1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. goals of manegment
2.1.1.1. palliative care
2.1.1.2. improve quality of life
2.1.1.2.1. reliefe symptoms and suffering
2.1.2. surgery
2.1.2.1. the size of the tumor and metastasis, along with PFT should be assessed for surgery choice
2.1.2.2. in cases of brain metastasis
2.1.3. chemotherapy
2.1.3.1. as palliative therapy to prevent complicartions
2.1.3.2. cisplatin with octerocide for 6 cycles
2.1.3.3. can be combined with radiation and helpful in improving quality of life
2.1.3.4. side effects should be discussed with the patient
2.1.3.4.1. cisplatin has more nausea and vomiting and less myelodepression
2.1.4. radiotherapy
2.1.4.1. in metastatic lung cancer to bones and it reduces bone pain
2.1.4.2. effective in superior venae cavae obstruction
2.1.4.3. relapsing rate is high
2.1.5. pain relief
2.1.5.1. physical pain should be managed well
2.1.5.2. weak opioids might be a start and if it fails strong ones like morphin can be tried
2.1.5.2.1. it reduces anxiety and SOB
2.1.5.2.2. NSAIDs or acetaminophen van be used as adjuvants
2.1.5.2.3. can be as PRN or titrated doses
2.1.5.2.4. laxatives should be used
2.1.5.2.5. benzodiazepine can reduce pain and anxiety
2.1.5.2.6. bisphosphonate can be used in cases of osteoporosis
2.1.6. nausea and vomiting
2.1.6.1. anti-emetic like ondasterone should be used
2.1.6.2. assessment of electrlite imbalance is important
2.1.7. psychiatric teams, physiotherapists and social workers should be involved to improve quality of life