Lung Cancer

 Introduction     

     

Lung Cancer in the Philippines, according to the World Health Organization (WHO), lung cancer is the most common form of cancer globally with 2.09 million cases recorded in 2018 which is the leading cause of cancer-related deaths among men and is the third for women. In the Philippines, the Global Cancer Observatory (GLOBOCAN) recorded 17,255 cases of lung cancer and 15,454 deaths due to the disease in 2018. Data from the Department of Health (DOH) also reveals that lung cancer is one of the most common types of cancers in the Philippines and the most common cancer types worldwide.

What is Lung Cancer?

        Lung Cancer  Lung Cancer is a condition characterized by the multiplication of abnormal cells lining the airways that grow and divide continuously to invade and cause damage to adjacent organs. Its impact on general health lies on the fact that it is a serious disease that can be treated but cure is less likely especially among those who are in advanced stages.

The type of lung cancer is named depending on the specific location where it is thought to arise. Histologic examination is required for the primary tumor classification while special immunohistochemical staining is done to further distinguish among the different subtypes of lung carcinoma. Several molecular biomarkers can also be tested when possible mutations exist. The 2  major  types  of  lung  cancer  are  non-small  cell  and small cell lung cancer.

The stage of lung cancer illustrates the behavior of the tumor including its size, location, invasion of lymph nodes and the spread to the distant organs of the body that  affects  its  function.  Detecting  lung  cancer  at  an  early  stage  before  it  invades  surrounding tissues will lead to a decrease in morbidity and mortality. Knowing the stage of the disease will guide the decision-making process with regard to choosing the type of treatment and predict the chances of survival after therapy.

Types of Lung Cancer

There are 2 main types of lung cancer: Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC) of the two, NSCLC is more common. An estimated 80% of lung cancer cases can be categorized as NSCLC. This type of cancer generally spreads slower than SCLC.

Non-Small Cell Lung Cancer can also be broken down into 3 different types, namely:

    Adenocarcinoma – This type of NSCLC develops in the epithelial tissues that line the lungs, which is why it is often found on outer areas of the lung.

    Squamous cell carcinoma – This NSCLC is typically located in the center of the lung, close to the main air passages (bronchus).

    Large cell carcinoma – A type of NSCLC that tends to grow faster than adenocarcinomas and squamous cell carcinomas; can be found anywhere in the lung.

Meanwhile, Small Cell Lung Cancer (SCLC) is less common and almost always linked to people with a history of smoking cigarettes. SCLC accounts for less than 20% of the cases of lung cancer in the Philippines.

Signs and Symptoms of Lung Cancer  

Most lung cancers do not cause any symptoms until they have spread, but some people with early lung cancer do have symptoms. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed at an earlier stage, when treatment is more likely to be effective.

Most of these symptoms are more likely to be caused by something other than lung cancer. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.   

The most common symptoms of lung cancer are:

• A cough that does not go away or gets worse
• Coughing up blood or rust-colored sputum (spit or phlegm)
• Chest pain that is often worse with deep breathing, coughing, or laughing
• Hoarseness
• Loss of appetite
• Unexplained weight loss
• Shortness of breath
• Feeling tired or weak
• Infections such as bronchitis and pneumonia that don’t go away or keep coming back
• New onset of wheezing

If lung cancer spreads to other parts of the body, it may cause:

• Bone pain (like pain in the back or hips)
• Nervous system changes (such as headache, weakness or numbness of an arm or leg, dizziness, balance problems, or seizures), from cancer spread to the brain
• Yellowing of the skin and eyes (jaundice), from cancer spread to the liver
• Swelling of lymph nodes (collection of immune system cells) such as those in the neck or above the collarbone

Some lung cancers can cause syndromes, which are groups of specific symptoms.

Horner syndrome

Cancers of the upper part of the lungs are sometimes called Pancoast tumors. These tumors are more likely to be non-small cell lung cancer (NSCLC) than small cell lung cancer (SCLC).

Pancoast tumors can affect certain nerves to the eye and part of the face, causing a group of symptoms called Horner syndrome:

• Drooping or weakness of one upper eyelid
• A smaller pupil (dark part in the center of the eye) in the same eye
• Little or no sweating on the same side of the face

Pancoast tumors can also sometimes cause severe shoulder pain.

