Correct!
4. 1 and 3
The thoracic CT scan shows a 3.8 cm mass in the left lung (Figure 4).
Figure 4. Representative image from thoracic CT scan in soft tissue windows showing a 3.8 cm lung mass (white arrow).
Clinically, the patient likely has lung cancer with metastases to the spine. The spine is unstable and a delay could result in the patient becoming paralyzed from the upper thoracic spine down. Since this likely is a lung cancer both a biopsy to establish the diagnosis and a CT scan of the brain, another common place for metastases, are indicated.
The patient undergoes spine stabilization surgery. Her primary tumor is biopsied and shows an adenocarcinoma with an exon 19 epidermal growth factor receptor (EGFR) mutation. ROS-1, KRAS, and anaplastic lymphoma kinase (ALK) mutations were not detected. Her CT scan of the brain reveals three lesions compatible with brain metastases.
Which of the following should be done at this time? (Click on the correct answer to proceed to the fifth of seven pages)