Respiratory System Problem (problem based learning)
Download as PPTX, PDF6 likes3,596 views
The document discusses a case study of a 26-year-old man presenting various respiratory symptoms including facial swelling, lumps, and chest pain, ultimately diagnosed with stage IV lung cancer. It explores the pathophysiology of nail clubbing, types of biopsies for tissue analysis, and details of lung cancer, including its main types and associated complications. Additionally, it covers the effects of cannabis, including its psychoactive properties and potential health risks.
![• 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](https://image.slidesharecdn.com/www-150109210559-conversion-gate01/85/Respiratory-System-Problem-problem-based-learning-3-320.jpg)
![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](https://image.slidesharecdn.com/www-150109210559-conversion-gate01/85/Respiratory-System-Problem-problem-based-learning-105-320.jpg)
Respiratory System Problem (problem based learning)
- 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
- 2. Patient’s 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
- 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 <160ᵒ angle (Lovibond angle) bet the nailbed & the fold (cuticula) ↑ convexity of the nail fold Thickening of the whole distal end finger (resembling drumstick) Shiny aspect & striation of the nail & skin
- 7. Schamroth’s Window Test Popular test for clubbing Distal phalanges of corresponding fingers of opposite hands are directly opposed Small diamond- shaped ‘window’ appear bet the nailbeds If this windows is absent, the test is + & the clubbing is present
- 8. Diseases Associations Lung diseases • Lung cancer • Non small cell carcinoma (54%) • Small cell carcinoma (<5%) • Interstitial lung CA • Complicated TB • Suppurative lung diseases • Lung abscess • Empyema • Bronchiectasis • Cyctic fibrosis • Mesothelioma of the pleura • Arteriovenous fistula Heart diseases • Sub-acute bacterial endocarditis • Benign tumor • Tetralogy of Fallot • Congenital cyanotic heart diseases (most common) • Any diseases featuring chronic hypoxia Gastrointestinal & hepatobiliary • Malabsorption • Chron’s diseases & ulcerative colitis • Cirrhosis • Hepatopulmonary syndrome (complication of cirrhosis) Others • Grave’s diseases (autoimmune hyperthyroidism) • Familial & racial clubbing & pseudoclubbing • Vascular anomalies of the affected arm • Axillary artery aneurysm (unilateral clubbing)
- 9. Pathophysiology of nail clubbing Exact cause = unknown Vasodilation Secretion of growth factors from lungs Disorder in prostaglandin metabolism in 1ᵒ osteoarthropathy Led to overproduction of PGE2 by other tissues
- 11. Discomfort or pain anywhere along the front of your body between your neck and upper abdomen.
- 12. • Pleuritic pain/worsened by breathing PULMONARY EMBOLISM • Inflammation of pleura/worsened by inhalation and cough / sharp pain PLEURISY • Inflammation of bronchitis/related with smoking CHRONIC BRONCHITIS • Inflammation of lung PENUMONIA • Inflammation costal cartilage TIETZE’S SYNDROME • Begin suddenly/PNEUMOTHORAX LUNG COLLAPSE
- 13. • Pressure from the cancer mass LUNG CANCER • Pus collection in naturally existing cavity PLEURAL EMPYEMA • Caused by normal flora in mouth and GIT/worsened pain by taking a deep breath PULMONARY ACTINOMYCOSIS • Chronic inflammation by Mycobacterium tuberculosisTUBERCULOSIS
- 16. DEFINITION TYPES OF LUMP LUMP EXAMINATION
- 17. What is Lump • A lump is an abnormal protuberance and a palpable mass that generally has no definite size and shape • Common occurrence that can grow in any part of the body which may or may not be harmful • The medical significance of lump depends on the character or nature of the lump including the areas where it has developed
- 18. Type of Lump • DERMATOFIBROMA • LIPOMA • CYST • WARTS • ANGIOMA • MALIGNANT TUMORS
- 19. • Dermatofibromas Dermatofibromas are very common and is characterized by dimpling of the overlying skin. This type of lump can occur in any areas of the body but it is more commonly found under the skin of the legs.
