[os 213] Sgd 01 Malignancy (b)-1

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OS 213: Human Disease Treatment 3 (Circulation and Respiration) Respiration) SGD 01: MAL!"A"C#  O$TL"% Case 1 Case 2 Case 3 Case  Genera! "otes CAS% 1 R&S&' ' M CC: #$g%t !ung nodu!e • • • o o H*: 2 mo PTC C&# done done 'or emp!o( emp!o(men mentt purpo purposes ses re)ea re)ea!e !ed d a o solitary pulmonary nodule measuring approx. 2 cm Px den$ed ot%er s(mptoms except 'or an o occasional dry, non-productive cough d$agnosed *$t% P+ and *as g$)en ant$-+ meds o regu!ar!( ta.en ta.en 'or 2 mont%s  After 2 months repe repeat at c%es c%estt &-ra( -ra( *as *as done done and and re)e re)ea! a!ed ed an o increase in the size of mass to 3cm o c%est c%est C+ scan re)e re)ea!e a!ed d 3.5 x 2.8 cm enhancing mass as s at S/PE#O# SEGME"+ O # /PPE# /"G 4-5 en!arged per$6ronc%$a!, %$!ar, med$ast$na! nodes o o st$!! st$!! no ot%er s(mptoms except except 'or occasional dry  cough *MH+: /nremar.a6!e 4/7#5 *SS+: 485 Smo.$ng: 1 pac.7da( 'or 20 (ears 420 pac. (ears5 ROS: 4-5 anorex$a, %eadac%e, *e$g%t !oss, 6ac. pa$n, %emopt(s$s *%:  4-5 pa!pa6!e !(mp% nodes, C!ear !ung 9e!ds, /7# a6domen A supr suprac ac!a !a)$ )$cu cu!a !arr mass mass due due to a Panco ancoas astt tumor 4ap$ca! tumor $n)o!)$ng C? and +1-2 ner)es caus$ng s%ou!der pa$n rad$at$ng do*n to t%e arm5 S@C s(ndrome 4upper extrem$t( s*e!!$ng *$t% or *$t%out 'ac$a! s*e!!$ng due to )ascu!ar o6struct$on5 C!u66$ng o' 9ngers and adenopat%( suggest$)e 46ut not pat%ognomon$c5 o' an under!($ng ma!$gnanc( Ta0le 1& Dia,nostic *rocedures C%est &-#a( tumor in the lungs en!argement $n t%e med$ast$num due to en!arged !(mp% node opac$t( or *%$te-out !ung ma( $nd$cate presence o' ma!$gnanc( or tu6ercu!os$s ot%er t%orac$c causes C%est and localizing tumors , espec$a!!( A6dom$na! C+ centra! masses not )$sua!$ed $n Scan c%est &-ra( metastasis if present! " commonly in the #rain and adrenal glands determ$n$ng t%e presence o' Bu$d ass$st $n 6$ops( procedures 4C+ GA5 Pos$tron Em$ss$on )$sua!$e tumors 1 cm $n  +omograp%(  +omograp%( d$ameter, ma!$gnant !es$ons and 4PE+5 Scan so!$tar( pu!monar( nodu!es a$d $n stag$ng med$ast$na! tumors #7O act$)e $n'ect$on 4a!so ta.e up g!ucose5 Expens$)e /sua!!( n ot recommended one Scan detect 6one metastas$s7es Magnet$c determ$ne determ$ne 6ra$n 6ra$n metastas$ metastas$s s and #esonance sp$na! compress$on mag$ng 4M#5 ru!e out 4#7O5 Potts d$sease C%est /!trasound eus$on locate lung tumors extent o' tumor $n9!trat$on guide needle during thoracentesis or #iopsy. =$stopat%o!og( detect cancer cells spec$a! sta$ns 4ac$d 'ast5 to #7O +  +%oracentes$s dra$n Bu$d 'rom p!eura! eus$on co!! co!!ec ectt samp samp!e !es s 'or 'or %$st %$sto! o!og og$c $c exam, presence o'   serosangu$nous Bu$d $s $nd$cat$)e o' ma!$gnanc( ma!