Darline Stvictor-Viau
Molloy College
Abstract
Lung cancer is a leading cause of death in the United States today. While smoking is a significant risk factor, there are other causes of the disease. Second-hand smoke, exposure to radon gas and asbestos, and possibly other environmental contaminants act in conjunction with gender and ethnicity to result in a diagnosis of lung cancer. Numbers indicate that more non-smokers are being diagnosed with lung cancer at this time than non-smokers due to development of the disease after cessation. Early diagnosis and treatment can significantly extend the life of the lung cancer patient while studies continue seeking improvement in prevention, diagnosis, and treatment.
While is has long been acknowledged that lung cancer can be attributable to smoking, there are statistics to show that non-smokers develop lung cancer for a variety of reasons. It is estimated that 10 to 15 percent of patients diagnosed with lung cancer have never smoked Second-hand smoke, exposure to radon gas and asbestos and other pollutants, and genetics all contribute to development of the disease (Homa et al., 2015).
Epidemiology
According to the American Thoracic Society (2009), lung cancer is the abnormal and uncontrolled growth of cells within the lung. Lung cancer is divided into two major subtypes, small cell lung cancer and non-small cell lung cancer (Alberg & Samet, 2010). Non-small cell lung cancer is composed of squamous cell carcinoma, adenocarcinoma, and large cell carcinomas. Adenocarcinoma is the most common form of lung cancer in adults who have never smoked.
Lung cancer deaths comprise 27 percent of all deaths from cancer and are the leading cause of death among cancer patients (Cancer.org, 2015). The disease is responsible for more than 1.56 million death every year around the world (Stewart & wild, 2014). More lung cancer patients die every year than patients from prostate, breast, and colon cancer combined (see graph 1). Two-thirds of patients diagnosed with lung cancer are over the age of 65 with the age of 70 being the average; less than 2 percent of all cases are in people younger than age 45.
Graph 1. Comparison of deaths estimated from lung cancer to other cancer deaths in 2015 (Cancer.org, 2015)
Second-hand smoke occurs when an individual inhales burning tobacco products unintentionally (MedicineNet, 2015). Exposure can results in sudden infant death syndrome, ear infections, respiratory infections, and asthma attacks in small children and infants; non-smoking adults may experience lung cancer, stroke, and coronary heart disease (United States Department of Health and Human Services, 2015). In addition, second-hand smoke costs America around $5.6 billion each year in lost productivity (Max, Sung & Shi, 2012). There is no level of second-hand smoke exposure that is without risk (United States Department of Health and Human Services, 2006).
The United States Environmental Protection Agency states that exposure to radon gas is the leading cause of lung cancer in non-smokers (Simon, 2014). Radon gas is a naturally occurring gas that is formed when uranium decays (Subramanian and Govindan, 2010). Although it occurs in harmless amounts outdoors, it can sometimes become highly concentrated in homes that are built on soil with natural uranium deposits (Simon, 2014). Individuals who have lived in an environment of this type have a higher risk of developing lung cancer. Stoppler and Marks (2009) suggest that one in every fifteen American homes contains radon gas. Radon gas is responsible for over 20,000 or 12% of all lung cancer deaths each year in America (Stoppler and Mark, 2009; Simon, 2013); the National Cancer Institute (2014) credits radon with contributing to 30% of lung cancer deaths.
The National Cancer Institute (2014) indicates an association between air pollution and developing lung cancer in non-smokers. Cooking fumes, biomass and coal have shown evidence of causing the development of cancer in non-smokers (Samet et al., 2009). Occupational agents such as asbestos, arsenic and silica have also been reported as causes of lung cancer.
Prevalence
It is estimated that in 2015, there will be approximately 221,200 new cases of lung cancer diagnosed with the majority being male (Cancer.org, 2015). Unfortunately, approximately 158,040 patients will die from the disease in the same year. According the United States Department of Health and Human Services (2015), second-hand smoke is the cause of over 41,000 deaths of adults who do not smoke and 400 deaths of infants annually.
The symptoms associated with lung cancer often vary, especially in non-smokers (Alberg & Samet, 2010). When taking a medical history, it is important to inquire about hoarsness, persistent coughing, chest pain, loss of appetite and weight loss, sputum that is frothy or rust-colored, shortness of breath, fever for no reason, recurring infections such as pneumonia or bronchitis, and tiredness (American Thoracic Society, 2009).
Dyspnea is experienced by many lung cancer patients and may be accompanied by cyanosis, tachypnea, pallor, and/or tachycardia (Irving, 2009). Hypoxia may result from breathlessness and manifest in restlessness, cognitive impairment, or confusion. If the patient is elderly, these types of behavior should not be dismissed as associated with general signs of aging, but should be assessed for dyspnea. Diagnosis
The diagnosis of lung cancer is made when the physician recognizes symptoms that indicate to him that there is a more serious diagnosis present than bronchitis or other milder illness. After taking a medical history and performing a physical examination, he continues with more extensive tests to evaluate his suspicion of a diagnosis of lung cancer. The patient will generally present with a cough of unknown origin accompanied by other symptoms such as shortness of breath, weight loss, frothy or rust-colored sputum, hoarseness, and/or chest pain. At this point a chest xray is the next logical step.