- 20. • Lipoma Lipomas are fatty lumps that are benign in nature and occur where the fat can get bigger. Lipomas can cause symptoms when the lump has increased in size and put pressure on the surrounding tissues.
- 21. • Cysts SKIN: Cysts are round lumps that develop under the skin and have a yellowish color. It is movable and feels like a pebble under the skin. The cyst is generally harmless with a size that typically stays the same although may also increase in size. WRIST: Ganglion cysts develop as rubbery or soft swellings, usually in response to a minor injury that triggers excess joint fluid to collect in a saclike structure next to the joint. Ganglion cysts also can occur on the fingers or feet. OTHER LOCATION: KNEE, KIDNEY, BREAST, CERVIX & OVARY
- 22. • Warts Warts are skin colored lumps that usually occur in clusters. It is generally harmless but is contagious and can spread into other areas of the body or can be transmitted to others. Warts are benign (not cancerous) skin growths that appear when a virus infects the top layer of the skin. Viruses that cause warts are called human papillomavirus (HPV)
- 23. • Angiomas Angiomas are harmless lumps composed of a collection of blood vessels that make the lumps appear bright red or slightly purplish.
- 24. • Malignant tumors Malignant tumors are the type of lump that grows rapidly and the consistency of the lump is rather hard and immovable. Eg: Liposarcoma, Fibrosarcoma, Angiosarcoma Abdominal giant liposarcoma Primary cutaneous angiosarcoma
- 25. LUMP EXAMINATION 1) Proper exposure of the lump site 2) Inspection - Site : Anatomical site of lump by using body land mark - Overlying skin : texture (colour, rough, dry, etc.) - Shape - Margins - Size
- 26. 3) Palpation Feel: Tenderness and temperature Surface (smooth, irregular, nodular) Edge (sharp or blunt, smooth or rough or nodular, well defined or diffuse, etc) Consistency (stony hard, firm, rubbery, spongy, soft) Press: Pulsatility (expansile pulsation, transmitted pulsation) Compressibility (disappear on pressure and reappear on release) Reducibility (reappear only on application of another force: cough) Fluctuation (the 2 fingers moved apart when middle area pressed) Fluid thrill: indicates presence of fluid
- 27. 4) Percussion -Dull/resonant -Resonant if fluctuant swelling due to presence of air 5)Auscultation -Listen for bruits, venous hums, etc -Vascular swellings will have systolic bruits (such as aneurysms), -arterio-venous malformations will have a continuous bruit heard throughout diastole and systole -hernias which contain gut loops might let you hear bowel sounds
- 28. 6) Examine surrounding tissue -Lymph node: In cases of acutely tender and inflamed swellings, local lymph nodes might be swollen (pointing towards an infection). -Any swelling at other part : same/difference -State of local tissue: arteries (ischemia), nerves (muscle wasting and change in sensation), lymphatic (edema), bones and joints (erosion), inflammation. 7) General physical examination on the patient : Health overview
- 29. TERATOMA
- 30. TERATOMA • A teratoma is a type of germ cell tumor which contains several different types of cells, caused when germ cells actively dividing and start replicating at site where they should not. • This type of tumor actually present at birth but only noticed until later in life • They can contain skin,hair,bone,cell like those found in organ and glands
- 31. Benign & malignant • Cystic form teratoma • Remove by surgery benign • Solid form teratoma • Chemotheraphy and radiation malignant
- 32. • Other cancers often associated is : Small cell carcinoma Acute myelogenous leukemia (AML) Myelodysplasia (MDS) Embryonal rhabdomyosarcoma Malignant histiocytosis
- 33. • Malignant teratoma occurs most often in young men in their 20s - 30s • It is often located in the chest area. • The symptoms include : Chest pain Cough fatigue Shortness of breath Limited ability to tolerate exercise
- 35. CANNABIS
- 36. • commonly known as marijuana • the word used to describe the dried flowers, seeds and leaves of the Indian hemp plant • Street names, such as: astro turf, bhang, dagga, dope, ganja, grass, hemp, home grown, J, Mary Jane, pot, reefer, roach, Texas tea and weed.
