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Lung Cancer: A Case Study

by Anna Stewart RN, BSN, MSN-C
Murray State University Nursing 622

      Lung cancer is the number one cause of cancer-related death in men and the second most common in women. Lung cancer is responsible for 1.3 million deaths worldwide annually. The main types of lung cancers consist primarily of small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).  In 2008, the National Cancer Institute (NCI) estimated in the United States that there were 215,020 new cases and 161, 840 cancer related deaths of SCLC and NSCLC combined. The most common cause of lung cancer is smoking. Other risk factors include genetics, radon gas, asbestos and air pollution which includes secondhand smoke.

      Diagnostics is an important part of cancer treatment. Distinction between lung cancers is important because of the difference in treatments. Chest radiograph and computed tomography (CT scan) are used to visualize the lung cancer. A biopsy is done to confirm the diagnosis and usually achieved via bronchoscopy or CT guided biopsy.  Categorization is done by viewing the cells under a microscope.  NSCLC arises from epithelial cells and SCLC begins in the nerve cells or hormone-producing cells of the lung. The term “small cell” refers to the size and shape of the cancer cells as seen under a microscope.  The histological classification of lung cancers is significant because it determines the type of treatment and prognosis, the stage (degree of metastasis), and patients performance status.

       The frequency of NSCLC is 80.4% compared to 16.8% of cases of SCLC. Other types of lung cancers (carcinoid, sarcoma and unspecified lung cancers) are less than 3%.  Surgery, chemotherapy, and radiotherapy are possible treatments.  The NCI states that the five year survival rate is 15% with treatment.

      SCLC has the poorest prognosis of lung cancer because it is the fastest growing and has usually metastasized by the time a diagnosis is made. Although lung cancer can metastasize anywhere in the body, the most common sites are the lymph nodes, lungs, bones, brain, liver, and the adrenal glands. Metastases from lung cancer can cause additional difficulties such as breathing problems, bone pain, abdominal or back pain, headache, weakness, seizures, and/or speech difficulties. Lung tumors can release hormones that result in chemical imbalances, such as low blood sodium levels or high blood calcium levels, but this is uncommon (NCI, 2008).
 

Staging of small cell lung cancer

      Because almost all small cell lung cancer has spread outside the lung when discovered, very few patients with small cell lung cancer are treated with surgery, and all receive chemotherapy. Some patients with small cell lung cancer can benefit from radiation therapy. The staging for small cell lung cancer helps identify which patients can be treated with radiation therapy in addition to chemotherapy. Small cell lung cancer is classified as either limited stage or extensive stage:

    * Limited stage means the cancer is located on one side of the chest and involves a single region of the lung and adjacent lymph nodes. This region can be treated in its entirety with radiation therapy. About 30% of patients have limited stage.
    * Extensive stage means the cancer has spread to other regions of the chest, or outside of the chest, and cannot be treated completely with radiation therapy. Most patients (70%) have extensive stage disease and are treated with chemotherapy only (McCance, 2006).

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