Patient Summary Patient RAB, 49 y/o male, diagnosed with Non-Small Cell Lung Cancer. Medical History shows that he had wedge resection last November 2010 and Lobectomy last June 2011 because of Right Adenocarcinoma. He also had a Segmentectomy due to Left Adenocarcinoma last December 2011. PET scan performed last August 2012 reveals hypermetabolic pleural nodules at the Right Lower Lobe. Based on his physical examination done last September 2012, he is negative EGFR (Epidermal Growth Factor Receptor), Vital Signs Stable, Decreased Breath Sounds and NRRR. His initial recommendations are Pemetrexed (Alimta) and Zoledronic Acid (Zometa). Patient undergone 2 cycles of Pemetrexed and shifted to Gemcitabine HCL (Gemzar) last December 3, 2012. Lung Cancer Overview Lung Canceris a disease characterized by uncontrolled cell growth in tissues of the lung, also known as bronchogenic carcinomas. There are two main types of lung cancer: Non-small Cell Lung Cancer (NSCLC) is the most common type of lung cancer, accounts for 80%. Squamou s Cell Carcinoma (Epidermoid Carcinoma)– it is the most common type ofNSCLC and the most common type of lung cancer in men. This forms in the lining of t he bronchial tubes. Adenocarcinoma - the most common type of lung cancer in women and in non- smokers. It forms in the mucus-producing glands of the lungs. Bronchioalveola r Carcinoma - this type of lung cancer is a rare type ofadenocarcinoma that forms near the lungs' air sacs. Large-cell Undifferentiated Carcinoma - a rapidly growing cancer which form near the outer edges or surface o f the lungs. This is the least common type of NSCLC. Small Cell Lung Cancer (SCLC) comprises about 20% of lung cancers. This is the most aggressive and rapidly growing of all lung cancers. This is mostly related to cigarette smoking, with only 1% of these tumors occurring in non-smokers. If the lung cancer is made up of both types, it is called mixed small cell/large cell cancer. If the cancer started somewhere else in the body and spread to the lungs, it is called metastatic cancer to the lung.
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Patient Summary
Patient RAB, 49 y/o male, diagnosed with Non-Small Cell Lung Cancer. Medical History shows
that he had wedge resection last November 2010 and Lobectomy last June 2011 because of Right
Adenocarcinoma. He also had a Segmentectomy due to Left Adenocarcinoma last December 2011. PET
scan performed last August 2012 reveals hypermetabolic pleural nodules at the Right Lower Lobe. Basedon his physical examination done last September 2012, he is negative EGFR (Epidermal Growth Factor
Receptor), Vital Signs Stable, Decreased Breath Sounds and NRRR. His initial recommendations are
Pemetrexed (Alimta) and Zoledronic Acid (Zometa). Patient undergone 2 cycles of Pemetrexed and
shifted to Gemcitabine HCL (Gemzar) last December 3, 2012.
Lung Cancer Overview
Lung Cancer is a disease characterized by uncontrolled cell growth in tissues of the lung, also
known as bronchogenic carcinomas.
There are two main types of lung cancer:
Non-small Cell Lung Cancer (NSCLC) is the most common type of lung cancer, accounts for
80%.
Squamous Cell Carcinoma (Epidermoid Carcinoma) – it is the most common type of
NSCLC and the most common type of lung cancer in men. This forms in the lining of the
bronchial tubes.
Adenocarcinoma - the most common type of lung cancer in women and in non-
smokers. It forms in the mucus-producing glands of the lungs.
Bronchioalveolar Carcinoma - this type of lung cancer is a rare type of
adenocarcinoma that forms near the lungs' air sacs.
Large-cell Undifferentiated Carcinoma - a rapidly growing cancer which form near the
outer edges or surface of the lungs. This is the least common type of NSCLC.
Small Cell Lung Cancer (SCLC) comprises about 20% of lung cancers. This is the most
aggressive and rapidly growing of all lung cancers. This is mostly related to cigarette smoking,
with only 1% of these tumors occurring in non-smokers.
If the lung cancer is made up of both types, it is called mixed small cell/large cell cancer.
