(Disclaimer: This article is for scientific purposes only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient developed an intermittent cough with no apparent cause 5 months ago. At first, the patient did not pay attention to it and chose to take cough suppressants at home for treatment. However, during a physical examination 2 weeks ago, a chest CT showed an occupying lesion in the left lung, so he came to our hospital for consultation. Later, after puncture biopsy, the diagnosis of lung adenocarcinoma was confirmed. After chemotherapy and targeted drug treatment, the patient’s condition was controlled.
Basic information】Female, 37 years old
Disease Type】Pulmonary adenocarcinoma
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】September 2021
Treatment plan】Medication (docetaxel injection + cisplatin injection + granisetron hydrochloride injection + gefitinib tablets)
Treatment period] Hospitalized for 10 days, then transferred to oncology department
Effectiveness of treatment】The lesion was reduced and the disease was controlled.
I. Initial consultation
The patient had an intermittent irritating cough with no obvious cause 5 months ago, and did not go to hospital but took oral cough medicine at home. The patient was admitted to the respiratory department of the hospital today with an occupying left lung lesion as an outpatient. During the course of the disease, the patient had no fatigue, no loss of appetite, no wasting, sleep, and no abnormal urination or defecation. He had no history of smoking or alcohol consumption, and denied any familial history of hereditary disease.
As the patient was asymptomatic, no therapeutic drugs were used for the time being. The main objective of the patient after admission was to first confirm whether it was lung cancer or not, firstly, to improve the routine examination, including tumor marker examination, sputum exfoliative cells, blood routine, liver and kidney function, electrocardiography, coagulation picture. And do bronchoscopy preparation, bronchoscopy guided ultrasound probe, measuring the size of the mass as: 1.5cm×1.9cm, performing TBLB biopsy, and finally return: lung adenocarcinoma.
Further lung cancer staging was performed and the patient was advised to perfect PET-CT, which revealed enlargement of group 7 and 4L and 4R lymph nodes. Since it was related to whether surgery could be performed, the contralateral 4R lymph nodes were taken for biopsy, which finally returned malignant. So the patient’s stage of lung adenocarcinoma was stage IIIb.
II. Treatment history
As the patient had lost the chance of surgery, after detailed communication with the patient regarding his condition, the patient decided to follow the medical prescription for treatment. After completing the genetic test, the test result indicated that the patient had EGFR gene mutation. Based on this result, the patient underwent chemotherapy plus targeted drug therapy. The chemotherapy drugs used included docetaxel injection + cisplatin injection. During chemotherapy, the patient experienced nausea, vomiting and constipation, and the symptoms were reduced after the administration of antiemetic medication (granisetron hydrochloride injection). The patient continued chemotherapy for 3 times, completing a total of 4 chemotherapy sessions. After chemotherapy, the first-generation targeted drug gefitinib tablets were given orally.
III. Treatment effect
After the end of the 1st chemotherapy, the patient’s lesion shrank insignificantly, and then 3 more chemotherapy treatments were administered. At the end of the last chemotherapy, the patient’s leukocytes dropped to 1.0×10^9/L. The chemotherapy drugs were discontinued and leukocyte-raising therapy (riclosan tablets) was given, and the leukocytes gradually normalized. The lung CT was repeated: the lesion was reduced. After the end of chemotherapy, oral gefitinib tablets were given, and the patient showed no adverse effects. After 10 days of admission, the patient was transferred to the oncology department for further treatment.
IV. Notes
We are glad that the patient underwent treatment and the lesion shrank and the disease was controlled. Since lung adenocarcinoma progresses faster and consumes more on the organism, it is suggested that the patient should focus on high quality protein in the diet and exercise appropriately to strengthen the physical fitness. Oral targeted drugs may appear drug resistance, so it is necessary to follow up regularly at the outpatient clinic to monitor whether the tumor has progressed, and to change the targeted drugs at any time if drug resistance appears.
V. Personal insight
Lung adenocarcinoma is a pathological type of lung cancer, which is not closely related to smoking, and is relatively common in women. This patient was found by physical examination, so it is very important to have annual lung CT examination. It is recommended that patients over 40 years old should have annual lung CT examination, and patients with family history of lung cancer should be followed up earlier.