CT scans - Lung cancer

My mom (age:64) Asian diagnosed with lung cancer.

Summary: She is diagnosed with Stage IV lung cancer with rib cage bone metastasis. X-ray, CT on Thorax and Adomen, MRI on spine, blood test, Sputum cytology taken. CT scan show diffused nodules on both lung with consolidation on the upper left lobe. MRI shows compression fracture on T9 and T12 and minor press on spinal code. Blood test shows elevation of CEA tumor marker, 50x of normal reading. Sputum cytology suspect of Adenocarcinomas.

Treatments: She has RT therapy for 2 weeks to treat the back pain followed by a week rest before Iressa intake for 6 days. Before the Iressa, she is on oxygen support but she is able to put it off for hours. After the iressa, she relied on the oxygen support more heavily and still breathless. There is an acute onset of dyspnea or worsening of the breathlessness, with cough and fever. She is under antibiotic and cough mixture to control the lung infection.

Diagnosis (details) before treatment:

Radiograph of the chest - There are extensive patchy confluent parenchymal opacities in both lungs with a larger opacity in the left upper/mid lung (measuring 3 x 4 cm); these are likely of infectious etiology. An underlying mass in the left upper/mid lung cannot be excluded. There are no pleural effusions. The heart size is within normal limits.Mild degenerative changes of the spine are noted.

Blood Test:

Alphafetoprotein 13 ug/L (0-9 normal)
CEA 252 ug/L (0-5 normal)
CA125 15 U/mL (0-35 normal)
CA19-9 12 U/mL (0-35 normal)

Sputum cytology - Atypical cells suspicious of adenocarcinoma (3ml of bloodstained mucoid fluid was used, 4 slides examined show a moderate cell yield. Atypical cells showing enlarged nuclei with coarse chromatin and pleomorphic nucleoli are noted. The cytoplasm are vacuolated. Microorganism and inflammatory cells including neutrophils and lymphocytes are noted in the background)

CT THORAX AND ABDOMEN

IV contrast-enhanced multi-slice contiguous axial sections of the thorax and abdomen were obtained. Total 90 ml of intravenous Omnipaque 350 were administered as contrast medium. Comparison was made with previous study dated 05/02/07.

Diffuse subcentimeter nodules are seen in both lungs with areas of coalescence. Collapse consolidation of the anterior segment of the left upper lobe with some heterogeneous enhancement near the hilum. There is no pleural effusion detected. The tracheobronchial tree is unremarkable. Enlarged right paratracheal, pertracheal, subcarinal and bilateral hilar lymph nodes are noted. A few right supraclavicular and left axillary lymph nodes are also seen.

The mediastinal vessels, cardiac chambers show normal opacification. The visualized thoracic aorta is of normal caliber with no significant thrombus formation.

The liver is enlarged and again shows multiple large cysts. Mild interval increase in size of the segment 6 cyst now measuring 10.3x8.3 cm. This is seen displacing the right kidney inferiorly. No suspicious focal lesion is seen. The hepatic and portal vessels show normal enhancement. The biliary tree is not dilated. Gallstones are seen. No evidence of cholecystitis.

The visualized pancreas, spleen, kidneys, adrenals and opacified bowel loops are unremarkable.

Multiple sclerotic foci are noted along the sternum, thoracolumbar and sacral spine compatible with mestastasis. Compression fracture of T9 vertebral bodies noted. Metastatic body lesions involving the left scapula, right 6th, left 4th, 9th and 10th ribs are noted.

Comment:

- Collapse of the anterior segment of the left upper lobe with some heterogeneous enhancement near the hilum. Underlying malignancy cannot be excluded. Bronchoscopic biopsy is suggested.
- The pulmonary nodules in both lungs are suggestive of metastasis.
- Mediastinal lumphadenopathy
- Diffuse bony metastasis as described above.
- Hepatic cysts, the one in segment 6 showing mild interval increase in size.
- Gallstones.

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Tags:

• lung cancer
• adenocarcinomas
• NSCLS
• cancer
• CT
• CT scan