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Case Presentation: Lung Cancer in a 71-Year-Old Female with a Solitary Pulmonary Nodule

This case presentation discusses a 71-year-old female patient, previously healthy, who presented with a solitary pulmonary nodule in the right upper lung (RUL) discovered during a health screening in February 2011. She was admitted for lung cancer workup in April 2011. Her medical history includes hypertension, diabetes mellitus, and past surgeries, including cataract surgery. The patient has symptoms like abdominal pain and constipation but denies headaches, dyspnea, or significant weight loss. Diagnostic procedures for lung cancer management and staging challenges are also covered.

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Case Presentation: Lung Cancer in a 71-Year-Old Female with a Solitary Pulmonary Nodule

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Presentation Transcript

  1. Case Presentation 성균관대학교 의과대학 2007313075 손의영

  2. Chief Complain • 이O연, F/71 • For Lung Cancer w/u

  3. Present Illness • Previously healthy • 2011. 02 건강검진상 발견된 RUL의 solitary pulmonary nodule평소 이상 증상 없었음 • 2011.04.03 Lung cancer w/u 위해 입원

  4. Other History • PMHx. • HTN/DM/Tb/hepatitis/Allergy ( - / - / - / - / - ) • 약물력 : Local에서 Both knee에 OA 진단 받고 Medication 중 • 수술력오른쪽 백내장 수술 (왼쪽도 받을 예정) 2010. 치질 수술 • FHx. • 넷째 오빠 심장병으로 수술 받으신 것 외에 특이사항 없음 • SHx. • occupation: 농업, 임업 • smoking: no • alcohol: no • 생강과 마가 섞인 한약재를 가끔 드심

  5. Review of system • GW / EF ( - / - ) • Weight change : 6mo 동안 6kg 증가 (d/t increased appetite ) • fever/chill ( - / - ) • Headache/dizziness ( - / - ) • Rhinorrhea/ cough /sputum ( - / + / - ) : 3YA, 일상생활 지장 X • Dyspnea (+) : ATS grade II • chest pain / palpitation ( - / - ) • anorexia/nausea/vomiting ( - / - / - ) • abdominal pain/discomfort ( + / - ) : 폭식 후 심해짐 • constipation/diarrhea ( + / - ) • hematemesis/melena/hematochezia ( - / - / + ) : 수술 하였으나 지속 • Urinary Sx (-) • Arthralgia (+) : both knee • Myalgia (-)

  6. Physical Exam Vital Sign 172/88 mmHg - 63 - 18 - 36℃ • G/A Generally well-looking appearance • Mentality Alert & well orientation • HEENT pinkishconjunctivae, anictericsclerae Dehydrated tongue (-)PNS tenderness(-) PTH/PI (-/-) JVP (-) Neck VE (-) Cervical LNE (-/-) Thyroid enlagement (-) • Chest Symmetric chest expansion Regular heart beat w/o murmur Clean breathing sound w/o wheezing

  7. Physical Exam • Abdomen Soft & flat Bowel sound – normoactive No tenderness/rebound tenderness No shifting dullness • Back No CVAT • Extremities Skin rash(-) Joint ROM limitation (-) Joint swelling & stiffness (-) deformity (-)

  8. Imaging

  9. Spirometry / EKG

  10. Problem List / Assessment • Problem List • #1. solitary pulmonary nodule at RUL • #2. Hypertension • #3. Abdominal Sx. (pain, hematochezia) • Assessment • #1. : Lung cancer

  11. Diagnostic w/u • RUL mass gun Bx • Bronchoscopy • PET

  12. Lung cancer – Dx • Screening • Sputum cytology, CXR, CT • Tissue Diagnosis • Fiberopticbronchoscopy, Transthoracic FNA(PCNA) • Mediastinoscopy, VATS (thoracoscopy) • Operative specimen • Staging Procedures

  13. Lung cancer – Staging Lung Cancer Staging Essentials: The New TNM Staging System and Potential Imaging Pitfalls <RadioGraphics>

  14. Lung cancer – Px • Non-small lung cancer의 Stage에 따른 예후 • Stage IA : MSD 60개월 / 5YSR 50% • Stage IB : MSD 43개월 / 5YSR 43% • Stage IIA: MSD 34개월 / 5YSR 36% • Stage IIB: MSD 18개월 / 5YSR 25% • Stage IIIA: MSD 14개월 / 5YSR 19% • Stage IIIB: MSD 10개월 / 5YSR 7% • Stage IV : MSD 6개월 / 5YSR 2%

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