- 37. -Material from the Cannabis plants • Cannabis sativa and Cannabis indica -Cannabis smoking is the inhalation of smoke or vapors released by heating the flowers, leaves, or extracts of cannabis - Contain psychoactive chemical : • Tetrahydrocannabinol (THC) • Cannabidiol (CBD), • Cannabinol (CBN) • Cannabigerol (CBG)
- 38. SMOKING METHODS
- 39. How cannabis makes you feel • The effects of cannabis vary from person to person: – some people may feel chilled out, relaxed and happy – others get the giggles or become more talkative – hunger pangs are common – this is sometimes known as "getting the munchies" – you may become more aware of your senses – it’s common to feel as though time is slowing down • Cannabis can have other effects too: – it makes some people feel faint and/or sick – this is sometimes known as a "whitey" – it can make you feel sleepy and lethargic – some people find it affects their memory, making it harder to remember things – it makes some people feel confused, anxious or paranoid, and some experience panic attacks and hallucinations.
- 40. RISK ASSOCIATED WITH CANNABIS LUNG -Like tobacco, it contains cancer-causing chemicals (carcinogens) that increase your risk of lung cancer FERTILITY -disrupt sperm production in males and ovulation in females. MENTAL HEALTH - increased risk of developing a psychotic illness, such as schizophrenia. - Depressive disorder ABILITY TO DRIVE UNBORN BABY -affect your baby's brain development -smoking cannabis with tobacco is associated with an increased risk of your baby being born small or premature.
- 42. Does cannabis have medicinal benefits? • Herbal cannabis contains many different compounds, called cannabinoids, which have different effects. One of these cannabinoids – tetrahydrocannabinol, or THC for short – is the active ingredient of a prescribed drug called Sativex. Currently this is only licensed in the UK as a treatment to relieve the pain of muscle spasms in multiple sclerosis. • Further research is under way to test the effectiveness of cannabis-based drugs for a range of other conditions including the eye disease glaucoma, appetite loss in people with HIV or AIDS, epilepsy in children and pain associated with cancer. We won’t know whether or not these treatments are effective until trials have concluded.
- 43. CHEST X-RAY
- 45. ABNORMAL X-RAY & CT SCAN
- 48. Types of biopsy What is BIOPSY? A biopsy is a procedure to remove a piece of tissue or a sample of cells from your body so that it can be analyzed in a laboratory While imaging tests, such as X-rays, are helpful in detecting masses or areas of abnormality, they alone can't differentiate cancerous cells from noncancerous cells. For the majority of cancers, the only way to make a definitive diagnosis is to perform a biopsy to collect cells for closer examination.
- 49. Continue... TYPES OF BIOPSY A) Endoscopic biopsy B) Needle biopsy C) Skin biopsy D) Surgical biopsy E) Stereotactic Core biopsy F) Ultrasound Guided Core biopsy
- 50. Continue... During endoscopy, the doctor uses a thin, flexible tube (endoscope) with a light on the end to see structures inside your body. Special tools are passed through the tube to take a small sample of tissue to be analyzed.
- 51. Continue...
- 52. Continue... During a needle biopsy, the doctor uses a special needle to extract cells from a suspicious area. A needle biopsy is often used on tumors that doctor can feel through the skin, such as suspicious breast lumps and enlarged lymph nodes. When combined with an imaging procedure, such as X-ray, needle biopsy can be used to collect cells from a suspicious area that can't be felt through the skin.
- 53. Continue...
