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Lung Cancer II
MEDICATIONS DRUG(S) OF CHOICE: • NSCLC, chemotherapy. Indicated only in patients with a good functional status.
• Cisplatin (Platinol) and cisplatin-based regimens are standard although response rates with cisplatin alone are <20% in stage IIIB/IV disease with a 3 year survival rate of 8%. Combination regimens can improve survival an average of 2 months with a 5-year survival rate improved by about 10% in stage III disease.
• Newer agents include paclitaxel (Taxol), docetaxel (Taxotere), vinorelbine (Navelbine), gemcitabine (Gemzar), and irinotecan (Camptosar) either alone or as radiation sensitizers have led to response rates up to 40% in non-small cell tumors
• SCLC, chemotherapy. Excellent response, including complete remissions possible.
• Palliative measures
• Analgesics: hydrocodone, morphine, fentanyl (Duragesic)
• Dyspnea: oxygen, nebulized morphine, benzodiazepines [e.g., lorazepam (Ativan) 1-2 mg po, SL, SC, or pr q2-6 h]
Contraindications: Refer to manufacturer's instructions
Precautions: Refer to manufacturer's instructions
Significant possible interactions: Refer to manufacturer's instructions
ALTERNATIVE DRUGS: N/A
FOLLOW UP PATIENT MONITORING: • Surgically resectable
• First year each 3 months
• Second year each 6 months
• Third though fifth year once a year
• Surgically unresectable
• As necessary for palliation
• Consider early hospice referral
PREVENTION/AVOIDANCE: • Stop smoking; avoid second hand smoke exposure
• Despite numerous studies, no cost effective screening measure has been found for lung cancer. Therefore, prevention via aggressive smoking cessation counseling and therapy is the cornerstone of patient management.
• Avoid radon exposure
• Avoid occupational exposure to asbestos, metals
• Consider prophylaxis with retinoid, such as beta-carotene
POSSIBLE COMPLICATIONS: • Development of metastatic disease to brain, bones and liver
• Local recurrence of disease
• Postsurgical complications
• Side effects of chemotherapy or radiation
• Dysphagia (radiation-induced, fungal)
• Infections
• Bleeding
• Radiation pneumonitis
• Terminal restlessness
EXPECTED COURSE AND PROGNOSIS: • Overall survival rate is 15%
• Stage I, 50% survival status postresection of squamous, adenocarcinoma or large cell
• Stage II, 33% survival status postresection for squamous and 20% for adenocarcinoma or large cell
• Stage IIIa, 15% survival status postresection for squamous
• Note: Presurgical staging is less accurate so survival figures are lower
• If nonresectable, prognosis is poor with mean survival of 8-14 months
MISCELLANEOUS ASSOCIATED CONDITIONS: • Hypertrophic pulmonary osteoarthropathy
• Superior vena cava syndrome
• Homer's syndrome
• Eaton-Lambert syndrome
• Hypercalcemia (ectopic parathyroid hormone)
• Syndrome of inappropriate antidiuretic hormone ( SIADH)
• Hypercoagulable state
AGE-RELATED FACTORS:
Pediatric: N/A
Geriatric: More common in elderly (> 75 years)
Others: N/A
PREGNANCY: N/A
SYNONYMS: • Lung cancer
ICD-9-CM: 162.9 Malignant neoplasm of bronchus and lung, unspecified
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