$gnanc( and and to determ$ne $' t%e Bu$d $s a transudate or exudates $ne "eed!e  +o  +o co!!ect samp!es 'rom t%e Asp$rat$on $ops( !es$ !es$on ons s t%at t%at are are too too !arg !arge e to 4"A5 exc$se 'or c(to!og$c e)a!uat$on usua!!( C+-gu$ded ronc%oscop( can a!so 6e used $'  t%e !es$on $s centra!!( !ocated Exc$s$on $ops( $' mass $s not too !arge P!eura! $ops( samp!es 'rom p!eura! t$ssue ronc%oscop( evaluate lung lesions  4esp centra!5 $n)est$gate unexp!a$ned %emopt(s$s or ad)ent$t$ous !ung sounds o6ta$n mater$a!s 'or m$cro6$o!og$c stud$es •  • • • • •  • • • • • Dia,nosis 4"ote  'rom t%e transers: Case 1 conta$ns a!! genera! data app!$ca6 app!$ca6!e !e to !ung ma!$gnan ma!$gnanc$es c$es Italicized Italicized and underlined p%rases are app!$ca6!e to Case 15 As *$t% d$agnos$ng an( d$sease cond$t$on 4$n t%$s case, and $n a!! ot%er cases cases (ou (ou *$!! *$!! encoun encounter ter5, 5, t%e most most cruc$a! $n$t$a! step $s a t%oroug% %$stor( and p%(s$ca! exam$nat$on -. H+: Sx o' !ung cancer can ar$se 'rom 1oca! mass eects and s(stem$c eects S(mptoms re!ated to tumor $tse!': %emopt(s$s and c%est pa$n Const$ Const$tut tut$on $ona! a! non-sp non-spec$ ec$9c 9c s(mpt s(mptoms oms suc% suc% as: anorex$a, *e$g%t !oss, 'e)ers7n$g%t s*eats  +umor  +umor mass eects suc% as coug% due to ner)e $rr$ $rr$ta tat$ t$on on,, %oar %oarse sene ness ss due due to comp compre ress ss$o $on n o'  recu recurr rren entt !ar( !ar(ng ngea ea!! ner) ner)e, e, and and 'ac$ 'ac$a! a!7u 7upp pper er extrem$t( s(ndrome 2Eects o' metastat$c d$sease 6one, p!eura, 6ra$n, !$)er, and adrena! g!ands 3E Eects o' products produced 6( t%e tumor 4paraneop!ast$c s(ndromes5 • • • • ;Mos ;Mostt !ung !ung canc cancer ers s ar$s ar$se e $n pat$ pat$en ents ts *$t% *$t% a   long smoking history < t%e s(mptoms o' cough and d(spnea are are re!at e!at$) $)e! e!( ( nonnon-sp spec ec$9 $9c c =o*e =o*e)e )er, r, an acute c/an,e $n pre)$ous!( sta6!e s(mptoms can 6e a c!ue to an under!($ng ma!$gnanc( • -. *%: C!ass$c PE 9nd$ngs assoc$ated *$t% !ung CAs: =orner =orner>s >s s(ndr s(ndrome ome 4s(mpa 4s(mpat%e t%et$c t$c gang! gang!$on $on d(s'unct$ d(s'unct$on on *$t% ptos$s, ptos$s, m$os$s, m$os$s, enopt%a!m enopt%a!mos os and an%(dros$s5 C%S' M' OLO • • • • • •  • •  •  • • • • • • • • • • • $*CM 21 -: &@, a!ang Fapanta( 1 o4  OS 213: Human Disease Treatment 3 (Circulation and Respiration) SGD 01: MAL!"A"C#  Med$ast$noscop(  +%oracoscop( Pu!monar( unct$on +est 4P+5 CC • • • • • • n com6$nat$on *$t% c%emot%erap(: treat t%e tumor and !(mp% nodes $n t%e c%est< $mpro)e 3-(ear sur)$)a! rates, espec$a!!( $n pat$ents !ess t%an I (ears o!d A'ter c%emot%erap(: .$!! an( sma!! depos$ts o'  o cancer t%at ma( rema$n C/emot/erap. - ma$n treatment 'or SCC Suprasterna! approac% to o6ta$n spec$mens 'rom med$ast$na! nodes )$sua!$$ng and 6$ops( o' p!eura! and med$ast$na! nodes esta6!