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Brian, 52 years old, Persistent cough, chest pain, weight loss,…
Brian, 52 years old, Persistent cough, chest pain, weight loss
Pathophysiology
Uncontrolled cell growth & division → forms tumor mass →Due to genetic mutations (oncogene activation, tumor suppressor loss)
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Inflammation & cytokine release (IL-6, TNF-α)→ fatigue, fever, weight loss
Local tissue destruction → airway irritation, cough, hypoxia
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Invasion & metastasis → cancer cells penetrate basement membrane and spread through lymphatic & blood vessels
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Treatment Modalities
Surgery → Removes tumor and affected lung tissue (lobectomy or pneumonectomy) Best for early-stage, localized disease
Radiation Therapy → Uses high energy rays to kill remaining cancer cells. Can be curative or palliative depending on stage
Chemotherapy → Cytotoxic drugs destroy rapidly dividing cells. Common agents: cisplatin, carboplatin, paclitaxel
Targeted Therapy → Blocks specific molecular mutations (EGFR, ALK, KRAS). Example: osimertinib (EGFR+), alectinib (ALK+)
Immunotherapy → Stimulates immune system to recognize and attack cancer cells. Example: pembrolizumab (Keytruda) – PD-L1 inhibitor
Palliative Care → Focuses on comfort and symptom relief.
Improves quality of life during and after treatment.
Brian's Case: Combination approach: Lobectomy + cisplatin-based chemotherapy. Immunotherapy added due to PD-L1 positivity.
Medications
Chemotherapy Agents: Cisplatin, carboplatin, paclitaxel → destroy rapidly dividing cells
Monitor for: nausea, fatigue, myelosuppression, neuropathy
Targeted Therapies: Osimertinib (EGFR mutation). Alectinib (ALK positive). Block specific molecular pathways that drive tumor growth.
Immunotherapy:
Pembrolizumab (Keytruda) → PD-L1 inhibitor. Boosts immune system recognition and destruction of cancer cells.
Supportive Medications: Antiemetics (ondansetron) → manage nausea. Corticosteroids → reduce inflammation. Analgesics/opioids → relieve pain and improve comfort.
Adjunct Medications: Prophylactic antibiotics or growth factors (filgrastim) → prevent infection during chemo. Stool softeners or hydration support → manage treatment side effects
Brian's Case: Receiving cisplatin and paclitaxel, with pembrolizumab added to therapy.
Ondansetron prescribed for nausea management
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Provide written materials from: American Cancer Society (cancer.org), American Lung Association (lung.org), National Cancer Institute (cancer.gov)