Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have summarized the current role of surgery for primary lung cancer based on solid evidence from clinical trials. Notably, LCSG 821 is the sole clinical trial that has compared lobectomy with limited resection for early stage non-small cell lung cancer (NSCLC). This study demonstrated that limited resection led to a three-fold increase in locoregional recurrence and a 30% increase in mortality. Lobectomy has been the standard procedure based on the results of this single study, which was conducted in 1980's. Four clinical trials compared mediastinal lymph node dissection with sampling; however, all except 1 failed to demonstrate the survival benefit to lymph node dissection. The role of mediastinal lymph node dissection should be a more precise staging of mediastinal lymph node metastases. The role of surgery for NSCLC with mediastinal lymph node metastasis (ie, stage III A/N2)has not been proven in clinical trials. Because of the heterogeneity of patients with stage III A/N2 NSCLC, current guidelines recommend a multi-disciplinary discussion for each case. Superior sulcus tumor, which invades the chest wall, including the first rib, is a challenging operation for surgeons. Two phase II studies(in the United States and Japan) demonstrated that induction chemoradiotherapy followed by surgery offered promising results, with an approximately 70% complete resection rate and a 50%survival rate at 5 years. Video-assisted thoracic surgery(VATS)was evaluated in a multiinstitutional phase II study, which concluded that this approach is feasible for early stage NSCLC. However, significant evidence was accumulated based on retrospective cohort studies, and VATS lobectomy has become popular in daily practice.
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PMID:[Primary Lung Cancer Surgery-Clinical Trial Results]. 3038 33

BACKGROUND Shoulder pain is a common complaint in general practice and typically has an orthopedic or rheumatological etiology. However, it may be the presenting symptom of a serious underlying condition, such as lung cancer. CASE REPORT A 60-year-old man with a 30 pack-year history of smoking presented with worsening right shoulder pain over the last 6 months. He had no respiratory symptoms or weight change. He was seen at several general practice clinics and treated for a rotator cuff injury. However, his pain became severe, to the point that it affected his activities of daily living. A shoulder X-ray revealed opacity in the right apical zone. After a thorough investigation, the patient was found to have lung cancer with local invasion and intracranial metastases. However, in light of the advanced stage of the disease, a palliative approach was taken. The patient remained on multiple oral analgesics for the control of his pain. CONCLUSIONS The present case shows that common symptoms such as shoulder pain can be indicative of serious underlying pathology. Physicians should remain alert and maintain a high index of suspicion for Pancoast tumor in patients who are heavy smokers. Furthermore, a chest X-ray needs to be performed in elderly patients and smokers with shoulder pain.
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PMID:Pancoast Tumor: The Overlooked Etiology of Shoulder Pain in Smokers. 3291 77


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