Introduction
Lung cancer was considered a sporadic disease until recently. There were only 140 cases of lung cancer in the medical literature by 1898. It is a serious medical problem with high prevalence and serious consequences for human health. According to the World Health Organization (WHO), more than 2.2 million new cases of lung cancer were recorded in 2020. This fact makes it one of the most common causes of cancer death.
Among the risk factors are smoking, radon, and air pollution. The main risk factor for lung cancer is tobacco smoking. It is the most significant known risk factor, and more than 85% of lung cancer cases are related to smoking. The significance of the problem is underscored by its mortality rate, social and economic consequences, and preventability.
The Description of the Lung Disease Problem
Lung cancer is one of the leading causes of cancer death in the world. In general, lung cancer is a serious threat to human health due to its prevalence and difficulty in treatment. Prevention and early diagnosis play a key role in combating this problem. According to Schabath et al. (2019), “In the United States, lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death.” (p. 1563).
Etiology and Pathophysiology of Lung Cancer
Lung cancer is a malignant neoplasm that develops in the lungs. In the etiology of lung cancer, chemical compounds play a specific role associated with industrial processes and adverse etiological conditions. Hill et al. (2023) state that “Functional mouse models revealed that air pollutants cause an influx of macrophages into the lung and release of interleukin-1β.” (p. 160). However, despite the extensive list of carcinogenic effects that act on the transformation of normal cells of the lung epithelium into malignant ones, the contribution to the development of lung tumors does not exceed 10-20%.
The leading cause of lung cancer is smoking, as tobacco contains many carcinogens (substances that contribute to the development of cancer), and their inhalation leads to mutations in lung cells. Asbestos exposure can increase the risk of developing pleural mesothelioma (a rare type of cancer that occurs in the pleura, the lining that covers the lungs and the inside of the chest cavity). There are hereditary factors that can increase the risk of lung cancer in some individuals. If there have been cases of this disease in the family, the risk of developing it may increase.
The initial stage of cancer development involves initiation, where specific genetic changes or mutations in lung cells serve as the basis for further growth and division of these cells. After initiation by carcinogens or other factors, mutated cells are maintained and increased. This process can last for decades, and it does not always lead to the development of cancer. At this stage, malignant cells begin to grow uncontrollably and spread to surrounding tissues and organs through a process known as metastasis. Understanding the etiology and pathophysiology of lung cancer helps to develop methods of prevention, early diagnosis, and treatment of this disease.
The Clinical Presentation and Patient Assessment
Clinical manifestations may vary depending on the type of cancer, stage of the disease, and other factors. However, there are general symptoms and signs that doctors usually pay attention to when lung cancer is suspected. Among them are cough, hemoptysis, dyspnea, chest or back pain, weight loss, fatigue, and weakness.
Diagnosis of lung cancer includes blood tests and other laboratory tests. Levels of specific markers, such as carcinoembryonic antigen (CEA) and nonspecific mucin antigen (CA 19-9), are typically determined. X-rays, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) help evaluate the structure of the lungs and determine the presence of a tumor.
A biopsy of the lung tissue is typically performed for definitive diagnosis. Zhou et al. (2023) state that “Liquid biopsy has the advantages of low invasiveness and good reproducibility” (p. 1669). After the diagnosis, doctors determine the stage of lung cancer, which includes information about the tumor size, the presence of metastases, and damage to the lymph nodes.
Differential Diagnoses
Differential diagnosis of lung cancer includes distinguishing this disease from other pathologies and conditions that may have similar symptoms. The most common differential diagnoses are pneumonia, bronchitis, tumors in other organs, and upper respiratory tract infections. Pneumonia is an inflammation of the lungs, characterized by symptoms including coughing, shortness of breath, and chest pain. Evaluating symptoms, signs of infection, and imaging findings (such as X-rays and CT scans) helps distinguish pneumonia from lung cancer.
Chronic or obstructive bronchitis can also cause coughing and shortness of breath. However, symptoms can be more persistent and become worse over time in the case of lung cancer. Metastases in other organs can exhibit similar symptoms to those of lung cancer.
Therefore, it is essential to determine the site of origin of the tumor and check other organs to exclude other cancers. Viral or bacterial infections of the upper respiratory tract can have similar symptoms to those of lung cancer. Their diagnosis is based on the anamnesis and the results of laboratory and imaging studies.
