CASE

STUDIES ON
MAJOR
CONCEPTS
CELLULAR ABERRATION
 OVARIAN CARCINOMA
By: ALCE
Case Scenario – R.M. is a 49-year-old woman with a history of stage III ovarian carcinoma. She was initially treated
with an exploratory laparotomy that included a total abdominal hysterectomy, an ileocecal resection and
anastomosis, omentectomy, and peritoneal biopsies
The postoperative CA-125 level was 69 units/mL; currently, it is 328 units/mL. She has received four courses of
chemotherapy consisting of paclitaxel (Taxol) and cisplatin (Platinol). She is being admitted with shortness of breath,
complaints of nausea, and early satiety with recent weight loss of 10 pounds. Her abdomen is distended, and her
Sao2 is 86% on room air. The physician orders an MRI of the abdomen and pelvis, which reveals a mass in the left
lower quadrant and a malignant bowel obstruction. He immediately schedules R.M. for a tumor debulking and
possible placement of an ostomy.
Family History – Family history analysis reveals a strong positive occurrence of breast and ovarian cancer in R.M.'s
family. Her mother died of breast cancer at the age of 56, and a maternal aunt died of ovarian cancer at the age of
59. The physician suggests testing for the presence of the BRCA1 and BRCA2 genes and, if positive, testing R.M.'s
two daughters and son.
Pathophysiology
The majority of ovarian cancers are of epithelial origin, whereas fewer ovarian cancers develop from the remaining cell types,
such as sex-cord stromal, germ cell, or mixed cell-type tumors.
• The most common histological subtypes of epithelial ovarian carcinomas are serous (68-71%), endometrioid (9-11%), clear cell
(12-13%), mucinous (3%), transitional (1%), and mixed histologies (6%).
• Several groups have now convincingly established that there are 2 distinct types of epithelial ovarian carcinoma: type I and
type II.
• Type I tumors arise via well-recognized sequence either from borderline serous tumors or from endometriosis and include low-
grade serous carcinoma, endometrioid, and clear-cell carcinoma.
• These tumors are often early stage and low-grade tumors, with a relatively indolent disease course.
• Type II carcinomas are more frequent, usually of serous histology, are high grade, and seem to originate from the fimbrial
epithelium in up to 60% of the cases.
• Subsequently, high-grade serous carcinomas present clinically as stage 3 or 4 disease, consistent with the hypothesis of
peritoneal seeding by malignant cells from the fimbriated end of the tubes.
• At the time of diagnosis, the majority of epithelial ovarian cancers are advanced-stage, high-grade serous carcinomas and
have a poor prognosis compared with early-stage carcinomas (Nezhar, Apostal, Nezhat & Pajovic, 2015)
Concept Map

Prevention
Prevention

••Consider
Consider taking
taking birth
birth control
control
••Discuss
Discuss risk
risk factor
factor with
with the
the physician
physician

Risk
Risk Factors
Factors Signs
Signs and
and Symptoms
Symptoms

••Older
Older age
age ••Abdominal
Abdominal bloating
bloating oror swelling
swelling
••Hereditary
Hereditary ••Quickly
Quickly feeling
feeling full
full when
when eating
eating
••Estrogen
Estrogen hormone
hormone replacement
replacement ••Weight
Weight loss
loss
••Discomfort
Discomfort inin the
the pelvis
pelvis area
area
••Changes
Changes inin bowel
bowel habits,
habits, such
such as
as
constipation
constipation

Ovarian
Cancer
 THYROID CANCER
By: ADUNA

A 36-year-old female client presents to the clinic with chief complaint of swollen neck. She stated that it feels difficult to swallow
because of the swelling.
Past History: Father died from hypertension. Mother is alive but known to have hypertension as well. Client has two female siblings
and both alive and well. She has one daughter who is 9 years old now. Non smoker and non alcoholic. Client works from home and
one of her hobby is to watch movies.
Present history: Client stated that when she woke up this morning her voice is hoarse like usual. She said that she would have
hoarseness of voice from time to time. She drink water but she felt a very slight of pain upon drinking. She also noticed that her neck
looks a little swollen. When lunch time came, she had difficulty swallowing and could only take little sips of water. She then decided to
go to the doctor for check up.
Pathophysiology