$s% $' d(spnea $s card$ac or pu!monar( $n or$g$n #7O ot%er d$erent$a!s esta6!$s% $' pa!!or $s due to anem$a determ$ne t%e pat$ent>s 6!ood t(pe $' trans'us$on $s needed (M*ORTA"T "ote: A pat$ent *%o $s male, $%5 years old, &ith history of smoking, presenting &ith a solitary pulmonary nodule, s%ou!d a!*a(s 6e cons$dered to %a)e !ung CA un!ess pro)en ot%er*$se5 Sta,in, ("ote: See t%e ecture Ma!$gnanc$es 'or t%$s part5 trans o ("ote: or more comp!ete !$sts and deta$!s on t%e drugs used 6( ung Cancer pat$ents, see t%e ecture trans on O)er)$e* o' ung Ma!$gnanc$es5 Tar,eted T/erap. • • • on O)er)$e* o' ung Tumor tissue o0tained: 1 ( 6ronc%$a!7trans6ronc%$a! 6$ops( dur$ng O 2 ( node 6$ops( dur$ng med$ast$noscop( 3 rom operat$)e spec$men at t%e t$me o'   de9n$t$)e surg$ca! resect$on  ( percutaneous 6$ops( o' en!arged !(mp% node, so't t$ssue mass, !(t$c 6one !es$on, 6one marro* or p!eura! eus$on 'y ()*' + uided!  H Pre'erred 'or  t%$s Px 6ecause o' t%e per$p%era! !ocat$on o' t%e !es$on I rom adeJuate ce!! 6!oc. 'rom a ma!$gnant p!eura! eus$on • • • • • • • Cancer Sta,in,: /s$ng t%e +"M gu$de!$ne: T1 " M  Sta,e A 4"ote: Pat$ents usua!!( come $n !ate or ad)anced stages, se!dom!( ear!(5 Mana,ement • • • • Counselin, toget%er *$t% t%e pat$ent>s 'am$!( 3C6s: Copin,' Communicatin,' Connectin,  ADVISE TO QUIT SMOKING!!! Good 6a!anced d$et, exerc$se A)o$d cancer r$s.s: as6estos, rad$at$on exp!a$n$ng %$s cond$t$on: natura! %$stor( o' t%e d$sease 4stage o' %$s d$sease5, prognos$s, treatment opt$ons nter7ention Options Surgery  - cons$dered $' cancer $s on!( sma!! and !oca!$ed to one tumor nodu!e o Pneumonectom( o6ectom( - pre'erred operat$on 'or SCC o Segmentectom( o Radiation T/erap. - g$)en $n pat$ent *$t% SCC $n t%e  s$tuat$ons: C%S' M' OLO 8ollo9$p C%ec.-up e)er( 2mo post-treatment CA pat$ents s%ou!d 6e educated a6out s$gns and s(mptoms o' recurrence and potent$a! ad)erse eects re!ated to t%erap( Mon$tor$ng *$t%: C&#, C%est C+Sc $)er /+S e)er( I mont%s one scan e)er( (ear Cran$a! C+Sc $' *$t% 'reJuent %eadac%e or s$gns o' $nc CP CAS% 2 ' M' 8ilipino CC: Coug%, m$!d d$cu!t( o' 6reat%$ng, and progress$)e %$p pa$n T"M Classi5cation: used $n stag$ng "SCC>s 3.5x2.8 cm superior /0, no note of enlarged  peri#ronchial, hilar or mediastinal nodes1 'ut needs other modalities to rule out possi#le metastasis Complementar. Met/ods and *alliati7e Care G$)en a'ter c%emot%erap( sess$ons and t%roug%out treatment as an adKunct to t%erap(, or to reduce t%e s$de eects =e!p t%e pat$ent 'ee! 6etter and add to pat$entLs com'ort Ex med$tat$on to reduce stress, acupuncture to o pepperm$nt tea to re!$e)e relieve pain, nausea , aromatherapy , massage therapy , yoga Pa$n med$cat$on, pa!!$at$)e care, s(mptomat$c t%erap( 4'or d$cu!t( 6reat%$ng, etc5 can a!so 6e g$)en as necessar( Group Counse!$ng7+%erap( • H*: C&# re)ea!ed pu!monar( mass at t%e # upper !ung *$t% 2 nodu!es on t%e  upper and m$d-!ung 9e!ds *MH+: /7# *SS+: 485 smo.