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60 y.o. male factory worker underwent a routine chest X-ray during a scheduled work physical. This chest X-ray and subsequent CT scan revealed a 2.5 cm spiculated right upper lobe peripheral nodule. He is currently still smoking. He is active and walks 2 miles/day. His FEV1% is 80% of predicted and his DLCO% is 70% of predicted. He has normal cardiac function and had a negative stress test. PET/CT and CT scan revealed no evidence of distant or nodal disease. CT-guided biopsy reveals non-small cell lung cancer.
A 62 y.o. female was in a minor car accident with no resulting injuries. During her evaluation in the ED, a CT scan revealed a 2.2 cm peripheral mass in the left upper lobe. She is a previous smoker but quit 5 years ago. PET/CT demonstrated no evidence of nodal or distant disease. She walks her dog 1 mile/day with some effort. Her FEV1% predicted is 52% and her DLCO% predicted is 55%. She had a negative stress test. Biopsy of the mass revealed non-small cell lung cancer.
A 59 y.o. male smoker was treated for bronchitis with a 10 day course of antibiotics. His symptoms of cough resolved with the antibiotics but a chest x-ray performed during his work-up revealed a 2 cm peripheral right lower lobe mass. CT scan confirmed the 2 cm mass in the periphery of the right lower lobe with PET/CT and CT demonstrating no evidence of nodal or distant disease. He walks less than a block per day. He had a non-Q wave MI 2 years ago and is on Plavix. By ECHO, his EF is 35%. His FEV1 is 52% of predicted and his DLCO is 55% of predicted.
A 61 y.o. male underwent cardiac evaluation for atypical chest pain. He ultimately had a cardiac catheterization that was normal with good LV function. His pain resolved with proton pump inhibitors. A pre-cath chest x-ray revealed a 2.6 cm right upper lobe lung nodule. He quit smoking 3 years ago. He gets short of breath walking up one flight of stairs. His FEV1 is 45% of predicted and his DLCO is 45% of predicted. CT and PET/CT revealed no evidence of nodal or distant disease.
Second Vote for Question 8 Crabtree
A 57 y.o. male presents to the ED with exacerbation of his COPD with shortness of breath. His symptoms improve with bronchodilators, oxygen, and a short course of steroids. Chest x-ray reveals a 1.9 cm mass in the left lower lobe. CT scan confirms the presence of a peripheral 1.9 cm spiculated mass in the left lower lobe with calcified mediastinal lymph nodes. PET/CT is negative for nodal or distant disease. CT-guided biopsy confirms non small cell lung cancer. He recently had a negative DP thallium stress test and normal LV function on ECHO. His FEV1 is 30% of predicted and his DLCO is 25% of predicted. What treatment would you recommend for this patient?
An 80 y.o. female retired nurse had a screening CT scan as part of a clinical study that revealed a 2.6 cm left lower lobe mass in the periphery of the superior segment. She is a previous smoker but quit 10 years ago. PET/CT and CT revealed calcified lymph nodes but no evidence of nodal or metastatic disease. CT-guided biopsy revealed non small cell lung cancer. She does her own shopping but is unable to walk a flight of stairs without becoming short of breath. Stress test was negative and ECHO revealed good LV function. Her FEV1 was 46% predicted and her DLCO was 55% predicted. What treatment would you recommend for this patient?
An 82 y.o. retired colonel from the army fell off a ladder while working on the house. He had no major injuries but a chest x-ray revealed a 1.9 cm mass in the right lower lobe. Subsequent chest CT scan confirmed a 1.9 cm mass in the periphery of the right lower lobe. He quit smoking 5 years ago. Recent cardiac workup revealed normal LV function and no significant coronary disease by catheterization after a stress test was read as slightly abnormal. He has to take more frequent breaks when working around the house because he gets tired. His FEV1 is 57% of predicted and his DLCO is 55% of predicted. PET/CT revealed no evidence of nodal or distant disease. CT-guided biopsy revealed non small cell lung cancer.
An 80 y.o. female retired nurse had a screening CT scan as part of a clinical study that revealed a 2.6 cm left lower lobe mass in the periphery of the superior segment. She is a previous smoker but quit 10 years ago. PET/CT and CT revealed calcified lymph nodes but no evidence of nodal or metastatic disease. CT-guided biopsy revealed non small cell lung cancer. She does her own shopping but is unable to walk a flight of stairs without becoming short of breath. Stress test was negative and ECHO revealed good LV function. Her FEV1 was 46% predicted and her DLCO was 55% predicted.
A 79 y.o. retired male underwent coronary stenting 1.5 years ago for coronary artery disease. At the time of stenting he was noted to have a 1 cm peripheral mass in the RUL. This was followed, and on the most recent CT scan the mass had increased in size to 1.5 cm and is irregular. CT-guided biopsy revealed non small cell lung cancer. PET/CT is negative for nodal or distant disease. He gets short of breath after walking ½ mile with the dog. On recent ECHO, his EF was 25%. His FEV1 is 57% predicted and his DLCO is 60% of predicted.
An oxygen dependent 78 yo female with endstage COPD (FEV1 38% predicted) is found to have a peripheral 1.5 cm L upper lobe nodule which proves to be an adenocarcinoma on FNA. CT and PET scanning suggest no nodal or distant metastases. Naunheim
Surveillance screening identifies a PET positive (SUV 6) 8mm nodule centrally located in the R upper lobe which is subsequently diagnosed as squamous cancer using navigational bronchoscopy. CT and PET scans suggest no nodal or distant metastases and PFTs are near normal. Naunheim