Thyroid gland needs iodine to secrete thyroid hormone. Alteration in iodine metabolism cause malignant
development of thyroid cells due to defective synthesis of thyroglobulins. Thyroids cells displays impaired uptake of
iodine and reduced iodide capacity due to functional dedifferentiation. Abnormal iodiproteins to be synthesized and
secreted into circulation. Thyroid tumors produce and secrete excess amount of calcitonin. Calcitonin acts to lower
the blood calcium concentration by inhibiting the resorption of bone. (Reference: Pathophysiology of Thyroid
Cancer, Riccabona G. 1987)
Concept Map
 BREAST CANCER
By: BAYAUA
Case Scenario: Carol Edwards, a 39 year-old premenopausal woman, had a screening mammogram which revealed an
abnormality in the right breast. She had no palpable masses on breast exam. A mammographically localized surgical biopsy
was done and revealed a small (0.9 cm) grade III infiltrating ductal carcinoma with some associated ductal carcinoma-in-situ
(DCIS). The surgical margins were not clear (cancer cells were found at the posterior margin). Estrogen and
progesterone receptors are negative. The patient has been given the diagnosis in a telephone conversation with the surgeon a
few days after the biopsy, and they are now meeting to discuss definitive treatment. Surgical treatment must address two
issues: local control and staging.
History Of Present Illness: Patient had a screening mammogram which revealed an abnormality in the right breast. She had no
palpable masses on breast exam. A mammographically localized surgical biopsy was done and revealed a small (0.9 cm)
grade III infiltrating ductal carcinoma with some associated ductal carcinoma-in-situ (DCIS). The surgical margins were not
clear (cancer cells were found at the posterior margin). Estrogen and progesterone receptors are negative.
Family History: Patient’s mother died due to Breast Cancer
Pathophysiology

Breast cancer invades locally and spreads through the regional

lymph nodes, bloodstream, or both. Metastatic breast cancer may
affect almost any organ in the body—most commonly, lungs, liver,
bone, brain, and skin.
Concept Map
Patient’s mother
died due to Breast
Cancer
mammogram
which revealed
premenopausal an abnormality in
woman BREAST CANCER the right breast

Estrogen and A mammographically

progesterone localized surgical biopsy
receptors are
was done and revealed a
negative.
small (0.9 cm) grade III
infiltrating ductal carcinoma
with some associated
ductal carcinoma-in-situ
(DCIS)
 MELANOMA
By: BERNABEO

Case Scenario: A 62-year-old female patient who was referred to the clinic with a depigmented skin lesion with areas of
brown/black pigment in the middle, located on the left cheek. The patient could not tell when the lesion first appeared, but
she confirmed the presence of a nodular hyperpigmented lesion on the left cheek that started to bleed two years ago after a
local trauma. The depigmentation started three months earlier. The clinical examination revealed a cutaneous 7/2 cm
asymmetric patch with large pink discolorations and a central nodular, fibrotic pigmented area. No ulceration, crusting or
active bleeding was seen.

History of Present Illness: Presence of a nodular hyperpigmented lesion on the left cheek that started to bleed two years
ago after a local trauma.
Pathophysiology

Melanomas may develop in or near a previously existing precursor lesion or in healthy-appearing skin. A malignant
melanoma developing in healthy skin is said to arise de novo, without evidence of a precursor lesion. Solar irradiation
induces many of these melanomas. Melanoma also may occur in unexposed areas of the skin, including the palms,
soles, and perineum. Melanomas have 2 growth phases, radial and vertical. During the radial growth phase, malignant
cells grow in a radial fashion in the epidermis. With time, most melanomas progress to the vertical growth phase, in
which the malignant cells invade the dermis and develop the ability to metastasize.
Concept Map:

SIGNS &
RISK FACTORS
SYMPTOMS

Lesion asymmetry Development of Sun exposure Family history

or border an elevated
irregularity on area (or
moles palpable nodule)
  Indoor tanning Familial melanoma
 

