ABSTRACT
RATIONALE: Lung cancer is a leading cause of cancer-related deaths. Smoking is major risk factor for initial and subsequent lung cancer especially in active smokers. Treatment of subsequent lung cancer depends on whether it is synchronous or metachronous. We report a rare case of triple metachronous lung cancer and review of literature of patients with triple metachronous cancers. This will be the second case reported of triple metachronous lung cancer. PATIENT CONCERNS: A 60-year-old male, active smoker with diabetes mellitus, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease presented with cough and hemoptysis. Initial computed tomography (CT) scan showed right upper lobe spiculated mass. DIAGNOSIS: He underwent transthoracic needle biopsy for right upper lobe mass, showing primary lung adenocarcinoma (ADC)-Stage-IIIA. He continued to smoke and 9-years later had new left upper lobe spiculated nodule, which on surgical resection showed squamous cell carcinoma (SCC)-Stage-IA1. Despite counselling on smoking cessation, he was unable to quit. Six months later, he presented with shortness of breath and CT chest showing right hilar adenopathy in right upper and lower lobes. He underwent transbronchial biopsies of lesion which showed small cell lung carcinoma (SCLC). INTERVENTIONS: His initial lung ADC-Stage-IIIA, was treated with chemotherapy, weekly thoracic radiation and additional chemotherapy cycles. Nine years later, his left upper lobe mass showing SCC-Stage-IA1 was deemed curative after apical resection and he was kept on surveillance. Six months later, after diagnosis of SCLC in right upper and lower lobe, patient was not a candidate for systemic chemotherapy due to poor performance status and opted for hospice care. OUTCOMES: His initial lung ADC-Stage-IIIA showed complete radiological response with chemotherapy and radiation. Subsequent SCC-Stage-IA1 was deemed curative after resection. Due to his poor performance status, he was not a candidate for chemotherapy for SCLC and patient opted for hospice care. LESSONS: Smoking is a major risk factor for developing lung cancer and with continued smoking, patients are at higher risk for developing subsequent primary lung cancers. We recommend, patients with lung cancer must quit smoking, and those who do not, should remain on long-term surveillance.
Subject(s)
Adenocarcinoma/pathology , Carcinoma, Squamous Cell/pathology , Lung Neoplasms/pathology , Small Cell Lung Carcinoma/pathology , Tobacco Use/pathology , Humans , Male , Middle AgedABSTRACT
RESUMEN El vínculo entre Hipertensión Arterial (HTA) y Enfermedad Renal Crónica (ERC) es recíproco y complejo. La HTA es un factor de riesgo reconocido para el desarrollo de ERC, y la incidencia de enfermedad renal se incrementa conforme aumenta la severidad de la HTA. Adicionalmente la presencia de HTA se vincula a progresión de la ERC desde etapas tempranas hasta el desarrollo de ERC-extrema. La presencia de HTA enmascarada, HTA de túnica blanca y la pérdida del patrón dipping nocturno se vinculan a desarrollo y progresión de enfermedad renal. El tamizaje de ERC es recomendado para pacientes con HTA en riesgo de desarrollar la enfermedad. Es más discutido si debe realizarse tamizaje en individuos con bajo riesgo de desarrollar ERC. Las cifras objetivo de presión arterial en este grupo de pacientes son sugeridas por las guías KDIGO. Múltiples estudios han buscado identificar si el control intensivo de presión arterial disminuye la incidencia de ERC y su progresión pero los resultados no son concluyentes. El presente trabajo revisa el vínculo entre HTA y desarrollo y progresión de la ERC. Se puntualiza sobre la población con HTA que se beneficia del tamizaje de ERC y los valores objetivo de presión arterial en este grupo.
ABSTRACT The link between Arterial Hypertension (AHT) and Chronic Renal Disease (CKD) is reciprocal and complex. HBP is a recognized risk factor for the development of CKD, and the incidence of renal disease increases as the severity of hypertension increases. Additionally, the presence of hypertension is linked to progression of CKD from early stages to the development of extreme-ERC. The presence of masked HTA, white tunica HTA and loss of nocturnal dipping pattern are associated with development and progression of renal disease. Screening for CKD is recommended for patients with hypertension at risk of developing the disease. It is more controversial whether screening should be done in individuals at low risk of developing CKD. The target blood pressure figures in this group of patients are suggested by the KDIGO guidelines. Multiple studies have sought to identify whether intensive blood pressure control decreases the incidence of CKD and its progression but the results are inconclusive. This paper reviews the link between hypertension and development and progression of CKD. It is pointed out the population with hypertension that benefits from CKD screening and target blood pressure values in this group.