Superior vena cava syndrome

The superior vena cava (SVC) is a large vein that carries blood from the head and arms down to the heart. It passes next to the upper part of the right lung and the lymph nodes inside the chest. Tumors in this area can press on the SVC, which can cause the blood to back up in the veins. This can lead to swelling in the face, neck, arms, and upper chest (sometimes with a bluish-red skin color). It can also cause headaches, dizziness, and a change in consciousness if it affects the brain. While SVC syndrome can develop gradually over time, in some cases it can become life-threatening, and needs to be treated right away.

Paraneoplastic syndromes

Some lung cancers make hormone-like substances that enter the bloodstream and cause problems with distant tissues and organs, even though the cancer has not spread to those places. These problems are called paraneoplastic syndromes. Sometimes these syndromes may be the first symptoms of lung cancer. Because the symptoms affect other organs, a disease other than lung cancer may first be suspected as causing them.

Paraneoplastic syndromes can happen with any lung cancer but are more often associated with SCLC. Some common syndromes include:

• SIADH (syndrome of inappropriate anti-diuretic hormone): In this condition, the cancer cells make ADH, a hormone that causes the kidneys to hold water. This lowers salt levels in the blood. Symptoms of SIADH can include fatigue, loss of appetite, muscle weakness or cramps, nausea, vomiting, restlessness, and confusion. Without treatment, severe cases may lead to seizures and coma.
• Cushing syndrome: In this condition, the cancer cells make ACTH, a hormone that causes the adrenal glands to make cortisol. This can lead to symptoms such as weight gain, easy bruising, weakness, drowsiness, and fluid retention. Cushing syndrome can also cause high blood pressure, high blood sugar levels, or even diabetes.
• Nervous system problems: SCLC can sometimes cause the body’s immune system to attack parts of the nervous system, which can lead to problems. One example is a muscle disorder called Lambert-Eaton syndrome. In this syndrome, muscles around the hips become weak. One of the first signs may be trouble getting up from a sitting position. Later, muscles around the shoulder may become weak. A less common problem is paraneoplastic cerebellar degeneration, which can cause loss of balance and unsteadiness in arm and leg movement, as well as trouble speaking or swallowing. SCLC can also cause other nervous system problems, such as muscle weakness, sensation changes, vision problems, or even changes in behavior.
• High levels of calcium in the blood (hypercalcemia), which can cause frequent urination, thirst, constipation, nausea, vomiting, belly pain, weakness, fatigue, dizziness, and confusion
• Blood clots

 

Risk Factors for Lung Cancer in the Philippines

It is common knowledge that people who smoke cigarettes and tobacco — especially those who engage in chainsmoking — run a higher risk of developing lung cancer. This fact, however, was not enough to stop 30% of Filipino adults from smoking in 2015. This prompted the government to implement the Graphic Health Warning law in an effort to reduce the potential cases of lung cancer in the Philippines.

 However, even non-smokers can get lung cancer. Risk factors pertain to the elements that a person is exposed to which may increase their risks for developing a particular type of cancer.

CAUSES:

Smoking 

Smoking is still the top cause of lung cancer. In fact, 90% of lung cancer cases can be linked back to a history of smoking. DOH statistics from 2015 estimate that 3 out of 10 adults in the country are smokers. This further adds to smoking as a risk factor for lung cancer in the Philippines. Even non-smokers who breathe in secondhand or even thirdhand cigarette smoke in public and at home have increased chances of getting lung cancer.

Radon Exposure 

Radon is a radioactive gas that can naturally be found in soil. Constant and prolonged exposure to this odorless gas is the second leading cause of lung cancer. You can acquire radon gas test kits from your local hardware store to determine if your home places you at risk.

Medical Management

Bronchoscopy

         Diagnosis                 

  Testing healthy people for lung cancer

           People with an increased risk of lung cancer may be consider annual lung cancer screening using low-dose CT-scans. Lung Cancer screening is generally offered to older adults who have smoked heavily for many years or who have quit in the past 15 years.