Diameter over 7 Moles Race or ethnicity

A change in an
millimeters
existing mole
 
Age 65-year-old
Fair skin
 
The development of a
new pigmented of
unusual-looking growth
on your skin Previous skin Weakened or
cancer suppressed
 
immune system
 PANCREATIC CANCER
By: COCUSA

A 50 years old woman presented to her PCP with abdominal pain radiating to her back. CT scan of the abdomen and
pelvis performed on the same day as that of her husband revealed a mass in the pancreas with evidence of multiple
lesions in other organs. Subsequently, she had an endoscopic ultrasound guided biopsy and the pathology revealed
pancreatic adenocarcinoma. She denied any history of weight loss or loss of appetite. Her medical history was
significant for asthma and hypertension. Family history included diabetes in her mother and an unknown type of cancer
in her maternal aunt and paternal grandmother. She smoked cigarettes for several years, but quit 9 months prior to her
diagnosis. She denied any history of sustained alcohol consumption. Prior to marriage, her husband and she had
worked in the same office for at least a year. Her medications prior to diagnosis included oestradiol,
fluticasone/salmeterol inhaler, ipratropium/albuterol inhaler, lisinopril, monteleukast and multivitamins. Physical
examination demonstrated only mild upper abdominal tenderness. The patient's BMI was 29.5 kg/m2 at diagnosis.
Pathophysiology

Typically, pancreatic cancer first metastasizes to regional lymph nodes, then to the liver and, less commonly, to the lungs. It
can also directly invade surrounding visceral organs such as the duodenum, stomach, and colon, or it can metastasize to
any surface in the abdominal cavity via peritoneal spread. Ascites may result, and this has an ominous prognosis.
Pancreatic cancer may spread to the skin as painful nodular metastases. Metastasis to bone is uncommon.
Pancreatic cancer rarely spreads to the brain, but it can produce meningeal carcinomatosis.
 P Risk Factors
Concept Map Signs and symptoms of pancreatic cancer : A Factors that may increase your risk of
N pancreatic cancer include:
• Abdominal pain that radiates to your
back C • Smoking
• Loss of appetite or unintended weight R • Diabetes
loss
E • Chronic inflammation of the
• Yellowing of your skin and the whites pancreas (pancreatitis)
A
of your eyes (jaundice)
T • Family history of genetic
• Light-colored stools syndromes that can increase cancer risk,
I including a BRCA2 gene mutation, Lynch
• Dark-colored urine
C syndrome and familial atypical mole-
• Itchy skin malignant melanoma (FAMMM)
C
syndrome
• New diagnosis of diabetes or existing
A
diabetes that's becoming more difficult to • Family history of pancreatic
control N cancer
• Blood clots C • Obesity
• Fatigue E • Older age, as most people are
R diagnosed after age 65

Complication: Prevention:
 Weight loss  Maintain a healthy
 Jaundice weight
 Pain  Stop Smoking
 Bowel Obstruction
 COLORECTAL CANCER
By: DELA CRUZ
Case Scenario: A 70 year old white male patient is on status post resection of a stage III adenocarcinoma of the sigmoid colon,
approximately 10 days since his surgery. His surgery went well. He has been eating well and tolerating food well, and moving his
bowels with no problems. Approximately two weeks prior to surgery he also had significant coronary artery disease and underwent a
CABG at that time, and has done well from that surgery as well. His pathology showed a highly aggressive T3, N2 adenocarcinoma
of the colon, stage III with angiolymphatic invasion. The patient has been well until recently when he had some vague abdominal
pain.
Family History: Mother died of cancer of unknown etiology and had one son who died of lymphoma at age.
History of Present Illness: The patient is on status post resection of a stage III adenocarcinoma of the sigmoid colon, approximately
10 days since his surgery. His surgery went well. He has been eating well and tolerating food well, and moving his bowels with no
problems. Approximately two weeks prior to surgery he also had significant coronary artery disease and underwent a CABG at that
time, and has done well from that surgery as well. His pathology showed a highly aggressive T3, N2 adenocarcinoma of the colon,
stage III with angiolymphatic invasion. 6 of 11 lymph nodes were positive The margins on the tumor were negative, and I believe
given the fact that he is a relatively young man and in good health that he should be considered for an aggressive adjuvant
chemotherapy approach. He underwent adjuvant 5FU leucovorin chemotherapy for a Stage III, T3, N2 colon cancer. The patient has
been well until recently when he had some vague abdominal pain. A flexible sigmoidoscopy was negative. An ultrasound of the liver
showed calcifications leading to the CT scan which is also negative.
Pathophysiology