A spot on the film indicates a possible tumor; abnormalities include lung nodules or lung masses. A lung nodule has a 40 percent chance of malignancy, but can also be caused by pulmonary infarcts (the nodule lost its blood supply), cysts, or granulomas. If the lung nodule in question is larger than three centimeters, it is considered a lung mass. A cancerous lung mass may be a secondary site – metastasis from another location in the body. Other causes of a lung mass include lipoid pneumonia, abscesses, abnormal connections between arteries and veins, or infections; however, if a lung mass is present, it is generally cancerous.
There are a number of possible diagnostic procedures possible to further determine if the abnormality if malignant or benign. In the event the area is determined to be malignant, it must be decided if the cancer has metastasized to other parts of the body.
When lung cancer is suspected, a flexible bronchoscopy may be used to obtain a specimen of lung tissue for analysis (Carter, 2013). Obtaining a sputum specimen for laboratory analysis may also be effective for a diagnostic conclusion (American Lung Association, 2015). Other tests to confirm suspicion of lung cancer are tomography, mediastinoscopy, CT Scan, thoracentesis, and a thorough medical history.
Treatment
For a patient who smokes, the first step in treatment is to have him stop smoking; of course, for a non-smoking patient this is not necessary. The prognosis and course of treatment for lung cancer are based on several variables: the patient’s general health, the stage of the cancer, the type of cancer, if symptoms are present, and if the cancer has mutations in certain genes (National Cancer Institute, 2015). If the patient has confirmed non-small cell lung cancer, there are currently no effective treatments.
Options for treatment are determined by the physician in consultation with the patient. Various types of surgery seek to remove the tumor or lesion and any possible surrounding involved tissue. External radiation is an option for patients who do not want or cannot have surgery. Chemotherapy may follow surgery to improve chances for success. Sometimes all three therapies are combined in different progressions; for example, radiation may be followed by surgery which is followed by chemotherapy. Finally, there is often the option to participate in clinical trials for treatments that are under investigation. The recommendations of the physician are based on the variable previously mentioned and individual patient circumstances.
There are times during treatment when the nursing staff has the opportunity to assist the physician by evaluating the patient specifically for issues related to the lung cancer diagnosis. For instance, when dyspnea is present, an accurate nursing assessment can result in quickly providing appropriate treatment. Oxygen and medications may be administered to promote the patient’s comfort (Irving, 2009).
Precautions
There are precautions people who do not smoke can take to prevent inhaling second-hand smoke and decrease their risk of acquiring lung cancer. The primary intervention is related to second-hand smoke; according to the National Cancer Institute (2014), legislation is the most effective federal action. There is an inherent need for the legislatures of both state and federal governments to effectively address the issue of smoking in public and indoor places so as to reduce exposure to second-hand smoke. The government can pass to legislations: the enactment of laws that ban smoking in public and indoor places, and the enactment of laws that raise the tax threshold of tobacco manufacturers and cigarette purchase. Both of these methods have been found to be effective in the United States. More than 50 studies conducted in the United States have consistently associated lung cancer reduction with the introduction of smoke-free workplace laws (National Cancer Institute, 2014). In addition, non-smokers should take every precaution to stay away from areas where there are people smoking such as breakrooms, cars, homes, and other enclosed areas.
With regard to radon gas exposure, homes should be sealed to prevent the gas leakage and testing be done on a periodic basis since the gas is odorless and colorless (National Cancer Institute (2014). In the event the test shows positive, repairs should be made promptly and the area vacated until such time as they are performed.
There are a number of studies that show life changes can result in prevention or improvement of lung cancer. One such study in China drew a correlation between postmenopausal hormone therapy and lung cancer (Yang et al., 2013); the findings were that women who are the most soy in their diet before diagnosis lived longer than those that did not, and high soy consumers after diagnosis lived longer than patients who did not eat high amounts of soy. A previous study found that women who were non-smokers that ate a diet high in soy were less likely to develop lung cancer.
Conclusion
When patients are diagnosed early, some cases can be cured. More than 430,000 people today live in the United States that at some point in their lives been diagnosed with lung cancer (Cancer.org, 2015). Education is important for adults to be aware of the symptoms of lung cancer even if they are not smokers.
There is ongoing research into diagnosis and treatment for lung cancer. The field of immunology is showing promise (The University of Texas, 2015), as is epigenics to modify genetic expression (Kanwal & Gupta, 2010). In the meantime, early detection and preventative techniques are the hope for patient with lung cancer today.
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