Hypertrophic Pulmonary Osteoarthropathy (HPOA): An Unusual But Distinctive Complication of Lung Cancer

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Although it's uncommon, hypertrophic osteoarthropahy, or HPOA, is an odd and therefore memorable syndrome that can be a side effect of lung cancer. It features an abnormal proliferation of skin and bone tissue, primarily in the hands and feet. Patients can develop clubbing, which is most commonly associated with NSCLC (up to 1/3 of patients) more than SCLC (only about 5%), and adenocarcinoma in particular. Here's what it looks like:

The Subtleties of Progressive Disease: Why Some Oncologists Continue EGFR Inhibitors (or Other Agents) after Progression

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One of the basic concepts of oncology is that you treat patients with different drugs once they've shown progression on a treatment, rather than continue that a patient has presumably become resistant to. However, there are some exceptions to this: many or most women with breast cancer continue the antibody herceptin (trastuzumab) even after progression, adding it to one chemo and then the next, and the same is often done with avastin in colon cancer and sometimes lung cancer as well.

Clinical Factors of Prognosis in Surgical Series: A Focus on Smoking Status

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In my last post I wrote about the prognostic value of molecular markers like EGFR and K-Ras that have generally been studied in patients with advanced NSCLC and treated with EGFR inhibitors, but these studies looked at prognosis in patients with early stage NSCLC who underwent surgery. These studies also provided some interesting results on the prognostic value of some clinical variables as well.

Selection Bias, Eligibility Criteria, and Interpreting Trial Results (or, a little cynicism can be a good thing)

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My kids are right in the middle of that time when they watch SpongeBob and see commercials for toys, cereals, and music, nearly every one is puncuated at the end with, "Daddy, can we get that? I want that." There comes a time in everyone's life, hopefully early on, when we learn that we won't actually find eternal bliss with every advertised item.

Management Options for SVC Syndrome

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As I introduced in my last post, the superior vena cava SVC syndrome occurs in about 2-4% of lung cancer cases, and lung cancer is the leading reason for it. One of the most important factors in managing it is to determine, usually with CT imaging, the cause of the SVC syndrome -- generally whether it's caused from tumor or a blood clot, such as around a catheter.

The Timeliness Factor: Duration of Work-Up for Lung Cancer

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One issue that everyone with lung cancer faces, but that we haven't covered before, is the duration of a lung cancer work-up. I've worked in a range of treatment settings and see patients for second opinions who come from very different backgrounds and receive their work-ups through completely different medical systems. In that process, you see some patients who receive a stunningly fast series of tests and a short interval from first suspicious finding to diagnosis and ultimate treatment of cancer.

Actions Speak Louder than Words: When Pathology and the Clinical Picture Don't Fit

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I've been involved in a wide range of discussions, both here and in my own clinical, about the fairly common situation of how to approach a situation in which the story on paper and what you see actually happening are incompatible. For instance, last week I and several of my colleagues participated in a journal club (a group discussion of a new and/or controversial journal article or two), in which the topic was the potential utility of doing surgery for unusually early small cell lung cancer tumors.