The Clinical Management: Treatment Plan
A lung cancer treatment plan is a comprehensive approach that includes clinical guidelines, medications, and patient education. The patient assessment and diagnosis are the first steps, which help to conduct a detailed history of the illness and a physical examination of the patient. Moreover, X-rays, CT scans, PET scans, or MRIs of the lungs should be performed to determine the tumor’s size and stage. Also, a biopsy should be performed to confirm the diagnosis and determine the type of lung cancer.
The next step is to provide a treatment plan, which can include surgical treatment, chemotherapy, and medications for metastatic lung cancer. According to Rudin et al. (2021), “In the rare patients who present with very early-stage disease at diagnosis, treatment can include surgery and adjuvant platinum-based chemotherapy, although, more typically, patients with early-stage or locally advanced disease are treated with concurrent radiation and platinum-based chemotherapy.” (p. 2).
The optimal surgical approach should be guided by clinical guidelines such as tumor size and the presence of metastases. Perform chemotherapy using drugs such as platinum compounds (such as carboplatin or cisplatin) and drugs such as paclitaxel or doxorubicin. Chemotherapy can be given before or after surgery, depending on the stage of the disease. According to Iksen et al. (2021), “Many types of targeted therapies for lung cancer are currently available, such as epidermal growth factor receptor (EGFR) inhibitors (erlotinib and gefitinib) or anaplastic lymphoma kinase (ALK) inhibitors (crizotinib and alectinib).” (p. 2).
Patient education is a crucial part of lung cancer treatment. The nurse practitioner plays a key role in explaining the diagnosis, the stage of the disease, and the selected treatment methods to the patient. Moreover, the nurse’s task is to provide information about possible drug side effects. The nurse practitioner should also encourage the patient to engage in regular physical activity and adopt a healthy lifestyle.
Heinke et al. (2020) state that “Multidisciplinary cancer care is one of the ten goals outlined in the Quality Cancer Care Statement by the American Society of Clinical Oncology” (p. 1640). The nurse works as a team member with oncologists, surgeons, pulmonologists, and other specialists to coordinate patient treatment and care. The National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) are clinical guideline sources that should be used to update and maintain current information on best practices in lung cancer care. Nurses must continually update their knowledge and utilize interdisciplinary resources to deliver the best possible care and support to patients.
The Expected Patient Outcomes
The lung cancer treatment expected results can vary depending on the stage of the disease, the tumor type, and other individual factors. The primary goals of lung cancer treatment are to prolong life, alleviate symptoms, and enhance the patient’s quality of life. Time frames for achieving these results can vary and are typically discussed with healthcare professionals and patients.
A decrease in tumor size is expected, as indicated by lung follow-up images in imaging studies such as CT or PET-CT, following surgical treatment or radiotherapy. This process can take several weeks or months. If the treatment is successful, the patient may experience improvement in symptoms such as cough, shortness of breath, pain, and general fatigue. Improvement may be observed during the first few weeks of treatment. There can be a decrease in tumor markers, such as carcinoembryonic antigen (CEA) or nonspecific lung mucin-associated antigen (CA 19-9), which may be an indicator of treatment effectiveness for some patients.
One of the key goals of treatment is to improve the patient’s quality of life, reducing the pain and discomfort that can be associated with lung cancer. According to Martin et al. (2021), “optimizing a patient’s quality of life (QOL) and controlling symptoms continue to be crucially important objectives of lung cancer treatment in addition to prolonging survival.” (p. 285). The time frame for achieving these results can vary from patient to patient. It is usually determined by the stage of the disease and the chosen treatment method.
The nurse evaluates the achievement of expected treatment outcomes, which include the observation of the patient’s symptoms, recovery of physical function, and changes in laboratory values. It is essential to keep a record of the treatment progress and regularly report possible side effects or the patient’s progress to the team. Open communication with the patient and encouragement to be actively involved in the decision-making process regarding treatment will help determine whether the expected results have been achieved and whether adjustments are needed in the treatment plan.
The pause in lung cancer management is a responsible and challenging decision that can be considered in various situations. Palliative or hospice care may be considered if the patient is in a serious condition and treatment does not lead to improvement. In such cases, the nurse should collaborate with the palliative care team, which includes palliative care physicians, psychologists, social workers, and other professionals. Palliative care aims to alleviate symptoms and improve the patient’s quality of life in the final stages of their illness.
References
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Heinke, M. Y., & Vinod, S. K. (2020). A review on the impact of lung cancer multidisciplinary care on patient outcomes. Translational lung cancer research, 9(4), 1639–1653.
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