If the cancer started somewhere else in the body and spread to the lungs, it is called metastatic cancer
to the lung.
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CAUSE SIGNS AND SYMPTOMS INCIDENCE PROGNOSIS
Smoking
Passive Smoking
Asbestos Fibers
Radon Gas
Familial
Predisposition
Lung Disease
(COPD)
Air Pollution
Persistent or intense coughing
Pain in the chest shoulder, or
back from coughing
Changes in color of the mucus
that is coughed up from the
lower airways (sputum)
Difficulty breathing and
swallowing
Hoarseness of the voice
Harsh sounds while breathing
(stridor)
Chronic bronchitis or
pneumonia
Coughing up blood, or blood in
the sputum
Lung cancer is the
deadliest type of
cancer for both men
and women. Each
year, more people
die of lung cancer
than of breast, colon,
and prostate cancers
combined. In 2008,
there were 1.61
million new cases,
and 1.38 million
deaths due to lung
cancer.
The overall prognosis
for lung cancer is poor
when compared with
some other cancers.
Survival rates for lung
cancer are generally
lower than those for
most cancers, with an
overall five-year
survival rate for lung
cancer of about 16%
Diagnosing Lung Cancer
Medical History and Physical Examination
Chest X-ray
CT Scan (Computerized Tomography)
MRI (Magnetic Resonance Imaging)
PET Scan (Positron Emission Tomography)
Bone Scan
Sputum Cytology
Bronchoscopy
Needle Biospy
Thoracentesis
Blood Tests
Staging Lung Cancer
The most common cancer staging method is called the TNM system.
T (1-4) indicates the size and direct extent of the primary tumor
N (0-3) indicates the degree to which the cancer has spread to nearby lymph nodes
M (0-1) indicates whether the cancer has metastasized to other organs in the body.
For example, a small tumor that has not spread to lymph nodes or distant organs may be staged as (T1,
N0, M0).
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For non-small cell lung cancer, TNM descriptions lead to a simpler categorization of stages. These stages
are labeled from I to IV, where lower numbers indicate earlier stages where the cancer has spread less.
More specifically:
Stage I is when the tumor is found only in one lung and in no lymph nodes.
Stage II is when the cancer has spread to the lymph nodes surrounding the infected lung.
Stage III A is when the cancer has spread to lymph nodes around the trachea, chest wall, and
diaphragm, on the same side as the infected lung.
Stage III B is when the cancer has spread to lymph nodes on the other lung or in the neck.
Stage IV is when the cancer has spread throughout the rest of the body and other parts of the
lungs.
Small cell lung cancer has two stages: limited or extensive. In the limited stage, the tumor exists in one
lung and in nearby lymph nodes. In the extensive stage, the tumor has infected the other lung as well as
other organs in the body.
Treatment
Surgery
Wedge Resection (Segmentectomy) - is a surgical operation where a part of a lung is
removed. It is done to remove a localized portion of diseased lung, such as
early stage lung cancer.
Lobectomy - is a type of lung cancer surgery in which one lobe of a lung is removed.
(The right lung has 3 lobes, and the left lung has 2 lobes.) A lobectomy of the lung is
performed in early stage non-small cell lung cancer patients. It is not performed on
patients that have lung cancer that has spread to other parts of the body. Pneumonectomy - is a type of lung cancer surgery in which an entire lung is removed as
a treatment for lung cancer.
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Radiation
Chemotherapy
Chemotherapy utilizes strong chemicals that interfere with the cell division process -
damaging proteins or DNA - so that cancer cells will commit suicide. These treatments
target any rapidly dividing cells (not just cancer cells), but normal cells usually can
recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is
considered systemic because its medicines travel throughout the entire body, killing the
original tumor cells as well as cancer cells that have spread throughout the body.
Combination therapies often include multiple types of chemotherapy, and
chemotherapy is also given as adjuvant therapy as a complement to surgery and
radiation. Adjuvant therapy is designed to reduce the risk of cancer recurrence after
surgery and killing any cancer cells that exist after surgery. Chemotherapy can be given
before surgery, called neo-adjuvant therapy, to shrink tumors and to make surgery