Scribe BC - Radiation Oncology Lung Cancer Consult

DIAGNOSIS Non-small cell lung cancer, Stage IIIB, with a 5cm lesion in the right upper lobe. Confirmed by CT scan and PET/CT. EGFR mutation negative. PLAN SUMMARY Stereotactic body radiation therapy (SBRT) to the right upper lobe lesion, 60 Gy in 15 fractions. 68-year-old male, seen today for a consultation regarding a new diagnosis of lung cancer. Accompanied by his wife. The patient initially presented with a persistent cough and shortness of breath. A chest X-ray revealed a suspicious nodule in the right upper lobe, prompting a CT scan which confirmed a 5cm mass. Subsequent PET/CT scan showed increased FDG uptake in the lesion, with no evidence of distant metastasis. The patient was referred to Dr. Emily Carter, a pulmonologist, for further evaluation, including bronchoscopy. Bronchoscopy and EBUS were performed, revealing a biopsy-proven non-small cell lung cancer. The patient also consulted with Dr. David Lee, a medical oncologist, who recommended concurrent chemoradiation. The patient was also seen by Dr. Sarah Jones, a thoracic surgeon, who deemed the patient unsuitable for surgical resection due to the size and location of the tumour. The patient reports a worsening cough, occasional shortness of breath, and mild fatigue. He denies any hemoptysis, chest pain, or new neurological symptoms. His appetite is slightly decreased, but he maintains a good performance status. INVESTIGATIONS * CT Chest: Confirmed 5cm mass in the right upper lobe. * Bronchoscopy/EBUS: Biopsy-proven non-small cell lung cancer. * PET/CT: Increased FDG uptake in the right upper lobe lesion, SUV max 12. No evidence of metastasis. PAST MEDICAL HISTORY * Hypertension (diagnosed 2018) * Hyperlipidemia (diagnosed 2020) PAST SURGICAL HISTORY * Appendectomy (2005) CURRENT MEDICATIONS * Lisinopril 10mg daily * Atorvastatin 20mg daily ALLERGIES No known drug allergies. SOCIAL HISTORY The patient lives with his wife in a single-family home. He is a retired accountant. He has a 40 pack-year smoking history, having quit smoking 5 years ago. He drinks alcohol socially, approximately 2-3 units per week. No recreational drug use. FAMILY HISTORY * Mother: Breast cancer, diagnosed age 68, deceased. PHYSICAL EXAMINATION Height: 178 cm Weight: 85 kg Vitals: BP 130/80 mmHg, HR 78 bpm, RR 16 breaths/min, SpO2 98% on room air, Temp 37.0°C General: Alert and oriented, appears in no acute distress. Cardiorespiratory: Clear to auscultation bilaterally. No wheezes or crackles. Lymph: No palpable lymphadenopathy. Neurologic: Normal neurological exam. ASSESSMENT AND PLAN The patient has been diagnosed with Stage IIIB non-small cell lung cancer. The differential diagnoses include other types of lung cancer and metastatic disease. The patient and his wife were informed of the treatment options, including chemotherapy, radiation therapy, and concurrent chemoradiation. The risks and benefits of each option were discussed in detail. SBRT will be delivered to the right upper lobe lesion, with a total dose of 60 Gy in 15 fractions. The patient was informed of the potential acute side effects, including fatigue, shortness of breath, cough, and chest tenderness. The patient was also informed of the potential delayed side effects, including esophagitis and radiation pneumonitis. The estimated likelihood of long-term local control is 80%. The patient was also informed of the potential for injury to surrounding structures. The patient has decided to proceed with SBRT. The rationale behind this choice is the desire for a shorter course of treatment and the potential for fewer side effects compared to concurrent chemoradiation. The next steps include scheduling the simulation and treatment planning appointments. The patient will be seen weekly during treatment for assessment and management of side effects. Contact information for the radiation oncology clinic was provided. AI CONSENT The patient provided verbal consent to use the AI scribe during this visit, understanding its purpose, potential benefits, and limitations, as well as the need for a temporary audio recording for documentation and associated privacy and security risks.