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Histopathology exam done. Have issues with high BP and heart disease. What treatment is recommended?

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Hi ,
I am 76 years old and I had the following results from a histopathology exam:
1.     Can you please let me know what this mean?
2.     Can you please let me know what treatment you recommend, knowing that I do also issues with high blood pressure and I do have heart diseases (cardio ischemia)?
Regards,
XXXXXX
Bulletin histopathology


Imunohistchimice stains were performed on the block 9020/13 Santomar:
AE1/AE3 CK highly +
15% CD56 + cells intensely
CK 7 + highly
Intense TTF1 +
Histology and IHC panel suggests a large cell neuroendocrine carcinoma.

Disease code 8014/3 code location 34
Posted Tue, 4 Jun 2013 in Cancer
 
 
Answered by Dr. Indranil Ghosh 25 minutes later
Hi
Thanks for your query.

Though you have not mentioned the site from where the biopsy was done, by the location code I assume that it is from the lungs.

Now this report means that you have got cancer in the lungs. Further management depends upon the stage of the disease and the fitness. You do have some other illnesses but otherwise I assume that you are quite fit. So now you should have a complete staging evaluation, which in lung cancer usually means a positron emission tomography scan (PET-CT). Depending on the results the treatment plan will be formulated.

If it is localised I feel Radiotherapy will be more appropriate for you (surgery may be quite risky for you). If it is advanced then chemo and/or Radiotherapy may be done.

Hope I have answered your query. I will be available for further followup quwries, if any.
Above answer was peer-reviewed by
 
Follow-up: Histopathology exam done. Have issues with high BP and heart disease. What treatment is recommended? 37 minutes later
Thank you Dr. Indranil,
The tumor is on Right Lung , but I did have diarrhea also for 6 months now ; I lost 20 kg ; I am not fit at all ;
I did a CT

CT
Chest CT
The examination was performed in axial sequences, coronal and sagittal;
results:
Tumor 58 mm diam applied dr, covered the mediastinal pleura, fat infiltrated the posterior mediastinum without adjacent bone on incentives;
No mediastinal lymphadenopathy and pulmonary changes observed;
No issues found pleural effusion.
The liver has normal size and structure. No changes observed biliary or portal;
Gallbladder is inhabited;
SR glands were normal appearance;
Kidneys, bilateral cortical index and normal in size;
Pronounced dorsal kyphosis;
Conclusion: Formation TU LASD T3N0M0

Do You know what stage the cancer is ?
How long do I still have to live ?
Regards,
XXXXXX
 
 
Answered by Dr. Indranil Ghosh 12 minutes later
Hi,
Thanks for followup.

From this CT it appears that it is stage IIB ( scale I to IV).However, bone scan or Pet scan and MRI brain are required to rule out stage IV disease.

The options are radiation with or without chemo. But I am afraid that if you are not fit at all according to your own assessment then the results are not good. You may not tolerate the treatment as well.

For life expectancy it is best to ask your own oncologist as it may be erroneus on my part sitting miles away.

Regards,

Above answer was peer-reviewed by
 
Follow-up: Histopathology exam done. Have issues with high BP and heart disease. What treatment is recommended? 2 days later
Hi Dr. Indranil,
here are the final results from oncologist :

1. Do you agree with the treatment the oncologist just started ? do you see another better way to treat this?
2. what results we should expect and in how long time we'll see improvements in patient health ?
Regards,
Follow-up: Histopathology exam done. Have issues with high BP and heart disease. What treatment is recommended? 23 minutes later
Epicrisis
Diagnosis: BP LSD applied T4 carcinoma (posterior mediastinum) N0M0, stage III B. Damage LSD post TBC.
76 years old patient presents to the diagnosis of carcinoma onclologie LSD applied BP T4 (posterior mediastinum) N0M0, stage III B, confirmed by bronchoscopy with biopsy.
Ex. HP: large cell neuroendocrine carcinoma TTF1 item
Ex. CT Chest 16.04.2013 :
The examination was performed in axial sequences, coronal and sagittal;
results:
Tumor 58 mm diam applied dr, covered the mediastina pleura, fat infiltrated the posterior mediastinum without adjacent bone on incentives;
No mediastina lymphadenopathy and pulmonary changes observed;
No issues found pleural effusion.
The liver has normal size and structure. No changes observed biliary or portal;
Gallbladder is inhabited;
SR glands were normal appearance;
Kidneys, bilateral cortical index and normal in size;
Pronounced dorsal kyphosis;
Conclusion: Formation TU LASD T3N0M0
Ex. Bronchoscopy 15.04.2013:
Trachea free. Tracheal Pintenele normal. Free bilateral bronchial tree. No signs neoplastic; mucosa has the appearance of chronic bronchitis, acutazita, scarring TBC antracotic deposit br. LSD. No signs cancer;

It has decide to start chemotherapy Navelbine 25mg/mp + Carboplatin 5AUC, day 1, 8.
RGR chest PA and LL law - opacity unorganized, located at the top of the right lung on LL; opacity appears projected in the middle lung field. Hili increased in volume.
Biological therapeutic limits.
It is administrated Chemotherapy antiemetic and antiallergic protection without actute reactions.
The patient returns for continuing chemotherapy on 22/05/2013.

Recommendations:
In case of nausea - metoclopramide 1 tablet every 8 hours for 5 days;
In the event of diarrhea - Imodium diarrhea stool 2 tablets after the first 4 hours and then 1 tablet after each other diarrheal stool, maximum 6-8 cpr / day;
In case of temperature> 38 Celsius - Augment 1 gr 1 tablet in 12 hours and Ciprofloxacin 500 mg every 12 hours for 7 days if the fever does not respond within 48 hours will harvest blood counts and will address the Territorial oncology service management of febrile aplasia periodically.
 
 
Answered by Dr. Indranil Ghosh 6 hours later
Yes, I think it is a reasonable way to treat this condition.
After 2-3cycles we would know if it is working or not. At that time another scan will be done.
About 30% patients respond well and another 30% have stable disease. Rest do not benefit from chemo. In any case long term prognosis is not good and survival beyond 1 yr is unusual with his age and fitness.
Regards
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