Patients with Lung Cancer: Navigating the Challenges

Lung cancer can be classified into two major types: small cell lung cancer, or SCLC, and non–small cell lung cancer (NSCLC). However, sometimes lung cancer represents symptoms of both types, therefore labeled as small cell/large cell carcinoma. Both types can produce paraneoplastic syndromes, further complicating cases.

SCLC is sometimes called small cell undifferentiated carcinoma and oat cell carcinoma. Of all lung cancer cases, SCLC accounts for 13% of them. It is characterized by small, round to oval cells that generally begin in the neuroendocrine cells of the bronchi epithelium of the lungs. They start to replicate rapidly in the form of tumors and spread to lymph nodes and other organs in the form of metastases. In the majority of cases, at the time of diagnosis, it has already metastasized, often to the brain, liver, or lymph nodes.

The remaining 87% of the lung cancer cases are diagnosed as NSCLC. It is classified into three subtypes:

• Squamous cell carcinoma: associated with smoking, tends to be located centrally, near a bronchus, and accounts for approximately 25% to 30% of all lung cancers.
• Adenocarcinoma: accounts for 40% of all large cell carcinoma and is usually found in the outer region of the lung. A type of adenocarcinoma known as bronchioloalveolar carcinoma tends to have a better prognosis compared to other types of lung cancer.
• Large cell undifferentiated carcinoma: accounts for 10 to 15% of cases of lung cancer. It can start in any part of the lung, grow rapidly, and result in poor prognosis.

The most frequent site for the occurrence of lung cancer is the hilus of the lung, close to the larger divisions of the bronchi. Abnormal cells replicate and accumulate. As time passes, they turn into carcinoma, which makes the bronchial lining uneven and irregular. The tumors may penetrate the lung wall and surrounding tissues or grow into the opening of the bronchus. In more than 50% of patients, the tumor spreads into the lymph nodes and then into other organs.

Lung cancer also causes systemic effects unrelated to metastasis, affecting the endocrine, neuromuscular, dermatologic, and hematologic systems. These changes may also cause vascular and connective tissue abnormalities, referred to as paraneoplastic syndromes. The most common paraneoplastic syndromes in lung cancer are SIADH and hypercalcemia.

Lung cancer can cause other complications of the lungs, such as emphysema, bronchial obstruction, atelectasis, pulmonary abscesses, pleuritis, bronchitis, and compression on the vena cava.

What Causes Lung Cancer?

The most common cause of lung cancer is cigarette smoking. In smokers, lung cancer is ten times more prevalent than in non-smokers. Other risk factors for lung cancer include exposure to carcinogenic industrial and air pollutants, such as asbestos, coal dust, radon, and arsenic, and family history.

What are the Treatment Options for Lung Cancer?

The treatment of lung cancer depends on its stage and the type of cancer. Chemotherapy, surgery, and radiation therapy are all used. It is often not curable unless the tumor is small without metastasis when discovered. For cancers that have metastasized beyond the lungs, chemotherapy is used, both as primary treatment and an adjuvant treatment to surgery, often given as a combination of drugs.

In patients unable to undergo surgery, radiation therapy is the primary treatment for lung cancer patients. It is also used palliatively to alleviate symptoms of lung cancer. However, with surgery, radiation is sometimes used to kill the tiny cancerous cells that are hard to see. Radiation therapy is given in two forms: external beam therapy and brachytherapy. External beam therapy delivers radiation from outside the body and is directed toward the cancer. In brachytherapy, small pellets of radioactive material are inserted directly into the cancer or in the affected airways, where it kills the cancer cells.

Surgical treatment ranges from segmentectomy or wedge resection to lobectomy and pneumonectomy. These procedures all require general anesthesia. Sometimes, a thoracotomy is also done in which a surgical incision is made in the chest. Suppose patients are unable to undergo a thoracotomy because of other serious medical problems or widespread cancer. In that case, the healthcare providers use laser surgery to relieve blocked airways and lower the threat of pneumonia or shortness of breath.

The Bottom Line

Lung cancer has a poor prognosis. However, supportive treatment can help in relieving symptoms up to some extent. As a healthcare provider, talk to the patient, counsel them, and relieve their anxiety. Inform them about their treatment and how it works so they have a know-how about it. Explain to them the possible side effects of the radiation therapy, such as bronchial secretions becoming too thick. Guide them to keep themselves hydrated during radiation therapy sessions.

About the Author:

Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.

Mariya is an independent contributor to CEUfast’s Nursing Blog Program.

Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.

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