Colorectal cancer starts in the innermost layer and can grow outward through some or all of the
other layers. When cancer cells are in the wall, they can then grow into blood vessels or lymph
vessels. From there, they can travel to nearby lymph nodes or to distant parts of the body. The
stage of a colorectal cancer depends on how deeply it grows into the wall and if it has spread
outside the colon or rectum.
Concept Map
Signs and Symptoms Risk Factors

Unexplained and unintentional

Age
weight loss
Black race

Stomach pains, bloating, fullness or cramps

Gender
that occur frequently and don’t go away
Family history of
Bowel habit changes colorectal cancer

Blood in or on the stool

Physical inactivity
COLORECTAL
and obesity
Bleeding from the
CANCER
rectum
Adenomatous polyps
Diarrhea

Inflammatory
Constipation bowel disease
Fatigue
Abnormally narrow Weakness
Nausea or Smoking
stools Incomplete bowel
movements vomiting
 PROSTATE CANCER
By: MUNGCAL

Case Scenario: Carlos Aquino, a 63 year old Filipino male with hormone-refractory prostate cancer is your clinic patient. Mr.
Aquino was diagnosed with benign prostatic hypertrophy (BPH) several years ago and was taking alpha blockers for this
condition.
A year ago, his BPH symptoms worsened despite maximal therapy. At that time you performed a digital rectal exam and
noted that he had a new hard nodule (1cm x 1cm) in the right lobe of his prostate and a PSA of 2.4 (PSA in the year prior to
that was 2.2). A prostate biopsy revealed high-grade adenocarcinoma in 5/5 R lobe biopsy specimens with Gleason’s score
of 4+5, and 2/5 of L lobe biopsies. A bone scan showed a small focal abnormality in the lumbar spine at the level of the L2
vertebra. The prostate cancer was staged as T2b.
 
History of Present Illness: Patient is here with his wife to see you for routine follow-up. He reports moderate pain control on
his current pain regimen. He also states that his appetite is poor and that he tires easily. He is independent in his ADLs and
IADLs, and even working occasionally on his good days. You note that he has lost 2 pounds since his last clinic visit 2
months ago. (BMI= 25.6).He is alert and oriented. His recent labs show a PSA = 70.7
Pathophysiology
 
 Prostate cancer is an adenocarcinoma as it develops primarily from
the glandular part of the organ and shows typical glandular patterns
on microscopic examination.
 The cancer cells grow and begin to multiply, initially spreading to
the immediately surrounding prostate tissue forming a tumor
nodule.
 Such a tumor may grow outside the prostate (extracapsular
extension) or may remain localized within the prostate for decades.
 Prostate cancer commonly metastasizes to the bones and lymph
nodes.
 Metastases to the bone are thought to be at least partially a result
of the prostatic venous plexus draining into the vertebral veins.
Concept Map

SIGNS AND
SYMPTOMS RISK FACTORS
Frequent urination.
Weak or interrupted urine flow or Age
the need to strain to empty the
bladder.
Race/Ethnicity
The urge to urinate frequently at
night.

Blood in the urine.