$ng: 0 pac. (ears ROS: 485 'ac$a! s*e!!$ng upon a*a.en$ng, *e$g%t !oss, anorex$a 4-5 %eadac%e, a6dom$na! pa$n, or %emopt(s$s *%: 2x2 cm %ard, 9xed r$g%t suprac!a)$cu!ar node, decreased 6reat% sounds at t%e r$g%t upper !ung 9e!d *$t% du!!ness to percuss$on, and occas$ona! $nsp$rator( *%ee$ng on a!! !ung 9e!ds Dia,nosis Ta0le 2& Di;erentials (Case 2) Disease Reason 4or R< SCC 485 Pu!monar( mass 485 Coug% 485 D(spnea 485 ac$a! s*e!!$ng 4p!et%ora5 485 e$g%t !oss Smo.$ng %x: N • • • • • • • • • Reason 4or Ror=in, mpression: non small cell' s?uamous cell lun, CA I (o, M, Smo.er, *$t% Pu!monar( Mass   pro6a6!( ma!$gnanc( Coug%, d(spnea  Common man$'estat$on o' pu!monar( d$sease< cou!d 6e due to compress$on o' a$r*a( 6( a mass $n t%$s case ac$a! s*e!!$ng upon a*a.en$ng  Cou!d 6e due to t%e compress$on o' t%e Super$or @ena Ca)a 4S@C s(ndrome5 6( t%e mass on t%e r$g%t upper !ung *%$!e on sup$ne pos$t$on 4s!eep$ng5 e$g%t !oss, anorex$a  Eect o' cancer  +*o nodu!es on  upper  m$d !ung 9e!d  Metastas$s to t%e  !ung =ard, 9xed # suprac!a)$cu!ar node  "oda! metastas$s 'rom # !ung Progress$)e %$p pa$n  Metastas$s to t%e %$p 6one Dia,nostic *rocedures C@R and C/est CT Scan A0dominal and Cranial CT Scan' -one Scan: detect metastas$s -iops.: "A o' t%e suprac!a)$cu!ar node, ronc%oscop( o' med$ast$na! !(mp% nodes 4'or poss$6!e metastas$s< t%e more spec$mens, t%e 6etter5 *%T scan: detects *$despread metastases< 6ut  aga$n, expens$)e  Sputum c.tolo,.: $' 485, #7O %ead and nec. pr$mar( !es$ons Mana,ement Counselin, 4see Case 1 Q Management Q Counse!$ng5 • • • • • • • • • •  Ancillar. Tests: paraneoplasms C%S' M' OLO ma$n!( Sta,in, T"3M1  Sta,e B Lun, CA  + H 2 x 2 cm %ard suprac!a)$cu!ar node "3 H $n)o!)ement o' med$ast$na! and contra!atera! !(mp% nodes M1 H presence o' metastas$s to suprac!a)$cu!ar node and %$p @er( poor Prognos$s Med$an sur)$)a! 'or untreated pat$ents *$t% Stage @ 6ronc%ogen$c CA:  -I mont%s  -(ear sur)$)a! rate: 2 Sur)$)a! t$me $mp.ro)es *$t% c%emot%erap( and ot%er targeted t%erap$es 'or detect$on • • • • nter7ention Options S(mptomat$c Management pa$n: g$)e non-op$o$ds 9rst 6e'ore mo)$ng on to o stronger drugs !$.e morp%$ne *%en t%e pa$n $s a!read( un6eara6!e coug% 4and %emopt(s$s5: can 6e treated o p%armaco!og$ca!!( Pa!!$at$)e rad$ot%erap( O#: ronc%$a! o6struct$on *$t% pneumon$t$s, o %emopt(s$s, upper a$r*a( or S@C o6struct$on 6ra$n or spinal cord compression  4$mportant5, or pa$n'u! 6on( metastases  t pro)$des re!$e' o' $ntrat%orac$c s(mptoms: o =emopt(s$s 4?5, S@C s(ndrome 4?05, D(spnea o 4I05, Coug% 4I05, Ate!ectas$s 4235, @oca! cord para!(s$s 4I5 o A!so 'or: card$ac tamponade, pa$n'u! 6on( metastas$s, C"S compress$on, 6rac%$a! p!exus $n)o!)ement C%emot%erap(: Pa!!$ates s(mptoms, $mpro)es RO, and $mpro)es sur)$)a! $n ne*!(-d$agnosed pat$ents o $rst-!