Skip to main content

62 years old man with non small cell adenocarcinoma and biomarker evaluation for targeted therapy

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here after collecting informed patient consent (form downloadable Click Here)  by BMJ Elective Student. 


The 62 year old man appears to have a non-small-cell lung (NSCLC) adenocarcinoma lung with cerebral metastasis and the doctors are looking to further test for bio-markers that may predict response to targeted precision Medicine. 

Add caption













WhatsApp Discussion:
SC:should prophylactic cranial irradiation be performed in bronchial adenocarcinoma/NSCLC as is advocated for SCLC? Because this patient had a brain met

RB: Yes "traditionally, whole-brain radiation therapy (WBRT) has been the standard treatment for brain metastases with multiple intracranial lesions although studies have shown no overall survival benefit and no improvement in quality of life.
It's one of the reasons why oncologists currently have shifted to what are termed as precision Medicine approaches and one sees case reports where "small-molecule inhibitor of EGFR-TKI is used in lung adenocarcinoma with brain metastases  showing EGFR mutation-positive with reasonable quality of life outcomes. This is perhaps what has also been planned for our patient in Tata memorial. Shreyas do you have his current update?

Comments

Popular posts from this blog

57 Year Old female with goiter and thyrotoxicosis

This 57 year olf lafy presented with neck swelling, anxiety and tremor. Her medical information is attached below: We need to take a decision on this lady. To operate or not to operate. Now that our clinical suspicions of thyroticosis have been proved and malignancy not proved (not disproved either) what would be the next best step? Medical management for her thyrotoxicosis or still get an excision biopsy with sub total thyroidectomy (and subtotal thyroidectomy other than disproving malignancy will also become treatment for her hyperthyroidism). So which one should we prefer (if the family has no reservations from their side)?

Consent Forms

Hindi BMJ Consent form   Bengali BMJ Consent form English BMJ Consent form   Telegu BMJ Consent Form Telegu BMJ Consent Form   UDHC Consent Form                

A 55 year old man with childhood asthma and Acute exacerbation of COPD

This is a 55 year old man in ICU with severe hypercapnia refractory to positive pressure ventilation with PCO2 ranging from 100-120 mm of Hg after 24 hours of ventilation. He appeared to have a history of Bronchial asthma since childhood. Perhaps for the last 45 years. His last three years appear to have been spent in perennial shortness of breath and wheeze. He has a barrel shaped chest and his CXR pa shows pushed down diaphragms. He was referred from a nursing home on a ventilator ambulance and his ABG during admission was showing a PCO2 of 90. After 24 hours of ACMV with a RR of 20 and tidal volumes of 400 ml his PCO2 increased to 120s.  This case of AECOPD with resp. Acidosis on mechanical ventilator was found to have total WBC count increasing overtime (15300 (ICU 2nd Day)/ 18500/ 27500/ 35600 (13th day). So, we started empirically with Clavum & Augmentin and later on planned for meropenam & Colistin antibiotic based on further deterioration in Total WBC Count....