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  #1  
Old 04-26-2012
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Lungs Elderly Lady with Small Cell Lung CA?

An 83-year-old woman is evaluated in the office for a 4-month history of weight loss and fatigue. She is a former cigarette smoker, but quit smoking 10 years ago. She is otherwise well and does her own cooking, cleaning, and grocery shopping. Diagnostic studies show a 5-cm left perihilar mass and metastatic disease involving her skeleton and liver. Biopsy reveals small-cell lung cancer.

Which of the following is the best treatment option for this patient?
A Chemotherapy
B Chemotherapy and radiation therapy
C Chemotherapy and surgery
D Palliative care only
E Radiation therapy
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Old 04-26-2012
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This is a tough one but I'll go with D Palliative care only since she has advanced metastatic disease and won't be able to tolerate Chemo & radiation.
E Radiation therapy is a good option if she has presented with symtoms of localized bony mets
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Old 04-26-2012
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Anyone else want to try before I post the answer.
This was a tough one for me too.
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Old 04-26-2012
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i would say E. PALLIATIVE CARE ONLY since she has a nonresectable tumor (extrathoracic mets) and considering her age, chemo/radiation will not be tolerated.
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Old 04-26-2012
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A.CHEMOTHERPY ALONE,since she's on advance stage.regarding her age most of smc pt are abov 65 .but q might be to rx with 2 or 3 agent.
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Old 04-26-2012
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Correct Answer = A

Small-cell lung cancer, even at an advanced stage, responds to chemotherapy, and treatment markedly improves survival. Small-cell lung cancer accounts for approximately 15% of all cases of lung cancer and occurs almost exclusively in current or former smokers. It is a systemic disease, and patients almost always have concurrent micrometastases at diagnosis. The mainstay of chemotherapy for extensive disease is a combination of a platinum agent (cisplatin or carboplatin) and etoposide or irinotecan. For patients with extensive small-cell lung cancer, combination chemotherapy alone may result in a 70% to 85% overall response rate and a 20% to 30% complete response rate. Median survival is 8 to 12 months, with survival beyond 2 years rare.

Even patients with extensive disease and poor performance status (i.e.,, those who are usually bed bound) may derive significant short-term palliative benefit and improved survival from chemotherapy. This patient's performance status is good, and she will likely benefit from treatment.

At diagnosis, 30% of patients with small-cell lung cancer have visibly localized disease that can be encompassed within a radiation therapy port, usually with confinement to one hemithorax lymph node, the mediastinum, and supraclavicular lymph nodes. Such patients are designated as having limited disease. Patients with limited small-cell lung cancer have a 5% absolute improvement in 3-year survival rates after receiving combination chemotherapy and radiation therapy compared with chemotherapy alone. This patient has extensive disease, i.e., disease that extends beyond the radiation port, and the best treatment is chemotherapy alone.

Surgical resection is indicated only in patients with stage I small-cell lung cancer (small, localized tumors), and surgery is augmented with induction or adjuvant chemotherapy. The few patients who can undergo complete resection have the best prognosis. Some of these patients may actually have atypical carcinoid or well-differentiated neuroendocrine tumors, which are much less likely to metastasize but are histologically similar to and may be mistaken for small-cell lung cancer.
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Old 04-26-2012
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Good question.
I learned something good today.
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Oncology-, Pulmonology-, Step-2-Questions, Surgery-

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