- 54. Continue... A skin (cutaneous) biopsy removes cells from the surface of your body. A skin biopsy is used most often to diagnose skin conditions, including cancers, such as melanoma. What type of skin biopsy you undergo will depend on the type of cancer suspected and the extent of the suspicious cells
- 55. Continue...
- 56. Continue... If the cells in question can't be accessed with other biopsy procedures or if other biopsy results have been inconclusive, the doctor may recommend a surgical biopsy. During a surgical biopsy, a surgeon makes an incision in the skin to access the suspicious area of cells. Examples of surgical biopsy procedures include surgery to remove a breast lump for a possible breast cancer diagnosis and surgery to remove a lymph node for a possible lymphoma diagnosis. Surgical biopsy procedures can be used to remove part of an abnormal area of cells (incisional biopsy). Or surgical biopsy may be used to remove an entire area of abnormal cells (excisional biopsy). The may receive local anesthetics to numb the area of the biopsy. Some surgical biopsy procedures require general anesthetics to make y unconscious during the procedure. Patient may also be required to stay in the hospital for observation after the procedure.
- 57. Continue... Stereotactic core biopsy is the biopsy procedure which require guide using the mammogram.
- 58. Continue... Ultrasound guided core biopsy is the biopsy procedure which require guide of ultrasound device.
- 59. Continue... Ultrasound guided core biopsy is the biopsy procedure which require guide of ultrasound device.
- 60. Differential Diagnosis • Lung Carcinoma (chest pain, weight loss) • Tuberculosis (weight loss, cachexic) • Lymphoma (right axillary lymphadenopathy) Confirmed Diagnosis Stage IV Lung Cancer
- 61. ANATOMY OF CHEST
- 62. • b/t neck and diaphragm in front of body • Helps protect some of the major internal organs. • Supported and protected by the ribcage and shoulder. ANATOMY OF CHEST
- 63. ANATOMY OF CHEST
- 64. • All the breadth of the shoulders is due to the shoulder girdle, and contains the axillae and the heads of the humerus. • Thoracic skeleton • It consists of the ribs and sternum. • The ribs of the thorax are numbered in ascending order from 1-12. • Ribs 1-7 are true ribs. • Ribs 8-10 are termed false ribs. • Ribs 11 & 12 are known as floating. ANATOMY OF CHEST
- 65. ANATOMY OF CHEST
- 66. ANATOMY OF CHEST •PECTORALIS MAJOR: Large fan-shaped muscle. Majority of the chest muscle mass. It originates at clavicle, ribs, and sternum, and inserts into the upper portion of your humerus. The pectoralis major helps moves your arm toward. •PECTORALIS MINOR: Thin, triangular muscle that is found underneath the pectoralis major. It attaches at the 3rd, 4th and 5th rib, and it reaches to the scapula (shoulder blade). Its job is to help pull the shoulder down. •SERRATUS ANTERIOR: Originates on the surface of the 1st to 8th ribs at the side of the chest and inserts along the entire anterior length of the medial border of the scapula. It is functions are to move the scapula forward and upward.
- 67. ANATOMY OF CHEST •INTERCOSTAL MUSCLE : several groups of muscles that run between the ribs, and help form and move the chest wall. The intercostal muscles are mainly involved in the mechanical aspect of breathing.