$ne: C$sp!at$n or Car6op!ate$ne, +exane 4pac!$taxe!, docetaxe!5, Gem$c$ta6$ne o Second-!$ne: Docetaxe! or pemetrexed Gro*t% 'actor support $s rare!( needed EG# +argeted +%erap(: Er!ot$n$6 42 nd or 3rd !$ne5 Pro!ong ssur)$)a!, Second or +%$rd !$ne t%erap( o o @er( expens$)e Management 'or one Metastas$s o #ad$ot%erap( $sp%osp%onates: reduce secondar( c!ose, pre)ent o Comp!ementar( Met%ods and Pa!!$at$)e Care ("ote: n s?uamous cell lun, CA' .ou 9ill not ,i7e -e7aciuma0 4*%$c% $s an ang$ogenes$s $n%$6$tor5  *$!! cause t%e pat$ent to 6!eed out5 o'   $*CM 21 -: &@, a!ang Fapanta( 3 o4  OS 213: Human Disease Treatment 3 (Circulation and Respiration) SGD 01: MAL!"A"C#  CAS% 3 Pu!monar( em6o!$sm 2' M CC: non-product$)e, assoc$ated *$t% 6ac. pa$n • H*:  mo PTC o "on-product$)e progress$ng coug%, assoc p!eura! c%est pa$n  "#ys PTC 485 =emopt(s$s, at$gue, Anorex$a o • • Pneumon$a ROS: 485 30  *e$g%t !oss< 4-5 %eadac%e, a6dom$na! pa$n, 6ac. pa$n *%: S!$g%t!( cac%ex$c, no pa!pa6!e nodes, occas$ona! *%ee$ng at a!! !ung 9e!ds C@R: arge 6u!.( mass *$t% %$!ar adenopat%( • • • • • • CT Scan: 3x cm tumor $n)ad$ng t%e # ma$n 6ronc%us, 3 cm d$sta! to car$na Ate!ectas$s at %$!ar reg$on En!arged $ps$!atera! %$!ar and med$ast$na! !(mp% nodes Dia,nosis Ta0le 3& Di;erentials (Case 3) Disease Reason 4or R< ronc%oge 10 pac.-(ear n$c CA smo.$ng 4SCC5 485 unproduct$)e coug% 'or 1 mo 485 occas$ona! p!eur$t$c c%est pa$n 485 =emopt(s$s 485 Anorex$a, *e$g%t !oss 485 *%ee$ng $n a!! !ung areas on PE arge 6u!.( mass *$t% %$!ar adenopat%( on C&# 3x tumor $n)ad$ng # ma$n 6ronc%us En!arged $ps$!atera! %$!ar and med$ast$na! !(mp% nodes Ate!ectas$s at %$!ar reg$on on C+ Pu!monar( 10 pac.-(ear  +u6ercu!os$ smo.$ng s 485 unproduct$)e coug% 'or 1 mo 485 occas$ona! p!eur$t$c c%est pa$n 485 =emopt(s$s 485 Anorex$a, *e$g%t !oss arge 6u!.( mass *$t% %$!ar adenopat%( on C&# Reason 4or Ror=in, mpression: Small cell lun, CA Ar$ses $n per$6ronc%$a! !ocat$ons and $n9!trate t%e 6ronc%$a! su6mucosa /sua!!( occurs $n t%e 6$g a$r*a(s 4%$!ar  centra!5 @er( rap$d progress$on and %$g%!( ma!$gnant Smo.$ng $s a r$s. 'actor 4as *e!! as 6e$ng ma!e5 Common spread $s to t%e med$ast$na! !(mp% nodes, !$)er, 6ones, adrena! g!ands and 6ra$n  LimitedSta,e  Counselin, 4see Case 1 Q Management Q Counse!$ng5 • • • • C%S' M' OLO • 4-5 e)$dence o' eus$on 4transudat$)e or exudat$)e5 no reported d(spnea Mana,ement • • • Con5nement to one Hemit/ora+ Disease • • • Sta,in,  +"M C!ass$9cat$on $s not used $n stag$ng SCC nstead, *e descr$6e t%e ma!$gnanc( as Limited or %+tensi7e Limited $m$ted to one s$de o' t%e c%est o Can 6e treated *$t% suc$ent rad$at$on t%erap( o Prognos$s: 20 mont%s, 2-(ear sur)$)a! rate o' 2, o -(ear sur)$)a! rate o' 20 %+tensi7e o Spread to ot%er s$de and7or ot%er d$stant organs 4$nc!ud$ng p!eura!7per$card$a! eus$on or %ematogenous metastases5 Prognos$s: 12 mont%s, 2-(ear sur)$)a! rate o' I o • • 10 pac.