Onc Bronchial CA
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Information Sheet for Candidates A 45 year old waiter, John, comes to you for a flu injection and he mentions that he has noticed some breathing difficulties over the last 3 to 4 months. He feels a bit wheezy at times, quite often at night time and it is similar to his wife’s asthma. He actually has used her puffer a couple of times with some relief but he thought he should have a proper check-up and his own prescription. How do you respond to the patient’s request?
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Transcript of Onc Bronchial CA
Information Sheet for CandidatesA 45 year old waiter, John, comes to you for a flu injection and he mentions that he has noticed some breathing difficulties over the last 3 to 4 months. He feels a bit wheezy at times, quite often at night time and it is similar to his wife’s asthma. He actually has used her puffer a couple of times with some relief but he thought he should have a proper check-up and his own prescription.
How do you respond to the patient’s request?
HOPC: as above, he can sleep lying flat, it perhaps gets a bit worse with exertion but he has no other symptoms of cardiac failure or other respiratory problems.No weight loss or loss of appetite.
PHx: appendicectomy at age 18, mild hypertension treated with betablocker (50 mg atenolol / Tenormin daily) for the last 4 years.
FHx: mother and father still alive and well, 2 brothers and one sister healthy.
SHx: married, 2 children (healthy), has been a waiter for 26 years, drinks about 8 to 10 standard drinks per day, smokes 30 cigarettes per day (for 25 years). No allergy, no other medications.
EXAMINATION:BP 140/80 r=l, P 62/min and regular, RR 22, SaO2 97 on room air, T 37.0.Except for mild wheeze over both lungs although r < l no pathological findings.Peak expiratory flow rate (PEFR) is 400 improving to 430 after ventolin puffers.
WHAT IS THE MOST LIKELY DIAGNOSIS AND MANAGEMENT?
A) ? ASTHMA : not true in this case but if mentioned and managed, the patient does not really improve and returns in 6 weeks with ongoing wheeze, he now has developed irritating cough and feels easily fatigued.
B) BRONCHIAL CARCINOMA !!!! (accounts for 95% of primary lung ca’s, very poor prognosis!)Lung cancer is the leading cause of cancer-related mortality in both men and women in the United States and throughout the world. The prevalence of lung cancer is second only to that of prostate cancer in men and breast cancer in women. Lung cancer recently surpassed heart disease as the leading cause of smoking-related mortality. Most lung carcinomas are diagnosed at an advanced stage, conferring a poor prognosis.
Non–small cell lung cancer. Symptoms and signs of lung cancer
INVESTIGATIONS CXR CT chest Fibre-optic bronchoscopy PET scan Fluorescence bronchoscopy
The bronchoscopy reveals a non-small cell, adenosquamous-carcinoma in the lowest part of the right main bronchus.
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THERAPY: Most likely only palliative care with combined chemo and radiation therapy although this will be determined by thoracic surgeon and oncologist..
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