Small Cell Lung Cancer After a Remote Chest Gunshot Injury

What happened, in summary

A man in his 70s sought care for a severe persistent cough and shortness of breath. Imaging found a 7.6 by 7.5 cm mass in his left lung. Metal fragments from a gunshot wound 45 years earlier were still present within and around the area. He also had a remote smoking history but had quit about 30 years before the cancer diagnosis. A metastatic work-up did not identify distant spread. Because the mass was solitary and could be completely removed, he underwent a left thoracotomy with upper lobectomy, mediastinal lymph-node dissection, and removal of the third and fourth ribs with the tumor. Pathology showed poorly differentiated small cell carcinoma with clear margins and 10 benign lymph nodes. He then received carboplatin and etoposide chemotherapy followed by radiation and completed treatment without major complications. Surveillance imaging was performed regularly. Three years after surgery, there were no clinical or imaging signs of recurrence. He described the surgery and recovery as difficult and noted that his breathing capacity and stamina were lower than before, but he had recovered and was doing well. His wife and a family friend provided extensive support during the early recovery period.