Case Presentation 2007313075 Chief Complain O F71 For

Case Presentation 성균관대학교 의과대학 2007313075 손의영

Chief Complain � 이O연, F/71 �For Lung Cancer w/u

Present Illness �Previously healthy � 2011. 02 � 2011. 04. 03 건강검진상 발견된 RUL의 solitary pulmonary nodule 평소 이상 증상 없었음 Lung cancer w/u 위해 입원

Review of system � GW / EF ( - / - ) � Weight change : 6 mo 동안 6 kg 증가 (d/t increased appetite ) � fever/chill ( - / - ) � Headache/dizziness ( - / - ) � Rhinorrhea/ cough /sputum ( - / + / - ) : 3 YA, 일상생활 지장 X � Dyspnea (+) : ATS grade II � chest pain / palpitation ( - / - ) � anorexia/nausea/vomiting (-/-/-) � abdominal pain/discomfort ( + / - ) : 폭식 후 심해짐 � constipation/diarrhea (+/-) � hematemesis/melena/hematochezia ( - / + ) : 수술 하였으나 지속 � Urinary Sx (-) � Arthralgia (+) : both knee � Myalgia (-)

Physical Exam Vital Sign 172/88 mm. Hg - 63 - 18 - 36℃ � G/A Generally well-looking appearance � Mentality Alert & well orientation � HEENT pinkish conjunctivae, anicteric sclerae Dehydrated tongue (-) PNS tenderness(-) PTH/PI (-/-) JVP (-) Neck VE (-) Cervical LNE (-/-) Thyroid enlagement (-) � Chest Symmetric chest expansion Regular heart beat w/o murmur Clean breathing sound w/o wheezing

Physical Exam � Abdomen Soft & flat Bowel sound – normoactive No tenderness/rebound tenderness No shifting dullness � Back No CVAT � Extremities Skin rash(-) Joint ROM limitation (-) Joint swelling & stiffness (-) deformity (-)

Imaging

Spirometry / EKG

Problem List / Assessment �Problem List �#1. solitary pulmonary nodule at RUL �#2. Hypertension �#3. Abdominal Sx. (pain, hematochezia) �Assessment �#1. : Lung cancer

Diagnostic w/u �RUL mass gun Bx �Bronchoscopy �PET

Lung cancer – Dx �Screening �Sputum cytology, CXR, CT �Tissue Diagnosis �Fiberoptic bronchoscopy, Transthoracic FNA(PCNA) �Mediastinoscopy, VATS (thoracoscopy) �Operative specimen �Staging Procedures

Lung cancer – Staging Lung Cancer Staging Essentials: The New TNM Staging System and Potential Imaging Pitfalls <Radio. Graphics>

Lung cancer – Px �Non-small lung cancer의 Stage에 따른 예후 �Stage IA : �Stage IB : �Stage IIA: �Stage IIB: �Stage IIIA: �Stage IIIB: �Stage IV : MSD 60개월 MSD 43개월 MSD 34개월 MSD 18개월 MSD 14개월 MSD 10개월 MSD 6개월 / 5 YSR 50% / 5 YSR 43% / 5 YSR 36% / 5 YSR 25% / 5 YSR 19% / 5 YSR 7% / 5 YSR 2%