- 68. Complication and pathophysiology of lung cancer
- 69. Define lung cancer • Lung cancer (malignancy of the lungs) is defined as an uncontrolled growth of abnormal cells in one or both of the lungs
- 70. Types of Lung Cancer • Two main Types of Lung Cancer: – Non Small Cell Lung Cancer (most common ~80%) • SQUAMOUS CELL CARCINOMA • ADENOCARCINOMA • LARGE CELL CARCINOMA – Small Cell Lung Cancer (20-25% of all lung cancers) • Combined patterns – Mixed sq.cell carcinoma + adenocarcinoma – Mixerd sq.cell carcinoma + SCC
- 71. Squamous Cell Carcinoma • Malignant bronchial epithelial tumour showing keratinization and/or intercellular bridges. • Strongly associated with smoking • Majority arise centrally in major bronchi – (obstruction and infection) • Cavitations in 10%
- 72. Click to add title
- 73. Adenocarcinoma • Malignant tumour with glandular differentiation or mucin production. • Gross : Adenocarcinoma of the lung. Usually found as white-tan nodule at the periphery of the lung. • Many variants : Acinar, papillary, bronchioloalveolar, solid, mixed subtypes • Strongly associated with asbestose
- 75. Small Cell Carcinoma • Oat cell carcinoma” • It arises from endocrine cells (Kulchitsky cells). • Closely associated with smoking
- 76. Pathophysiology disease limited to air passage lining: has not invaded lung tissue; can usually be treated and eliminated disease limited to lung tissue; has not invaded lymph nodes or other organs; spread to lymph nodes and chest wall (chest pain)
- 77. continue • disease has invaded lymph nodes outside of the lung area; (need surgery) • disease has invaded organs and structures surrounding the lungs such as the heart, trachea and esophagus • disease has invaded structures and organs throughout the body, such as liver, bones and brain; less than 2% chance of survival at 5 years if treated at this stage
- 78. Complication • Shortness of breath. Due to cancer has block the major airways. Lung cancer can also cause accumulation fluid around the lungs, thus SOB • Coughing up blood. Due to rupture of cappilary, bronchiolalviolar lead to blood cough (hemoptysis). • Pain. Advanced lung cancer that spreads to the lining of a lung or to another area of the body, such as a bone, can cause pain. • Fluid in the chest (pleural effusion). Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space). • Cancer that spreads to other parts of the body (metastasis). Lung cancer often spreads (metastasizes) to other parts of the body, such as the brain and the bones.
- 80. SURGERY RADIATION THERAPY CHEMOTHERAPY TARGETED THERAPIES IMMUNO THERAPY HORMONAL THERAPY ANGIOGENESIS INHIBITOR
- 81. SURGERY • The goal of the surgery can be either the removal of only the tumor, or the entire organ. • In theory, non-hematological cancers can be cured if entirely removed by surgery. • When the cancer has metastasized to other sites in the body prior to surgery, complete surgical excision is usually impossible. • Examples of surgical procedures for cancer include mastectomy for breast cancer, prostatectomy for prostate cancer, and lung cancer surgery for non-small cell lung cancer
- 83. RADIATION THERAPY • use of ionizing radiation to kill cancer cells and shrink tumors. • administered externally via external beam radiotherapy (EBRT) or internally via brachytherapy. • effects of radiation therapy are localised . • used to treat almost every type of solid tumor. • destroys cells in the area being by damaging their genetic material, making it impossible for these cells to continue to grow and divide.
- 85. CHEMOTHERAPY • treatment of cancer with drugs. • usually refers to cytotoxic drugs which affect rapidly dividing cells in general. • Most forms of chemotherapy target all rapidly dividing cells and are not specific to cancer cells. • Hence, chemotherapy has the potential to harm healthy tissue, especially those tissues that have a high replacement rate .
- 87. TARGATED THERAPIES • the use of agents specific for the deregulated proteins of cancer cells. • can also involve small peptides as "homing devices" which can bind to cell surface receptors or affected extracellular matrix surrounding the tumor.
- 89. IMMUNOTHERAPY • diverse set of therapeutic strategies designed to induce the patient's own immune system to fight the tumor. • use of interferons, vaccines and other cytokines to induce an immune response. • Allogeneic hematopoietic stem cell transplantation ("bone marrow transplantation" from a genetically non-identical donor) can be considered a form of immunotherapy, since the donor's immune cells will often attack the tumor.
