Tuesday, January 30, 2007

This is an 89 year old previous smoker with a probably stage 1b cancer:
No adenopathy.
She looks younger than her stated age but has emphysema on CXR:

We dont have PFT's but she has good exercise tolerance.

How would you proceed assuming the patient was willing to go with whatever the doctor recommends:
1. surgery (is age alone an absolute contraindication, even if she would otherwise be a surgical candidate)?
2. CT-guided bx (but what would you do with this info? it is obviously a cancer. Would you offer this 89 year old chemo?)
3. Do nothing.
4. Other.

Looking for all opinions - use anonymous or make up a name if you wish, but all comments encouraged.

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

Jeff H said...

I'd ignore her age and treat her as any patient with a lung cancer and good performance status. Get PFT's, get a staging PET to ensure there are no unexpected distant mets, and get her to surgery.

Baleeiro said...

I agree with Jeff H. Age alone should not be a contraindication.

Anonymous said...

Ask her to decide if you present her with risks and benefits of surgery and palliation. She may not want to take that responsibility but some patients feel more empowered if advised and given enough information to make an informed decision.

Anonymous said...

get her pfts..then treat her like any other patient...open biopsy then chemo....guided biopsy is pretty much worthless in this case...

Anonymous said...

When deciding a treatment strategy, the physiologic rather than chronological age should be carefully assessed as well as comorbidities, social support, patient’s wishes, etc. But many surgeons hate two-digit operative mortality rate as seen in this study.

Anonymous said...

Explain options (including doing nothing) and allow patient to decide.