Case of Adenocarcinoma of the Left Lung: a request for help [00058] Medicine On Line


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Case of Adenocarcinoma of the Left Lung: a request for help




Dear friends:

The present case history is being presented with the hope that a subscriber
can provide new insight for the postulated treatment of the patient
described below. Are there any new modalities of treatment that you
 -researchers, clinicians, general public- are aware of that has not yet
reached populatr attention? Are there any new promising concepts, drugs,
data from developing clinical trials that could be of help in the following
clinical picture? Is there any advice that could be shared?

Please bear in mind that I am not the patient nor am I a medical doctor,
although I am a member of the health profession; I
am a new subscriber to mol-cancer. I have great confidence in the medical
skills of the patient's physicians, who seem quite compassionate and aware.
This case historty is being sent out, nonetheless, knowing the power of the
computer and the vast amount of knowledge that has not yet reached the
doctors' desks. Can you help?

The patient is a 52-year old white male in otherwise good health, except for
a minor blockage in a coronary blood vesel. He has smoked for about 30
years, having stoped 3 months ago. He is a social drinker. He had had a
routine medical examination eight months ago, including chest x-ray, which
was negative.

About 1 month ago, he presented to his physician complaining of chest pain
and some difficulty in breathing during moderate exercise. Routine
radiographs now revealed the presence of a 1-2 cm mass in the apex f the
left lung. It was subsequently diagnosed as an adenocarcinoma, and it is the
primary and only tumour. Scans throughout the body revealed the presence of
no other masses or tumours. A preliminary biopsy of the mediastinum was
initially negative.

Based on the clinical data to that point, the patient was staged IIIa
pre-operatively. With the hope of a curative intervention, surgery was
carried out several weeks ago. During the surgery, it was felt that an
entire pneumonectomy was advisable in what proved to be a difficult and
delicate procedure. The left phrenic nerve and vagus nerve, by anatomical
necessity, wre severed with the lung. The post-operative biopsy report
indicated that the entire tumour had been removed, as all margins were
intact. There was nodular involvement within the removed lung. In adition,
four of eight lymph nodes from the mediastinum biosied during the surgery
were involved, restaging the tumour to IIIb.

Post-operative recovery was modrately difficult, as the patient experienced
some respiratory distress during the second day. Fluid accumulated around
the remaining lung, necessitating reintubation and the patient remained
sedated and intubated for four days. With the appropriate medication, the
patient recovered, was extubated, and sent home. He is presently alert,
relatively mobile, but with a poor appetite.

He has started radiotherapy, with a plan to continue on a daily (except
weekends) basis for 7 weeks, with the probability of chemotherapy when his
strength returns.

Are there any thoughts that can be helpful or hopeful?

Thanks