77 year old Male with Non Small Cell Carcinoma of Lung

This is the case of a 77-Year-old Gentleman, who is diagnosed with Non-Small Cell Carcinoma of the lung with mediastinal and skeletal metastasis. 

This case report aims at recording the Patients Journey. 

History Of Presenting Illness 

The patient was apparently asymptomatic 10 years ago. 

10 years ago, on a health checkup, it was found that there were elevated blood sugar levels and high blood pressure. The patient was diagnosed with Diabetes Mellitus Type 2 and Hypertension. The Patient is currently on medication for the same. 

3 years ago the patient started experiencing right knee joint pain which was continuous. The pain had started radiating to the hip joint and the lower back. The severity of the pain had also increased. It is aggravating on walking and relieving on on medication - Diclofenac. The patient visited a hospital last month and got a complete health check-up, with intentions to get a knee replacement surgery done. 

X-Ray of Both knees revealed-

  • osteoarthritis of right knee grade III, left knee grade II

On the CECT chest, (Reports present in the investigation section) - the impressions included

  • "suggestive of lung cancer with collapse consolidation of the apical segment of the left upper lobe. "
  • heterogeneously enhancing nodule in the body of the right adrenal gland - likely metastasis. 
  • There is metastasis in the 9th rib ,with soft tissue components, D7,D10,D11 vertebral metastasis 
  • Staging - T4N3M1C
The patient has currently finished 2 sessions of chemotherapy . 

2 years ago , the patient recollects an episode of hemoptysis , after which there is the only history of cough with seasonal and temperature variation. 

1 year ago, the patient developed difficulty in breathing, which has now been resolved. 

4 months ago, the patient noticed a loss in weight from 96KGs to 76Kgs. 

There is no history of headache, seizures, easy bruising, or clubbing of the nails . 

Past History 

10 years ago, the patient underwent surgery for Renal Stones . No urinary symptoms are currently present. 

3 years ago the patient had a  history of constipation as well, which was resolved by taking medication. 

The patient has no history of  TB , Epilepsy , Asthma, Jaundice , CHD.  

Family History 

No family History of cancer 

Personal History 

Daily water Intake - 2 Litres a day 

Appetite - Normal 

Diet - Vegetarian 

Allergies - no history 

No history of SMOKING or ALCOHOL consumption. 

Bowel and Bladder movements - are normal. 

PREVIOUS INVESTIGATIONS 















PET scan 














 Treatment history 

31/8/22

22/8/22

1/7/22

4/7/22

19/7/22

Discussion 

Q. Review of literature on treatment 

 https://academic.oup.com/jjco/article/35/4/188/817529?login=false


It was a Phase -II CLINICAL TRIAL 


INCLUSION CRITERIA - was exactly as in our patient 

- histological conformed non small cell carcinoma 

- no Previous chemotherapy 

- inoperable cancer 

- elderly patient > 70 years of age 

- 76 percent of chosen patients had stage 4 disease 

-20 per cent were male 


INTERVENTION 

- Paclitaxel - carboplatin regimen was given 


EFFICACY MEASUREMENT 

- complete response to therapy = complete dissaperarance of detectable tumors for 4 weeks 

-partial response = greater than ir equal to 50 per cent decrease in largest diameter of measurable lesion 

- response rate = number of patients who achieved partial or complete response 

- median survival time 


OUTCOMES 

- Response rate was 28 percent = 7 /25 * 100 

- Median survival time = 12.3 months 

- 1 year survival rate = 52 per cent 


*patients who were 75 years or above had similar tolerance and response to treatment*




 Sir I was also reading about the factors affecting the choice of treatment in NSCLC

-

 https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq


On the basis of history , age , other comorbidities , 

The current regimen seems to be appropriate .

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