-(ear smo.$ng 485 unproduct$)e coug% 'or 1 mo 485 occas$ona! p!eur$t$c c%est pa$n 485 =emopt(s$s 485 unproduct$)e coug% 'or 1 mo 485 occas$ona! p!eur$t$c c%est pa$n Dia,nostic *rocedures  C&#, C+ Scan -iops.: ronc%oscop( *$t% 6$ops(, C+ scand$rected need!e 6$ops(' Endoscop$c esop%agea! u!trasound *7 6$ops(' Med$ast$noscop( *7 6$ops( ' Open !ung 6$ops( ' P!eura! 6$ops( Ancillar. Tests: CC *$t% p!ate!et count' Serum e!ectro!(tes, g!ucose, ca!c$um, $)er unct$on  +ests 4A+, AS+5, #ena! unct$on +est, ECG, one Scan, PE+ Scan • • • • *MH+: /7# *SS+: 485 smo.$ng: 10 pac. (ear • • 4-5 n$g%t s*eats, 'e)er no tests done 'or A smear7cu!ture • nter7ention Options C%emot%erap(: %topside cisplatin < car0oplatin o C#x doses ma( 6e adKusted on t%e 6as$s o' nad$r o granu!oc(te counts !ood *or. 8CC $s needed pr$or to eac% c(c!e o'  o c%emot%erap( to ensure marro* reco)er( 6e'ore t%e next dose o' c%emot%erap( $s adm$n$stered Serum D= $s a good mar.er 'or response and o s%ou!d 6e mon$tored #ena! 'unct$on s%ou!d 6e mon$tored 6ecause o'  o nep%rotox$c$t( 'rom c$sp!at$n o C+ scans s%ou!d 6e o6ta$ned a'ter 2 c(c!es o'  t%erap( to assess response 4$' aorded5 $*CM 21 -: &@, a!ang Fapanta(  o4  OS 213: Human Disease Treatment 3 (Circulation and Respiration) SGD 01: MAL!"A"C#  • • #ad$ot%erap( n com6$nat$on *$t% C%emot%erap( o Ma$n treatment 'or our case *$!! cons$st o'  o com6$nat$on C%emot%erap( and c%est $rrad$at$on 4etopos$de p!us c$sp!at$n p!us  G( c%est rad$at$on t%erap(5 *RO*H#LACTC -RA" RADATO" TH%RA*#  o (*-RT)  ung CA can metastas$e to t%e 6ra$n H around I0 o' contro!!ed !ung CA  P#+ reduces t%e c%ance o' metastas$s to t%e 6ra$n  Px s%ou!d 6e ad)$sed o' t%e poss$6!e cogn$t$)e de9c$ts as a resu!t o' P#+ Supporti7e and Ot/er Considerations: Ant$emet$cs, !u$d support *$t% C$sp!at$n, Mon$tor$ng 'or 6!ood counts and 6!ood c%em$str(, s$gns o' 6!eed$ng and $n'ect$on, Poss$6!e !ood +rans'us$ons 'or t%e %emopt(s$s 4$' mass$)e5, "utr$t$on t%erap( 'or s$gns o' cac%ex$a, Ana!ges$cs 4'or t%e p!eur$t$c c%est pa$n5, Coug% suppressants, $' coug% 6ecomes uncom'orta6!e, ' reJu$red, use o' %emopo$et$ns 4treatment 'or anem$a5 Complementar. Met/ods and *alliati7e care Cac%ex$a and *e$g%t !oss suggest s(stem$c spread Su6car$na! and per$%$!ar !(mp%adenopat%( 46ronc%ogen$c CA5 Sma!! ce!! 485 c%ron$c coug% /sua!!( presents !ung *$t% centra! 485 *orsen$ng or carc$noma endo6ronc%$a! ne* d(spnea (SCLC) tumor 485 *e$g%t !oss 4-5 %eadac%e upon 485 %emopt(s$s consu!t 485 p!eur$t$c pa$n 485 decreased 6reat% sounds< du!! on percuss$on Cac%ex$a and *e$g%t !oss suggest s(stem$c spread Pu!monar( Smo.$ng %x 4-5 n$g%t s*eat$ng  +u6ercu!os$ 485 coug%, 4-5 ort%opnea, s %emopt(s$s P"D 485 c%est pa$n 485 *e$g%t !oss, anorex$a 485 per$%$!ar and su6car$na! !