*Statement: This article is only for popular science purposes and cannot be used as a basis for treatment. In order to protect patient privacy, the relevant information in the following content has been processed. [Disease type] Lung cancer, non-small cell lung cancer | NSCLC, T3

* Statement: This article is only for popular science purposes and cannot be used as a basis for treatment. In order to protect patient privacy, the relevant information in the following content has been processed

Reposted from Xiaohe Health App’s real experience

[Basic information] Female, 85 years old

[Disease Type] Lung cancer, non-small cell lung cancer | NSCLC, T3N2M1C stage IVB

[Time of consultation] January 2022

[Treatment plan] Palliative treatment , Recombinant human endostatin Intrapleural injection to inhibit the growth of pleural effusion

[ Treatment cycle] 5 months

[Treatment effect] The quality of life has improved, and the symptoms have improved significantly

First introduction to the patient

This is a patient admitted to the outpatient clinic on Monday, Grandma Fan, with silver hair, thin and small, the patient has no obvious triggers in the past month She developed shortness of breath, dry cough, and no fever. Her dyspnea gradually worsened in recent days. Physical examination showed that the left chest was slightly full, showed solid sound when percussed , and the breath sounds in the left lung disappeared.

I suspected that the patient had pleural effusion, so I performed a lung CT. The results showed: left pleural effusion, complete atelectasis of the left lung, right deviation of the mediastinum (tension effusion), and mass formation in the consolidation of the lower lobe of the left lung. , except for malignancy, it is recommended to strengthen; he has good health in the past; he denies a history of smoking and drinking.

Picture source: provided by the narrator

I considered that the patient had pleural effusion caused by a malignant tumor in the lungs, and recommended that the patient be hospitalized. The patient was particularly cute, "My child, as long as I can breathe, I can do anything. Grandma is writing this for you. Letter of commendation! "I quickly helped with hospitalization and hoped that Grandma Fan's pain could be resolved as soon as possible.

Treatment process

After admission, the complete blood routine, , liver and kidney function, coagulation and other indicators showed no obvious abnormalities. It is considered that the patient has lung cancer, so further examinations are needed to confirm the diagnosis. In view of the large amount of pleural effusion in the patient, in order to relieve symptoms and For further diagnosis, after obtaining the consent of the patient and his family, a chest drainage tube was placed, and the pleural effusion test and tumor cell detection were repeatedly completed. After the pleural effusion was reduced, chest contrast-enhanced CT was completed to better evaluate the nature of the lesion.

At the same time, we continued to evaluate the general condition. The patient's bone ECT reported slightly concentrated radioactivity in the spine, right 11th rib, and upper edge of the right acetabulum. Note bone metastasis . Abdominal contrast-enhanced CT and head magnetic resonance showed no definite abnormalities; the patient After the pleural effusion was reduced, the enhanced chest CT showed that occupied a space (3.9x5.4cm) in the left lower lobe and parahilar area, surrounding the branches of the left lower pulmonary artery and vein.

Tumor cells can be seen in the pathological report of pleural effusion, suggesting adenocarcinoma . It is recommended to improve the gene test . If it is positive, targeted therapy can be tried. The patient's family said that the patient is old and targeted drugs may have some side effects, and they do not want grandma Try it, but don’t want to wear the drainage tube for a long time, which will increase the psychological burden on grandma. After all, grandma has always been in good health and has not been to the hospital often.

I understand the concerns of the patient’s family and respect their decision. I suggest intrapleural injection of recombinant human endostatin to inhibit the growth of pleural effusion, 3 times a week (days 1, 4, and 7), with 3 consecutive injections as one cycle. After that, the patient was asked to turn over as many times as his condition allowed to make the medicine fully contact with the inner wall of the chest cavity. The patient was asked to return for a follow-up visit 3 weeks after discharge. When he came for the check-up, he would check the lung CT for a small amount of pleural effusion. He would consider the efficacy of the medicine and follow up for observation if the condition changes.

Picture source: The narrator provides

treatment effect

When the patient came to the clinic, he had obvious difficulty breathing and a dry cough. Physical examination: the left chest was slightly full, percussion showed solid sounds, and the breath sounds in the left lung disappeared. After a series of examinations, he was diagnosed as Lung adenocarcinoma (T3N2M1C stage IVB) , considering that the patient was not suitable for surgery, the patient refused to complete genetic testing.

In order to delay the growth of pleural effusion, intrapleural injection of recombinant human endostatin was given to inhibit the growth of pleural effusion. 3 times a week (1st, 4th, 7th day), 3 times in a row is one cycle. The patient was discharged from the hospital after one cycle of treatment. The relevant symptoms were significantly improved and the quality of life was significantly improved.

And the lung CT reexamination 3 weeks later showed a small amount of pleural effusion. It is considered that the pleural effusion will grow very slowly after discharge.I also feel very relieved to see that the drug is working and can improve the patient's symptoms.

Precautions for patients in daily life

. Maintain a happy mood and avoid anxiety.

. Pay attention to thoracentesis to avoid infection.

, cancer is a wasting disease, especially in the late stage of cancer, the physical consumption of is obvious, and the patient will have fluid quality, so nutritional supplementation is very important. It is recommended that patients supplement with high nutrition, high protein, High-vitamin substances, appropriate activities, enhance immunity .

Doctors’ insights

This patient, Grandma Fan, is a patient with malignant pleural effusion, which is the effusion caused by lung cancer. Once it appears, it usually indicates that the disease at the primary site has metastasized locally or spread throughout the body, so Grandma Fan finally evaluated It is stage IVB, an advanced tumor with a poor prognosis.

However, due to his advanced age and physical condition, he could not tolerate radiotherapy and chemotherapy , so the primary lesion was not treated. However, due to the large amount of fluid and its rapid development, it affected the cardiopulmonary function and was prone to complications atelectasis and repeated infections. In particular, oppression causes breathing difficulties, making the elderly in their 80s very miserable in their later years. So how can we solve the elderly’s pain with minimal side effects?

We chose to use intrapleural injection of recombinant human endostatin. Compared with intrapleural injection of cisplatin and other chemotherapy drugs, it can not only play an anti-tumor effect, but also participate in immune regulation and improve the patient's ability to respond to tumor cells. , and has little side effects.

Grandma Fan had no adverse reactions after application, and the pleural effusion grew slowly, so we can choose this method to reduce the pain of patients even in the terminal stage of the disease. From Grandma Fan's case, we can learn that malignant pleural effusion is also one of the common complications of the progression of advanced cancer. However, through active treatment, it can still be effectively controlled and improve the patient's quality of life. .

The copyright belongs to the author Zhang Qiang.

* Statement: This article is only for popular science purposes and cannot be used as a basis for treatment. In order to protect patient privacy, the relevant information in the article has been processed. The real experience is the real treatment experience of the author or his family. The copyright belongs to the author and no reproduction is allowed. If you find any errors in the content, please feel free to provide feedback in the message area or backend.

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