Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

924 Lung Cancer

Side Effects & Contraindications

■Surgery:

➣Side effects: prolonged pleuritic pain (weeks), infection (wound,

pneumonia), arrhythmia, bronchopleural fistula

➣Contraindications:

Absolute: active cardiac or cerebrovascular disease

Relative: severe pulmonary disease. Patients with apical

tumors and bullous disease may tolerate resection/bullectomy

without compromise

■Chemotherapy:

➣Side effects: leukopenia, anemia, nausea/emesis, renal dysfunc-

tion, fatigue, neuropathy

➣Contraindications:

Absolute: infection

Relative: renal dysfunction, poor performance status

■Radiation therapy:

➣Side effects: esophagitis, dermatitis, pulmonary fibrosis, radia-

tion pneumonitis

➣Contraindications:

Relative: limited pulmonary reserve with high likelihood of

pneumonitis

Absolute: inability to shield vital structures (spinal cord)

■Special Situations:

➣Carcinoma in situ: treatment options include brachytherapy,

photodynamic therapy (PDT), laser or cryotherapy

➣Isolated CNS or adrenal metastasis: aggressive resection of both

tumors improves survival

➣Synchronous primaries: stage/treat separately with independent

prognoses

➣Malignant pleural effusions: pleurodesis (talc, bleomycin, tetra-

cycline) either tube thoracostomy or video-assisted thoracos-

copy (VATS)

➣Progressive hemoptysis: bronchial artery embolization

follow-up

During Treatment

■Determined by specialty service (oncology, radiation oncology,

surgery or pulmonary)

Routine

■CBC, renal function weekly during chemotherapy

■CXR q 3 mo, annual chest CT