New onset of erectile
dysfunction. FAMILY HISTORY
Pain or burning during GENE CHANGES
urination, which is much less
common.
 ACUTE MYELOID LEUKEMIA
By: OMLANG
Patient: 66 year old male, named Bert 
 Retired Navy Seal and school bus driver
 Current Volunteer at Veteran’s Affairs Hospital in Louisville, KY
 Lives with wife of 45 years
 Type II diabetic, controlled
 Left Transtibial Amputation secondary to diabetic ulcer
 Previous physical therapy in acute, rehabilitation, and outpatient settings following surgery
Chief Complaint: Patient presents to outpatient physical therapy clinic (2 months post discharge), with desire for further prosthetic training. Patient’s prior outpatient PT included gait
training and stair training with use of cane. Now, patient desires more independence without assistive device and further training to accommodate his increased activity level in the
community with his volunteer work. Patient notes that he feels increasingly tired after a day of volunteering, therefore he wants more endurance training with his prosthetic.
Medical History:
• Previous history of smoking, 30 pack years
• Quit smoking at age 48, when he was diagnosed with Type II diabetes
• Diabetic ulcer on L heel, led to transtibial amputation approximately 1 year ago
• Patient reports history of anemia while in hospital post-op
• Recent onset of headaches, 3 out of 10 on pain scale
• Patient reports shortness of breath with increased activity
•1 year post-operation from amputation
• Discharged from outpatient physical therapy 2 months prior to current visit.
Pathophysiology:

The underlying pathophysiology in AML consists of a maturational arrest of bone marrow cells in the earliest
stages of development. The mechanism of this arrest is under study, but in many cases, it involves the
activation or inactivation of genes through chromosomal translocations and other genetic and/or epigenetic
abnormalities. This developmental arrest results in 2 disease processes. First, the production of normal blood
cells markedly decreases, which results in varying degrees of anemia, thrombocytopenia, and neutropenia.
Second, the rapid proliferation of the abnormal myeloblasts, along with a reduction in their ability to undergo
programmed cell death (apoptosis), results in their accumulation in the bone marrow, the blood, and, frequently,
the spleen and liver.
Concept Map

Acute
Myeloid
Leukemia

Signs and Symptoms Risk Factors

• Fever • Increasing
• Bone Pain age
• Lethargy and • Previous
Fatigue Cancer
• Shortness of Treatment
breath • Exposure to
• Pale Skin Radiation
• Easy bruising • Smoking
• Unusual • Genetic
bleeding Disorder
 NASOPHARYNGEAL CARCINOMA
By: ONIA

Case Scenario: The patient is a 35 y/o, Filipino, male, single, who works in a chemical factory was admitted with a chief
complaint of intense headache with difficulty of breathing.

History of Present Illness:

3 prior admission, the patient was about to finish his shift when he experienced headache with a pain scale of 10/10, difficulty
of breathing and difficulty speaking. The patient also noticed a discharge and mass near the nasal area.
 
Vital Signs: BP 90/60 HR: 79bpm RR: 21cpm Temp: 37.5 O2: 99%

Family History: (+) Nasopharyngeal carcinoma (Maternal) (-)Hypertension, DM, CVD, Asthma
Pathophysiology

Nasopharyngeal epithelium> genetic susceptibility, environmental

carcinogens and/or infection/inflammation of upper respiratory tract>
reversible mild hyperplasia> Epstein barr virus infection> subtle genetic
changes> Early premalignant lesion w/ severe dysplasia/ carcinoma in
SITU> Nasopharyngeal Carcinoma
Concept Map:

NASOPHARYNGEAL CARCINOMA

SIGNS AND SYMPTOMS RISK FACTORS

- Tumor mass in the nasopharynx (epistaxis, - Smoking or chewing tobacco
nasal obstruction, discharge) - Alcohol abuse
- Dysfunction of the eustachian tube, mass in the - High doses of radiation therapy
paranasopharyngeal space (tinnitus and - Exposure to asbestos
deafness) - Aging
- Neck Mass - Epstein barr virus
- Headache, diplopia, facial pain, numbness - Socio economic status
- Enlarged neck nodes - Salt preserved fish

