loss of fertility
16. 98. Vincristine can temporarily stop the normal muscle contractions of the bowel, causing sickness, a swollen abdomen and cramps Sensitivity to sunlight Loss of appetide Metallic taste in mouth or loss of taste Sore mouth and throat, and possibly mouth ulcers
17. 99. A side effect may get worse through your course of treatment This depends on How many times you've had a drug before Your general health How much of the drug you have (the dose) Other drugs you are having
18. 100. Contraindication Pregnant women Breastfeeding women
19. 101. Prognosis of Lung Cancer
20. 102. The prognosis of lung cancer is dependent upon : where the cancer is located size of the cancer presence of symptoms type of lung cancer overall health status of the patient The overall prognosis for lung cancer is poor compared with some other cancers. Survival rates for lung cancer are generally lower than those for most cancers, with an overall 5-year survival rate for lung cancer of about 17% compared to : 67% colon cancer 90% breast cancer 81% bladder cancer 99% prostate cancer
21. 103. Outcomes in lung cancer according to clinical stage Clinical stage Five-year survival (%) Non-small-cell lung carcinoma Small-cell lung carcinoma IA (up to 3cm) 50 38 IB (3-5 cm & nearby tissue) 47 21 IIA (5-7 cm & not in LN or 7 cm but not in LN)) 26 18 IIIA (> 7 cm & in LN) 19 13 IIIB (any size in nearby tissue or in LN of another lung) 7 9 IV (in both lung or in other parts of body) 2 1
22. 104. Small Cell Lung Carcinoma Most aggressive growth of all lung cancers, Most responsive to radiation therapy and chemotherapy. Because SCLC spreads rapidly and is usually disseminated at the time of diagnosis, methods such as surgical removal or localized radiation therapy are less effective in treating this type of lung cancer. When chemotherapy is used alone or in combination with other methods, survival time can be prolonged four- to fivefold Of all patients with SCLC, only 5% to 10% are still alive 5 years after diagnosis
23. 105. Non Small Cell Lung Carcinoma For people with inoperable disease, outcomes are worse in those with poor performance status and weight loss of more than 10% The best prognosis is achieved with complete surgical resection of stage IA disease, with up to 70% five-year survival.
24. 106. Epidemiology of Lung Cancer in Malaysia
25. 107. General view of cancers. Incidence of cancer in Malaysia increased from 32,000 new cases in 2008 to 37,400 in 2012. It is expected to rise to 56,932 by 2025 if no action is taken. World Cancer Day is done yearly on Feb 4 as a reminder.
26. 108. Lung Cancer (LA) 2,048 cases of lung cancer registered with NCR, comprising 1,445 of males and 603 of females. Second most common among males. Third most common cancer among populations in Peninsular Malaysia. Chinese were found to have higher incidence rate compared to Malay and Indians.
27. 109. Health Education for Lung Cancer
28. 110. Risk Factor People who smoke People exposed to second-hand smoke People exposed to indoor and outdoor air pollution People exposed to certain toxic substances, such as arsenic, radon or asbestos People whose jobs expose them to radiation People with personal or family histories of lung cancer
29. 111. So the advice here is.. Smoking is the most important risk factor for lung cancer. Dont smoke. If you smoke, quit. Stay away from second-hand smoke Make your home and community smoke-free. Eat lots of fruits and vegetables. Some research says being physically active may reduce your risk
30. 112. Stay away from air pollution, wear mask if working in a polluted area. Check your home for radon.(considered as the second leading cause of lung cancer and leading environmental cause of cancer mortality) Follow the guidelines of handling radioactive material eg. Experiment or work Early detection by low-dose helical CT scans reduced the rate of death from lung cancer.
31. 113. OK! TQ FOR UR ATTENTION