Lung Cancer

A 45-year-old man presents with a 1- to2-week history of low-grade fever and nonproductivecough. He has a long history of cigarette and alcoholabuse. The office nurse expresses her concern about thepatients cyanotic nail beds and requests your immediateevaluation.

Alimta (pemetrexed disodium) from Eli Lilly andCompany has received FDA approval for treatmentof malignant pleural mesothelioma. This orphan drug wasapproved under the FDA’s accelerated program for drugsthat treat cancer or life-threatening disease.

A 59-year-old woman presents with generalized facialswelling and dyspnea that has progressed graduallyover the past month. The patient also reports a sensationof pressure in her neck and ears and swelling of the lowereyelids, neck, upper chest, and upper limbs. The bloodvessels on her upper chest are prominent. A dry, irritatingcough has worsened.

A 48-year-old African Americanwoman with HIV infection who hadbeen hospitalized several days earlierfor presumed Pneumocystis cariniipneumonia (PCP) is readmittedbecause of worsening dyspnea and atemperature of 38.8oC (102oF).She also complains of painful swellingand erythema on her right arm.Her symptoms have worseneddespite treatment with trimethoprimsulfamethoxazole.

Several of my patients have asked me about full-body CTscans.

In their case report of a woman withsuperior vena cava syndrome (CONSULTANT,September 15, 2002, page1391), Drs Sonia Arunabh and K.Rauhilla appropriately indicate thatradiation therapy is the primary treatmentwhen the syndrome is caused bysolid malignancies.

A 47-year-old man has had a posterior neck mass for severalmonths. The mass is not painful and has not changed color, but it continues toenlarge.

A chest film obtained as part of a routine insurance evaluation reveals a nodulein the right lower lobe of a 67-year-old man.

A 62-year-old man has had nightsweats and worsening fever andcough for the last 4 days; 2 days agohe had an episode of hemoptysis. Hedenies trauma or travel to a foreigncountry but has a 30-pack-year smokinghistory. The medical history isotherwise noncontributory.

Breast cancer causesmore deaths than anycancer except lung cancer inwomen of all ages. In womenbetween the ages of 40and 59 years, it is the leadingcause of cancer death.1