Wednesday, March 15, 2006

Remote follow-up - Focal NSCLCa

I had posted this case on two previous posts. This is a 55 y/o remote smoker with a persistent cough who had an abnormal endoBBx (squamous cell Ca) despite a normal CT scan of the chest and a negative PET scan. many good suggestions were made to the role of inflammation in false-positive biopsies. I sent her to the chair of CT surgery at a nearby large university hospital and he was equally puzzled. While we were debating what to do, she developed new CHF, had a cath, PTCA, PM placed and and AICD. She has ischemic cardiomyopathy and was quite unstable to consider surgery rightb then and there. She has been stabilized, she is on medical therapy for GERD, COPD, post-nasal drip, HTN, CAD and CHF... Her CxR remains unremarkable.
I have re-bronch'ed her for surveillance: her bronchus intermediate still has an abnormal-looking mucosa with no clear mass and endoBBx came back once again as locally invasive squamous cell Ca.
Would you now suggest a lobectomy?

2 comments - CLICK HERE to read & add your own!:

Jeff H said...

Yes, if PFT's allow. Still don't know if it's correct, but if it is a carcinoma, the risk of leaving it alone is too great. I'd make sure the patient understands the uncertainty, and accepts the risk, etc.

Arenberg said...

One option that is very reasonable os to consider endobronchal therapy, of which there are several appropriate options...PDT, cautery (electro or laser), photocoagulation, implant brachytherapy etc.,

This may be better for her goven her recent cardiac event which makes a lobectomy high risk.