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Lung Cancer

Ashley Coffey

Demographics
White female
58 years old
No allergies
Diagnosed 2/5/2014

Medical and Social History


Hypertension
Chronic Obstructive Pulmonary Disease (COPD)
Surgery: dilation and curettage

Social:
pack of cigarettes a day for 30 years (current)
4-5 drinks a week

Family History
Mother: hypertension and myocardial infarction
Father: myocardial infarction
Brother: melanoma
Paternal Grandmother: breast cancer

Signs and Symptoms


Cough that doesnt go away
Chest pain
Dyspnea, wheezing
Weight loss (due to anxiety about disease)
Hemoptysis
Fever
Chief complaint: cold and congestion for several
months, shortness of breath

Less thank 5% asymptomatic

Diagnostic Workup
Original CT done at other location and suggested
transfer to OSUMC

CT of head, chest, abdomen, and pelvis


Head was clear
Suprahiler/mediastinal mass 8x7.5 cm in right upper lobe
of lung
Mets to pancreas and liver
Possibly kidneys

Since have developed non tender mass in right breast


Determined to be Small Cell

Epidemiology
Lung cancer leading cause of cancer death in both
men and women

More common in men than in women


Second highest in cancer occurrences
About 15% of all lung cancers is Small Cell
Average age 60-80 years old

Etiology
Smoking or second hand smoke (98% Small Cell
CA patients have smoking history)

Asbestos
Iron ore
Radioactive ores
Coal products (Small Cell most common)
Isopropyl oil

Anatomy

Mediastinum

Lymph Nodes

Histopathology
Small cell
Most common to have mets (50-80% will met to
brain)
More common as central lesion

Non small cell


Squamous, adenocarcinoma, large cell,
adenosquamous

Carcinoid tumors
Mixed tumors

Staging of Small Cell


Limited: one affecting one lobe and neighboring
lymph nodes
Treatment: concurrent chemo and radiation
(sometimes surgery)

Extensive: cancer has spread beyond one lung and


nearby lymph nodes
Treatment: chemo and clinical trials

Treatment Plan
30 Gy at 300cGy in 10 fractions
Typical total is 60-65 Gy

Palliative treatment
Concurrent chemo: cisplatin and etoposide
6x on MXE
AP/PA field with reduced AP field
0 degrees- 165MU + 25MU
180 degrees- 169MU

Field over mediastinum

SVC Syndrome
Obstructing the

Superior Vena Cava

Swelling face, neck,


and arms with poor
circulation on chest
wall

High dose RT 350-400

cGy/fx for first few days


to relieve symptoms
Then continue regular
treatment course

Patient Setup
Supine
F head rest
Arms at side
Knee sponge

DVH

Critical Structures (TD 5/5)


Lungs 1750 cGy (2/3 is 3000 cGy)
Heart 4000 cGy
Esophagus 5500 cGy
Spinal Cord 4700 cGy

Normal Chest X-Ray

Coronal

Axial

Sagittal

AP DRRs

PA DRR

Side Effects
Acute:

esophagitis
fatigue
skin reactions
airway irritation
Nausea (from chemo)
decreased blood counts

Long-term:

radiation pneumonitis
lung and esophageal scarring
radiation-induced heart disease
spinal cord injury
radiation-induced malignancy

Prognosis
60-70% of small cell lung CA patients are staged
as extensive

Extensive stage is incurable


2% survival in 5 years
Median survival with treatment is 7 months

Common Metastasis
Liver
Adrenal glands
Bone
Brain

Patient: chest wall, liver, retroperitoneal and

perinephric nodes, head and tail of pancreas,


possible mesenteric nodes

References
American lung association. (n.d.). Retrieved from

http://www.lung.org/lung-disease/lung-cancer/
resources/facts-figures/lung-cancer-fact-sheet.html

Tan, W. (2012, December 27). Small cell lung

cancer. Retrieved from


http://emedicine.medscape.com/article/280104overview

Hackworth, R. Lung Cancer