(mp%adenopat%( 4remem6er #an.e>s comp!ex5 *rimar. >or=in, mpression: S?uamous Cell Carcinoma Presence o' resp$rator( s(mptoms due to a poss$6!e !ung tumor 4coug%, d(spnea, %emopt(s$s - possi#le rich #lood supply of tumor! decreased 6reat% sounds at t%e r$g%t upper !ung 9e!ds *$t% du!!ness to percuss$on S$gns suggest$ng t%e presence o' a ma!$gnanc(: *e$g%t !oss, anorex$a, !(mp%adenopat%( mag$ng stud$es re)ea! a mass at t%e r$g%t apex =$stor( o' smo.$ng • • • • • • • • • • • • • • • • CAS%  ' M CC: C%ron$c coug% and *e$g%t !oss • • H*: $ mo PTC% c%ron$c coug% and *e$g%t !oss *MH+: sc%em$c =eart D$sease d$agnosed 2 (ears ago  +x: $sosor6$de monon$trate and asp$r$n "o recent attac.s o' c%est pa$n • *SS+: 485 smo.$ng, a!co%o! 4occas$ona!5 • ROS: 485 occas$ona! %emopt(s$s, exert$ona! d(spnea, 30 *e$g%t !oss, anorex$a, occas$ona! r$g%t s$ded p!eur$t$c c%est pa$n 4-5 %eadac%e, 6ac. pa$n, 'ac$a! s*e!!$ng, a6dom$na! pa$n, ort%opnea, and P"D • *%:  pa!e pa!pe6ra! conKunct$)ae, no pa!pa6!e cer)$ca! or suprac!a)$cu!ar nodes, decreased 6reat% sounds at t%e r$g%t upper !ung 9e!ds *$t% du!!ness to percuss$on o)er sa$d area, and an unremar.a6!e a6domen • •  +o ru!e $n: P+ 4d$cu!t to ru!e out un!ess pat$ent $s as.ed to %a)e sputum A and7or cu!ture5 • • C@R: 485 dens$t( at t%e r$g%t apex C/est CT Scan: xI? cm mass *$t% r$g%t per$%$!ar and su6car$na! !(mp% node en!argement • Dia,nosis Ta0le & Di;erentials (Case ) Disease Reasons 4or R< "SCLC 485 c%ron$c coug% 4sJuamous 485 *orsen$ng or ce!! CA5 ne* d(spnea 485 *e$g%t !oss 485 %emopt(s$s 485 p!eur$t$c pa$n 485 decreased 6reat% sounds< du!! on percuss$on • • • • • • C%S' M' OLO • Reasons 4or Rs sJuamous ce!! CA, $t $s !$.e!( t%at $t *$!! 6e detected us$ng t%$s procedure Anc$!!ar( tests Sta,in, T20"2M  Sta,e A  +2: +umor $s Q cm, does not d$rect!( $n)o!)e o car$na< $n)ades )$scera! p!eura  $*CM 21 -: &@, a!ang Fapanta(  o4  OS 213: Human Disease Treatment 3 (Circulation and Respiration) SGD 01: MAL!"A"C#  o o "2: metastas$s to $ps$!atera! med$ast$na! and7or su6car$na! !(mp% nodes M0: no d$stant metastas$s 46ased on PE 9nd$ngs< $dea!  rad$ograp%$c $mage o' !(mp% nodes5 • • Mana,ement Counselin, • 4see Case 1 Q Management Q Counse!$ng5 • • • • nter7ention Options Sur,ical resection 9it/ l.mp/ node dissection o ma( %a)e poor resu!ts 6ecause o' node $n)o!)ement o Some onco!og$st conc!ude t%at surger( s%ou!d on!( 6e conducted $n pat$ents *%o %a)e c!ear$ng o' t%e med$ast$na! nodes a'ter adKu)ant t%erap( C/emot/erap. 'o!!o*ed 6( Radiation T/erap. 4+x o' c%o$ce5 C$sp!at$n-6ased com6$nat$on 4*$t% etopos$de5 o mpro)ed sur)$)a! compared *$t% seJuent$a! o t%erap( 6ut more s$de eects suc% as 'at$gue, esop%ag$t$s and neutropen$a Supporti7e T/erap.: Pa$n re!