MD-2204 (Respiratory System) MD-2204 (Respiratory System) PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN MD-2204 (Respiratory System) PROBLEM BASED LEARNING (PBL) Dr Tin Htay Khine Lung Cancer
1. MD-2204 (Respiratory System) MD-2204 (Respiratory System)
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND
SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN MD-2204
(Respiratory System) PROBLEM BASED LEARNING (PBL) Dr Tin Htay Khine
Lung Cancer
2. Patients History PROBLEM BASED LEARNING (PBL) 2015
3. 26 year-old man Presented with : Facial swelling Lumps in
axillae Chest pain on & off for 3 months Weight loss during
past 6 months No medical,surgical or family history Not smoking
cigarette but smoked cannabis (2 [14 years-old] 8 [18-24 years-old]
joints daily) He was concious & afebrile No evidence of
cyanosis He looked pale & cachexic
4. Nail Clubbing
5. Drumstick fingers & watch-glass nails Deformity of the
fingers & fingernails Associated with number of diseases Mostly
heart & lungs Idiopathic clubbing = rare
6. Sign & symptoms of nail clubbing Fluctuation &
softening of the nail bed ( ballotability) Loss of the normal
6month after completing first-line chemotherapy can be treated with
that original first-line regimen (typically a platinum- based
doublet) again, with and expected response rate of 62-100%
Etoposide 50 mg/m2 PO daily for 3wk every 4wkor Topotecan 2.3 mg/m2
PO on days 1-5 every 21dor Topotecan 1.5 mg/m2 IV on days 1-5 every
21dor Carboplatin AUC 5 IV on day 1 plus irinotecan 50 mg/m2 IV on
days 1, 8, and 15 every 28do
89. Third-line chemotherapy for relapsed or refractory disease
Stage IV disease Etoposide 50 mg/m2 PO daily for 3wk every 4wkor
Topotecan 2.3 mg/m2 PO on days 1-5 every 21dor Topotecan 1.5 mg/m2
IV on days 1-5 every 21dor Carboplatin AUC 5 IV on day 1 plus
irinotecan 50 mg/m2 IV on days 1, 8, and 15 every 28dor Carboplatin
AUC 4-5 IV on day 1 plus irinotecan 150- 200 mg/m2 IV on day 1
every 21d] or Cisplatin 30 mg/m2 IV on days 1, 8, and 15 plus
irinotecan 60 mg/m2 IV on days 1, 8, and 15 every 28d
90. CISPLATIN Class: Platinum based atypical alkylator
Mechanism of action: binding to DNA - disrupting its function-
preventing DNA, RNA ,protein synthesis anti-tumor activity in a
wide variety of cancers Cisplatin is rarely used as an individual
agent
91. ETOPOSIDE Drug profile Class: Topoisomerase II inhibitor
Mechanism of action: inhibits specific enzyme in the cell -unravels
DNA strands break -leading to cell death. anti-tumor activity in a
wide variety of cancers One of component in drugs regimen to
patient prior bone marrow tranplantion
92. CAVE Regimen
93. What CAVE is CAVE is the name of a combination of
chemotherapy drugs used to treat small cell lung cancer. It is made
up of the drugs C = Cyclophosphamide A = Doxorubicin (also called
Adriamycin) V = Vincristine E = Etoposide
94. CAVE chemotherapy as cycles of treatment. Its may have up
to 6 cycles Each cycle lasts 3 weeks.
95. Mechanism of Action Etoposide (Toposar, VePesid) is an
effective antitumor medication. It slows or stops the growth of
cancer cells in the body by causing breakage in the DNA (genetic
material) strand. It may be given as an IV injection or as a pill.
Cyclophosphamide (Cytoxan, Neosar) interferes with the growth of
normal cells and cancer cells. It slows the growth of cancer cells
and their spread in the body. It may be given as an IV injection or
as a pill.
