Casee Scenario 1:
Robert P is a 72 year old retired factory worker from Detroit, Michigan.His medical history is notable for hypertension (well-controlled), hyperuricemia, and gout.
In September of 2015, he presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month’s duration. He is a former smoker and quit approximately 30 years ago.
- Chest X-ray in October 2015 showed a large mass in the upper left lobe and CT scan showed a left malignant pleural effusion and enlargement of the right mediastinal and hilar lymph nodes.
- MRI of the brain was negative for intracranial metastases.
- The patient underwent resection of the primary mass and biopsy of the affected lymph nodes which showed large cell carcinoma.
- His lung cancer was staged as 4; Biopsy of the primary lesion and lymph node metastases were sent for molecular testing and showed no actionable mutations in EGFR or ALK.
- His current performance status is 0.