Case 40 – History


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Case 40

History of smoking


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Past Medical and Surgical History

The patient was an elderly Caucasian woman, past smoker, who had lung cancer approximately 15 years prior status post left upper lobectomy and quit smoking at that time; and laryngeal cancer approximately 10 years prior status post laryngectomy complicated by tracheoesophageal fistula requiring partial esophagectomy and intestinal auto-transplant and also requiring numerous muscle grafts for local reconstruction of the tracheostomy site.


Brief Presenting History

She was recently diagnosed with a lateral right middle lobe mass and underwent fine needle aspiration and core biopsies.


Procedure Note


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Code Blue note (distortion from FAX)



Anesthesia Note (distortion from FAX)




The patient died during resuscitation in decision with the family.

The history is obtained from the family.


Next: External exam

Discussion Questions

1. Summarize the history.

2. How many different cancers did the patient have? Where were they?

3. Why did the patient have so many cancers?

4. How many different procedures did the patient have? What were they? Which were diagnostic? Which were for cancer resection? Which were to restore body function? Which were for post-operative complications?

5. Do you think the initial lung cancer and the later lung mass are related? If so, how?

6. What is the likelihood of a new metastasis years after an initial lung cancer is resected? What is the likelihood of a second, new lung cancer after a first?

7. What are common ways patients with lung cancer die? Which are gradual? Which are catastrophic events? What is the anatomic basis of each?

8. How would you incorporate end-of-life discussions into your care of cancer patients? At what point in the care would you have this discussion?

9. What unique discussions might you have with a patient with a central vs. peripheral tumor?

10. What are the risks of tumor biopsy?

11. How does the risk of cancer change after cessation of smoking?

12. What are the risks of a tracheostomy procedure?

13. How is an intestinal autotransplant performed?