     

    Test to Diagnose Lung Cancer

               Test may include:

Imaging Tests

Tissue Sample Biopsy

Sputum Cytology

• 
  Imaging Tests - An x-ray image of your lungs may reveal an abnormal mass or nodule. A CT-scan can reveal small lesions in your lungs that might not be detected on an x-ray.
• Sputum cytology - If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.
• Tissue sample (biopsy) - A sample of abnormal cells may be removed in a procedure called biopsy.

          Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted blue that's passed down your throat and into your lungs 

          Mediastinoscopy, in which an incision is made at the base of your neck and surgical tools are inserted behind your breastbone to take tissue samples from lymph nodes is also an option.

          Another option is needle biopsy, in which your doctor uses x-ray or CT images to guide a needle through your chest wall and into the lung tissue to collect suspicious cells.

Careful analysis of your cancer cells in a lab will reveal what type of cancer you have. Results of sophisticated testing can tell your doctor the specific characteristics of your cells that can help determine your prognosis and guide your treatment.

Test to determine the extent of the cancer

      Once your lung cancer has been diagnosed, your doctor will work to determine the extent (stage) of your cancer. Your cancer's stage help you and your doctor decide what treatment is most appropriate,

     Staging test may include imaging procedures that allow your doctor to look for evidence that cancer has spread beyond your lungs. These tests include CT, MRI, positron emission tomography (PET) and bone scans. Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you.

     The stages of lung cancer are indicated by Roman Numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lung. By stage IV the cancer is considered advanced and has spread to the other areas of the body.

NURSING MANAGEMENT:

1. Nursing Diagnosis:

• Ineffective airway clearance related to increased tracheobronchial secretion.
• Ineffective breathing pattern related to decreased lung capacity.
• Altered nutrition less then body requirement related increased metabolic demand and decreased food intake.
• Anxiety related to lack of knowledge
• Pain related to the pressure of the tumor.

        
2. Nursing Care:
          - Nurses plays a big role in taking care of a lung cancer patient. Here in the Philippines, the most common approach in treating lung cancer includes Chemotherapy, Radiation Therapy, and Surgery. Chemotherapy is a chemical drug that destroys or kill cancer cells. It usually works by keeping the cancer cells from growing, dividing, and making more cells. Radiation Therapy is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink the tumor. And the Surgery, it removes cancer that is contained in one area. Though, surgery removes some, but not all of the cancer tumor.

          Caring for a diagnosed patient depends on the individual's health status prior to giving any pharmacologic agents with inherent variable of toxicities. Monitoring for the response of the patient to the therapy requires constant examination for possible medical complications. And since accuracy and consistency of care is important, a regular follow-up of the patient should be established.

3. Health Teaching:
          - Health Teaching is important to let the patients be cautious about their health. In order to prevent lung cancer, you should avoid smoking or quit smoking. Because in most cases, smoking is the main cause of having lung cancer. If it is difficult for you to quit smoking on your own, you should seek help from your doctor about medications and resources that can help you quit smoking. Also, you should avoid exposure to second-hand smoke since it can also cause lung cancer. However, there are some cases that people who never smoke may develop lung cancer.
          Additionally, you should know the risk factors that may increase in developing lung cancer, such as:
• Cigarette smoking causes the majority of lung cancer.  Smoking pipe tobacco or cigars also can contribute to lung cancer. 
• Inhaling second-hand smoke from others increases your risk of lung cancer.
• Exposure to high levels of air pollution increases the risk of lung cancer.
• High levels of arsenic in drinking water are associated with lung cancer.
• Radon that is naturally-occurring radioactive gas in homes or businesses can cause lung cancer. 
• You have a greater risk for lung cancer if your family members have or had lung cancer.
• Lung scarring from chronic emphysema, bronchitis, and other conditions can raise the risk of lung cancer.
• Exposure at your job to cancer-causing substances, such as asbestos, uranium, arsenic, and certain petroleum products, increases the risk of developing lung cancer.  People that are exposed to such products and smoke have even a greater risk.
• Radiation therapy to the lungs can increase the risk of lung cancer.
          Therefore, as a responsible individual, you should avoid the things that could harm your health. Be reminded that having lung cancer is never easy, it will cause you trouble in breathing properly and clearly. So, it is better to stay healthy than to put your health at risk.