Lung cancer clinical presentation

LP is a 58-year-old man with newly diagnosed stage IIIA non-small cell lung cancer who presents to the clinic complaining of loss of appetite, excess thirst, nausea and vomiting, and confusion x 2 days. The medication history lists NKDA, hydrochlorothiazide 50 mg by mouth daily for hypertension, and naproxen 500 mg by mouth twice daily for arthritis. 

Paraneoplastic autonomic neuropathy is primarily seen with SCLC [103]. Lymphoma, non-small cell lung cancer, and ovarian cancer are also associated with autonomic disturbances [104]. Autonomic dysfunction affects 23-30% of Hu antibody positive patients [36, 98] and is the predominant symptom at presentation in up to 9% of the patients [90]. The onset of symptoms is usually subacute. A prominent clinical manifestation in patients with paraneoplastic autonomic neuropathy is gastrointestinal dysmotility and intestinal pseudo-obstruction, which can occur as part of the PEM/SN syndrome or as the sole symptom of Hu antibody related PNS. Ortostatic hypotension and erectile dysfunction are other common features [37, 105, 106], Autonomic neuropathy is also commonly associated with the CRMP-5 antibody and have been detected in more than 30% of CRMP-5 antibody positive patients [30], Inflammation in autonomic ganglia and infiltration of B and T cells have been demonstrated at autopsy [107], and Hu antibodies have been shown to induce neuronal apoptosis in cultured myenteric neurons [105],... 

Patients with lung cancer frequently have numerous concurrent medical problems. Such problems may be related to invasion of the primary tumor and its metastases, paraneoplastic syndromes (see clinical presentation, above), chemotherapy and radiotherapy toxicity, or concomitant disease states (e.g., cardiac disease, renal dysfunction, chronic obstructive pulmonary disease, asthma, or diabetes). Depression is also common and sometimes persistent in patients with SCLC and NSCLC and should be treated. Identification, diagnosis, and treatment of the patient as a whole may improve the patient s overall quality of life and tolerance to cancer treatments. 

Murthy R, Oh Y, Tam A et al (2006) Yttrium-90 microsphere treatment for liver dominant hepatic metastases from lung cancer. Presented at the American Society of Clinical Oncology Annual Meeting, Atlanta... 

Worldwide, hospitals that do not use these species can no longer be found [48] and their usefulness continues to grow. CM-Platin 1 is routinely used for treatment of testicular, ovarian, and non-small-cell lung cancers, and its use is increasing in the treatment of head and neck tumors and those of the bladder [45]. Besides CM-platin, the less aggressive carboplatin 2 and oxaliplatin 3 were later introduced, the latter specifically for treatment of colorectal cancers. At the present time, a dozen other Pt complexes are in advanced clinical trials, and three derivatives (nedaplatin, loboplatin, and heptaplatin) are in clinical use although less universally so [48]. 

Similarly, it is not possible at present to predict which tumours will respond to RT. Patients with lung cancer receiving RT will have a dose of RT based on, amongst other things, the size of the tumour, the patient s general health, and the localization of the tumour. Furthermore, RT is also associated with side effects. Therefore, S-FTIR spectroscopy could also be used to assess tumour cell resistance or sensitivity to RT. In this way, clinicians could deliver doses of RT based on S-FTIR spectroscopy data which would lead to an increase in the benefits of RT and a decrease in the side effects. This is known in clinical practice as the therapeutic index or ratio (the amount of a therapeutic agent that causes a therapeutic effect in relation to the amount that causes toxic effects). 

---