TREATED WITH
- Early stage: External Radiation/ EBRT + ICBT
- Late stage: KPS > 70 Concurrent Chemoradiation
KPS < 70 Palliative Radiotherapy
 CEVICAL CANCER
By: PANOPIO
A 66-year-old woman presented to the emergency department with complaints of vaginal bleeding and passing of large clots with
abdominal pain of 8 out of 10 using a numeric pain severity scale. She was admitted to the hospital where on examination she was found
to have a large cervical mass, which was biopsied and confirmed as invasive, well-differentiated carcinoma. She reported regular
menstrual cycles until 9 months ago,when she noticed increased vaginal bleeding, abdominal pain, and a malodorous vaginal discharge.
She also complained of poor appetite, dyspareunia, and constipation. She denied fever or chills. She was noted to be severely anemic
with a hematocrit of 23% and received 3 units of packed red blood cells.Computed tomography scan showed an 8.6 x6.0 cm cervical
mass with no evidence of hydronephrosis or lymphadenopathy. The patient underwent a cystoscopy and proctoscopy for clinical staging.
The final diagnosis received was stage IIB cervical cancer. She received daily pelvic radiation therapy and weekly cisplatin at 30
mg/m2intravenously. Upon initiation of treatment, she has had a cessation of bleeding, except minimal spotting. Her abdominal pain has
improved; however, she reports increasing fatigue and some shortness of breath on exertion. The patient is disabled and is currently on
Medicare.
History of Past Illness:
The patient experienced menarche at age 12. She has been pregnant 7 times and has 6 children. She reports her last Pap smear was 8 years ago and
was abnormal, but she did not follow up with her physician. Her medical history is positive for hyper-tension, for which she takes hydrochlorothiazide and
labetalol.
Family History:
She reports 2 grandparents and an aunt had cancer, but she is unsure of the type of cancer. Her mother, sister, and aunt have hypertension and
diabetes.
Pathophysiology
CANCER
By: PERENA
 LUNG CANCER
By: SANTOS

