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Diagnosed with small cell carcinoma. Reoccured after chemo. On topectan. Oxygen rate dropped. Has tumour in head. Advise?

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hello, my brother in law was DX in Sept with small cell lung CA. He had a reoccurence after initial Chemo and is now on Topectan. Today, his O2 sat rate dropped to 85%. They have ordered O2 at home now. What might be the reason for this new development. I am a nurse and I know his DX is EXTENSIVE. He also has a tumor in the head of his pancreas and mets to his adrenal gland. What might be next? Could this new development be paraneoplastic syndrome? thank you, XXXXXXX Trusso, R.N. in Cleveland
Posted Mon, 27 May 2013 in General Health
 
 
Answered by Dr. Satyadeo Choubey 2 hours later
Hi,

Thanks for your query.

Your brother has got small cell carcinoma with a stage of extensive disease. You also told that First chemotherapy failed and is on second line drug topotecan.

Decreased oxygen saturation can be due to lung infection owing to decreased immunity due to malignancy as well as by chemotherapy.

Metastasis can't be predictable. After adrenal and pancreas may be to bone, brain. or there is possibility that it has already metastasized to brain.

Paraneoplastic syndrome do not present like hypoxemia. It's just part and parcel of primary disease.
I wish if you could go for fresh complete blood count and chest x-ray to see for the development of infection. Accordingly sputum for gram's staining and culture is advised. If chest xray shows a new consolidation or ground glass opacity, a trial of antibiotic can be given. A short course of steroid under antibiotic cover may help to combat the acute situation. Continue the oxygen therapy.

I am sorry but you must be knowing the prognosis.

Best wishes
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Follow-up: Diagnosed with small cell carcinoma. Reoccured after chemo. On topectan. Oxygen rate dropped. Has tumour in head. Advise? 15 hours later
thank you. today he is at the cleve clinic to see about a STENT PLACEMENT. i DON'T THINK THIS WILL BE POSSIBLE. MY NEW CONCERN IS THAT THE CANCER HAS SPREAD FURTHER INTO THE BRONCHUS OR TO THE LEFT LUNG. HE HAS LOST SO MUCH WEIGHT AND DESPITE THE O2 THERAPY, THE COUGH IS TERRIBLE. i wish i knew his current LDH amd NA levels. Thank you. I will stay posted.
 
 
Answered by Dr. Satyadeo Choubey 8 minutes later
Hi,
Thanks for follow up.
Sorry but I have not fully understyood your query. What do you mean by LDH and NA? Please just clarify so that I can answer.
Above answer was peer-reviewed by
 
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