We report a patient with gingival metastasis of lung cancer in whom the use of sedatives was successfully avoided by employing holistic care approaches. A 64-year-old man had been receiving chemotherapy with the diagnosis of advanced lung cancer. Eighteen months later, a rapidly growing gingival metastasis was observed. Arterial embolization was performed, but it failed to control the bleeding. No active treatment was performed, and he was subsequently transferred to our hospital. He desired death, with markedly pessimistic views, and wished to undergo deep and continuous palliative sedation (DCPS) due to severe total pain (particularly psychological and spiritual) from the beginning. However, he died peacefully before receiving DCPS. We present a literature review of gingival metastasis from lung cancer, as well as our assessment and palliative care for the total pain of this patient.

It is not uncommon for edema in the end stage of advanced cancer to be caused by nephrotic syndrome (NS) as well as by cachexia, hypo-proteinemia due to malnutrition, or lymphedema. Such edema not only causes patients' quality of life (QOL) to be deteriorate, but may also result in earlier death in the absence of accurate diagnosis and treatment. We report a case of nephrotic syndrome with advanced uterine cancer, in which the patient's QOL was greatly improved by the accurate and timely diagnosis and treatment of NS. A 65-year old woman suffering from recurrent uterine cancer (lung and brain metastases) was admitted as an emergency due to deterioration of her general condition. Edema of both legs was severe, and laboratory findings (TP 5.0 g/dl, ALB 1.3 g/dl, T-Chol 369 mg/dl, proteinuria 3+) at the time of admission met the diagnosis criteria for NS rather than cachexia. We first administered albumin to stabilize circulation, and started treatment with prednisolone and cyclosporine, which greatly improved her general condition and edema of her legs. Subsequently, NS repeatedly improved and worsened and the tumors gradually progressed. The patient died of multiple organ failure induced by disseminated intravascular coagulation (DIC) at 81 days after admission. NS caused by malignancy is not uncommon. In general, however, such cases of NS are associated with solid tumors, such as gastrointestinal and lung cancer. NS caused by uterine cancer is very rare. We suggest that NS should be borne in mind in addition to cachexia, hypo-proteinemia or lymphedema as a possible cause of edema in the end stage of advanced cancer. Palliat Care Res 2011; 6(1): 316-323