96. Doxorubicin (Adriamycin, Rubex) causes destruction of DNA,
which slows or stops the growth and spread of cancer cells in the
body. It is an IV medication. Vincristine (Oncovin) is a
plant-based compound. It causes cell death by interfering with the
way genetic material (DNA) multiplies in the cell. It is only
available as an IV medication
97. Side Effects Tiredness and breathlessness An increased risk
of getting an infection Dark marks may occur in the creases of your
skin Urine may become a pink or red colour Women may stop having
periods but this may be temporary Loss of fertility
98. Vincristine can temporarily stop the normal muscle
contractions of the bowel, causing sickness, a swollen abdomen and
cramps Sensitivity to sunlight Loss of appetide Metallic taste in
mouth or loss of taste Sore mouth and throat, and possibly mouth
ulcers
99. A side effect may get worse through your course of
treatment This depends on How many times you've had a drug before
Your general health How much of the drug you have (the dose) Other
drugs you are having
100. Contraindication Pregnant women Breastfeeding women
101. Prognosis of Lung Cancer
102. The prognosis of lung cancer is dependent upon : where the
cancer is located size of the cancer presence of symptoms type of
lung cancer overall health status of the patient The overall
prognosis for lung cancer is poor compared with some other cancers.
Survival rates for lung cancer are generally lower than those for
most cancers, with an overall 5-year survival rate for lung cancer
of about 17% compared to : 67% colon cancer 90% breast cancer 81%
bladder cancer 99% prostate cancer
103. Outcomes in lung cancer according to clinical stage
Clinical stage Five-year survival (%) Non-small-cell lung carcinoma
Small-cell lung carcinoma IA (up to 3cm) 50 38 IB (3-5 cm &
nearby tissue) 47 21 IIA (5-7 cm & not in LN or 7 cm but not in
LN)) 26 18 IIIA (> 7 cm & in LN) 19 13 IIIB (any size in
nearby tissue or in LN of another lung) 7 9 IV (in both lung or in
other parts of body) 2 1
104. Small Cell Lung Carcinoma Most aggressive growth of all
lung cancers, Most responsive to radiation therapy and
chemotherapy. Because SCLC spreads rapidly and is usually
disseminated at the time of diagnosis, methods such as surgical
removal or localized radiation therapy are less effective in
treating this type of lung cancer. When chemotherapy is used alone
or in combination with other methods, survival time can be
prolonged four- to fivefold Of all patients with SCLC, only 5% to
10% are still alive 5 years after diagnosis
105. Non Small Cell Lung Carcinoma For people with inoperable
disease, outcomes are worse in those with poor performance status
and weight loss of more than 10% The best prognosis is achieved
with complete surgical resection of stage IA disease, with up to
70% five-year survival.
106. Epidemiology of Lung Cancer in Malaysia
107. General view of cancers. Incidence of cancer in Malaysia
increased from 32,000 new cases in 2008 to 37,400 in 2012. It is
expected to rise to 56,932 by 2025 if no action is taken. World
Cancer Day is done yearly on Feb 4 as a reminder.
108. Lung Cancer (LA) 2,048 cases of lung cancer registered
with NCR, comprising 1,445 of males and 603 of females. Second most
common among males. Third most common cancer among populations in
Peninsular Malaysia. Chinese were found to have higher incidence
rate compared to Malay and Indians.
109. Health Education for Lung Cancer
110. Risk Factor People who smoke People exposed to second-hand
smoke People exposed to indoor and outdoor air pollution People
exposed to certain toxic substances, such as arsenic, radon or
asbestos People whose jobs expose them to radiation People with
personal or family histories of lung cancer
111. So the advice here is.. Smoking is the most important risk
factor for lung cancer. Dont smoke. If you smoke, quit. Stay away
from second-hand smoke Make your home and community smoke-free. Eat
lots of fruits and vegetables. Some research says being physically
active may reduce your risk
112. Stay away from air pollution, wear mask if working in a
polluted area. Check your home for radon.(considered as the second
leading cause of lung cancer and leading environmental cause of
cancer mortality) Follow the guidelines of handling radioactive
material eg. Experiment or work Early detection by low-dose helical
CT scans reduced the rate of death from lung cancer.