- 91. HORMONAL THERAPY • The growth of some cancers can be inhibited by providing or blocking certain hormones. • Common examples of hormone-sensitive tumors include certain types of breast and prostate cancers.
- 93. ANGIOGENESIS INHIBITOR • Angiogenesis inhibitors prevent the extensive growth of blood vessels that tumors require to survive. • One of the main problems with anti-angiogenesis drugs is that many factors stimulate blood vessel growth. • Anti-angiogenesis drugs only target one factor, so the other factors continue to stimulate blood vessel growth
- 96. CHEMOTHERAPY treatment with chemicals kills cells that divide or grow rapidly Shrink,prevent spreading,slow growth skin, lining of the digestive tract, hair follicles Cause side effect
- 97. • treatment with anti-cancer drugs • oral,topically,intraperitoneally,intramuscula r, intravenous • drugs - bloodstream -throughout the body- useful for cancer anywhere in the body. Chemo is usually the main treatment for small cell lung cancer (SCLC). CHEMOTHERAPY
- 98. CHEMOTHERAPY • the type of cancer you have • where the cancer is in your body • where in your body it has spread to (if it has spread) • general health. • You will be offered the best standard treatment available that current research shows will be most helpful in your situation. This is why you may meet other people with the same cancer as you who are having different chemotherapy treatments.
- 99. SIDE EFFECTS OF CHEMO • Hair loss • Mouth sores • Loss of appetite • Nausea ,vomiting • Diarrhea or constipation • Easy bruising or bleeding (few blood platelets) • Fatigue ,infection(few red blood cells)
- 100. CYCLES OF CHEMO • given according to a treatment plan (protocol) • consists of several cycles of chemotherapy • with a rest period between each cycle. • rest periods longer than treatment periods • allow body to recover from any unwanted effects of the drug.
- 102. First line • best in clinical trials for- same type,stage • Drugs-combination,alone, • Cisplatin,etoposide,irinotecan,paclitaxel Second line • first line didn’t work@cause severe side effect • Drugs-combination,alone • Decreased in chance getting good result • CAVE regimen FIRST AND SECOND LINE TREATMENT
- 103. First-line chemotherapy for extensive-stage disease Stage IV disease: • maximum 4-6 cycles: • Cisplatin 60-80 mg/m2 IV on day 1 plus etoposide 80-120 mg/m2 IV on days 1-3 every 21-28dor • Carboplatin AUC 5-6 IV on day 1 plus etoposide 80-100 mg/m2 IV on days 1-3 every 28dor • Cisplatin 60 mg/m2 IV on day 1 plus irinotecan 60 mg/m2 IV on days 1, 8, and 15 every 28d or • Cisplatin 30 mg/m2 IV on days 1 and 8 or 80 mg/m2 IV on day 1 plus irinotecan 65 mg/m2 IV on days 1 and 8 every 21d
- 104. Second-line chemotherapy for relapsed or refractory disease Stage IV disease • at least 4-6 cycles but can be given until disease progression in some cases • Patients who have relapsed disease >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
- 105. 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
- 106. 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
- 107. 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
- 108. CAVE Regimen
- 109. 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
- 110. • CAVE chemotherapy as cycles of treatment. Its may have up to 6 cycles • Each cycle lasts 3 weeks.
- 111. 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.
- 112. • 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
- 113. 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
- 114. • 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
- 115. • 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
- 116. Contraindication • Pregnant women • Breastfeeding women
- 117. Prognosis of Lung Cancer
- 118. • 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
- 119. 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 <5 cm but in LN ) 36 38 IIB (5-7 cm 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
- 120. 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
- 121. 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.
- 122. Epidemiology of Lung Cancer in Malaysia
- 123. 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.
- 125. 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.
- 130. Health Education for Lung Cancer
- 131. 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
- 132. So the advice here is.. • Smoking is the most important risk factor for lung cancer. • Don’t 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
- 133. • 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.
- 134. OK! TQ FOR UR ATTENTION