CASE SCENARIO: Patient P is a white man, 58 years of age, who worked as a sales representative for a nationally known greeting card company. He travelled by car over a wide area and spent a great deal
of his time driving and smoking. The patient was first seen at his primary care physician's office for a routine physical that his wife had insisted he schedule.
When Patient P met the physician for the first time in September, he denied any major complaints and stated that he was there to appease his wife. His medical history revealed no major illness or injuries,
apart from an appendectomy at 14 years of age. He admitted he had smoked two packs of cigarettes every day for the last forty years.
When the office nurse observed a frequent, non-productive cough, she questioned Patient P about it. The patient claimed it was simply a tickle in his throat that came about every spring due to an allergy to
budding trees and flowers. Because it was no longer spring and the cough remained, the office nurse made a note for the physician to check into the cough when he examined the patient.
The physician found nothing remarkable on Patient P's physical examination, even though he listened to the patient's chest to assess the cough. As a precaution, however, he ordered a chest x-ray and some
routine lab work.
Three days later, the results of the exams were returned. The chest film showed an infiltrate in the patient's right lower lobe. Laboratory work showed mild anemia with a hemoglobin of 10.0 and hematocrit of
31. The patient was contacted and asked to return to the office to discuss the findings.
The next day at the office, the physician explained the results and showed Patient P and his wife the x-rays. He said that while he suspected lung cancer, he hoped he was wrong. A definitive diagnosis
required further testing. The physician ordered sputum for cytology, an MRI of the chest, and scheduled a bronchoscopy with biopsy for later in the week, contingent upon approval from the insurance
company.
Patient P was given instructions for collecting the sputum specimens. The Western States HMO utilization review office approved both the MRI and bronchoscopy as "urgent," which meant it was not routine,
but also not an emergency. The diagnosis on the authorization request was possible lung cancer, so a copy was automatically routed to Nurse B in the oncology disease management division.
Three days later, Patient P, accompanied by his wife, went to the outpatient department at City Memorial, the contracted hospital for Western States HMO. Patient P had been NPO since midnight. Once out of
his clothes and into a gown, Patient P was taken into the procedures suite for the bronchoscopy.
After the bronchoscopy was completed, the physician explained to Patient P's wife that everything appeared normal with the procedure, but he still wanted the MRI. After the MRI was completed, Patient P
recovered from the procedure and sedation and was ready for discharge. Just before they left, the physician came back into the room with a frown on his face.
The MRI showed a peripheral lung tumor. Based on the lung scan, the physician believed the mass was likely cancer, but he also wished to get a consult from a thoracic
surgeon and obtain a biopsy to determine exactly what they were dealing with.
The biopsy was scheduled for the following Wednesday, but on Sunday evening the patient's wife, sounding frantic, called the physician. She related that Patient P had had a
seizure and that she had called the paramedics. By the time the ambulance had arrived, her husband was awake and had refused to go with them. The paramedics insisted
that the family physician be contacted immediately. Per the physician's instructions, Patient P was driven to the emergency room at City Memorial where he was examined and
admitted to the Oncology Unit.
Shortly after their conversation, a transporter arrived to take Patient P to the imaging department for a MRI of the brain. While having the procedure, Patient P suffered another
tonic-clonic seizure. That afternoon, the physician, accompanied by Nurse W, went to the patient's room to speak with him and his wife. The physician related the findings of
the brain MRI, which showed several areas in the brain that appeared to be metastases. He also emphasized the need to begin medication and radiation treatments. First,
Patient P would be referred to a neurosurgeon for further examination and possible surgical intervention.
The neurosurgeon saw Patient P later in the day and scheduled a biopsy of the brain using stereotactic surgery for Tuesday, the next day. Results from the biopsy confirmed
metastatic adenocarcinoma from the lung.
After determining that the lung tumor had spread to the area blocking the flow through the superior vena cava, the physician, along with Nurse W, presented several options to
Patient P, including surgery, more radiation and chemotherapy, or returning home with hospice to help with the final days.
HISTORY OFPRESENT ILLNESS When the office nurse observed a frequent, non-productive cough, she questioned Patient P about it. The patient claimed it was simply a
tickle in his throat that came about every spring due to an allergy to budding trees and flowers. Because it was no longer spring and the cough remained, the office nurse made
a note for the physician to check into the cough when he examined the patient.
Pathophysiology
 Concept Map
Risk Factors
- Smoking
- Secondhand smoking
Some lung cancers can - Radon
cause syndromes, which are - Other subtances
Sign & Symptoms groups of specific symptoms. - Personal or family
The most common symptoms of lung cancer are:
Horner syndrome
history of lung cancer
A cough that does not go away or gets worse
- Radiation therapy to
If lung cancer spreads to other Drooping or weakness of the chest
Coughing up blood or rust-colored sputum (spit parts of the body, it may cause: one upper eyelid
or phlegm)
- Diet
Bone pain (like pain in the back or A smaller pupil (dark part in
Chest pain that is often worse with deep hips)
breathing, coughing, or laughing the center of the eye) in the
Nervous system changes (such as same eye
Hoarseness
headache, weakness or numbness Little or no sweating on the
Loss of appetite of an arm or leg, dizziness, balance same side of the face
Unexplained weight loss problems, or seizures), from cancer
spread to the brain   Manifestation
Shortness of breath
Yellowing of the skin and eyes   The initial clinical manifestations of lung cancer are diverse
Feeling tired or weak
and may occur with or without symptoms. Manifestations of
(jaundice), from cancer spread to pulmonary malignant lesions are produced by local growth or
Infections such as bronchitis and pneumonia that
don’t go away or keep coming back
the liver invasion, metastatic disease, or paraneoplastic processes.
Patterns of local invasion such as Pancoast's syndrome or the
New onset of wheezing Swelling of lymph nodes (collection
superior vena cava syndrome are relatively uncommon but
of immune system cells) such as well recognized. Metastatic lung cancer can involve almost any
  those in the neck or above the anatomic area by hematogenous, lymphatic, or, occasionally,
collarbone interalveolar dissemination. Complications related to
 
malnutrition, infection, electrolyte disturbances, and coexisting
  diseases influence the initial manifestations. Although
individual tumor cell types are associated with characteristic
features, no constellation of findings is pathognomonic for a
specific histologic variant. Because successful treatment of
pulmonary carcinoma depends on early detection, awareness
of the typical clinical manifestations is important.