$e', Emes$s t%erap(, Ondansetron, Proc%!oropera$ne, Dexamet%asone, "utr$t$ona! $nter)ent$on Complementar. Met/ods and *alliati7e Care • • • • • • • • • • On *atient >or=ups: e'ore do$ng 6$ops$es, do P+, P++ test to see $' t%ere are an( 6!eed$ng d$sorders Must %a)e card$opu!monar( c!earance 4ECG, etc5 6e'ore %a)$ng a 6ronc%oscop( P!at$num-conta$n$ng ant$-cancer drugs are nep%rotox$c 4a!so %epatotox$c5 - c%ec. .$dne( 'unct$on )$a /"7Creat$n$ne CC $s done to see $' t%e pat$ent %as reco)ered 'rom c%emot%erap( On Ot/er Treatment: C%emot%erap( and #ad$ot%erap( reJu$res good per'ormance status 4$e c%$!dren5 ot%er*$se t%e pat$ent m$g%t d$e 'rom t%e treatment Er(t%ropo$et$n trans'us$on can $ncrease t%e r$s. o'  stro.e and $sc%em$a $' g$)en at t%e *rong dose Proper reg$men $s %$g% dose er(t%ropo$et$n once a *ee. Com6$ne c%emot%erap( *$t% ot%er 'orms o' t%erap( !$.e ant$-ang$ogenes$s drugs and rad$ot%erap(, etc eads to a 6etter outcome Ot/ers: Sarco$dos$s $s rare!( a )$a6!e d$erent$a! $n t%e P%$!$pp$nes A!*a(s get a good %$stor(< t%e !ung ma!$gnanc( m$g%t on!( 6e secondar( !%"%RAL "OT%S On Histor. and *%: Gett$ng a good %$stor( and PE $s $mportant s$nce most CAs metastas$e to t%e !ungs or *omen, usua!!( comes 'rom 6reast cancer, and 'or men, recta! cancer You're Reading a Preview e'ore do$ng treatment 'or ung CA, a!*a(s c%ec. 'or %"D CA $n ot%er !ocat$ons Unlock full access with a free trial. Ces: =ere $t $s, 'rom N pages o' pure redundanc(, On Doin, a -iops. tenen =aa( Antox$c tu!o( magreorgan$e +$nox$c .o Do a 6$ops( to c%ec. 'or poss$6!e ma!$gnant ce!!s r$n (ata Download With Free Trialang sar$!$ .o sa pag-aa(os ng $sang trans na t%en c!ass$'( *%at t(pe o' cancer< a!*a(s opt 'or t%e %$nd$ naman 6a6asa%$n ng mga tao +TTT+ Sana gan$to most access$6!e 6$ops( 4eg !(mp% node5 pa r$n ung cases sa 'uture, para purpose'u! naman ang "A pagpapa.a-OC .o sa trans na Uto =a%a Fung %$nd$, o%*e!! C+-gu$ded 6$ops( 4C+ GA5: 'or per$p%era! masses ronc%oscop(-gu$ded 6$ops(: 'or centra! 4%$!ar or At da%$! sm$!e(s na !ang ang greet$ngs n$na M$..$ at med$ast$na!5 masses  Vo!o, uu6us$n .o na !ang ang space na Uto "ot Fa!a%at$ @A+S as a !ast resort $' (ouLre a6so!ute!( pos$t$)e t%at na !ang s$guro t%ereLs a ma!$gnanc( 6ut ot%er t%e met%ods %a)e 'a$!ed to g$)e a pos$t$)e resu!t =e!!o !oc.  Fumusta naman ang *ee.!( trans$ng On Sta,in, and Treatment: nat$nW tage dictates treatment  =e!!o 201I 2nd p!ace ang EPME#S sa A+E &@: Stage 1: Surger( t%en c%emo 4DonLt do rad$o5 a!ang Fapanta( Stage 2: Surger( =e!!o Medc%o$r 201I un 'un 'un 4and eat eat Stage 3A: C%emot%erap( t%en surger( EAAAA+5 $n San Vuan Sana next t$me ma.apunta na Stage : C%emot%erap( and #ad$ot%erap(< ta(ong !a%at 'or more c%$.a%an =a%a%a Mag-$pon na pa!!$at$)e !ang muna ta(o ng mga a!a-+%e u na mga tanong sa nga(on <5 On Ot/er dia,nostics: • • Sputum ce!! c(to!og( $s se!dom used as a d$agnost$c measure< do 6$ops( $nstead Do a 6ra$n C+ scan 'or sma!! ce!! carc$noma 6ecause $t $s )er( ma!$gnant C%S' M' OLO Mi==i' olo:  $*CM 21 -: &@, a!ang Fapanta(  o4 