Author of

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  IASLC Pre-Conference School of Nursing (ID 3)

  • Event: LALCA 2019
  • Type: Invited Speaker Session
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/17/2019, 09:00 - 15:30, Castillo A 5-6

  • 33612

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    PC3.06 - Pain and Symptom Management in Early Stage (ID 31)

    09:00 - 15:30  |  Author(s): Angela Maria Acevedo
    • Abstract
    • Slides

    The most common symptom leading to the diagnosis of lung cancer is cough, sometimes associated with wheezing or hemoptysis, from irritation due to a tumor located in or near the bronchus. Other early symptoms can include chest wall pain if the tumor is located peripherally, particularly if it is invading the pleura. Dyspnea is often a late symptom but can occur if the tumor is occluding the airway or causing volume loss. Anorexia with weight loss can occur in association with energy expenditure and fatigue from the effort of breathing, as well as the caloric demands of the tumor itself (usually late stage disease). Local effects of lung neoplasms include Horner syndrome (unilateral constricted pupil, drooping of the eyelid, and dry skin) if the tumor invades the sympathetic chain in the upper part of the chest, and superior vena cava syndrome if the tumor impedes venous return from the head, neck, and upper extremity. Pleural and pericardial effusions may cause dyspnea and chest pain syndromes. Metastatic disease may cause bone pain, and neurologic symptoms from brain involvement. Small cell lung cancer may produce hormones that are released independently from endocrine organs to cause what are classified as paraneoplastic syndromes, which can lead to Cushing's syndrome (high corticosteroid levels), SIADH (fluid retention and low sodium levels), and hypercalcemia.
    Most early stage lung cancer produces few if any specific symptoms, and most of those, such as cough and/or dyspnea, are commonly associated with other diseases, so clinicians must be vigilant in inquiring about appropriate aspects of one’s medical history (tobacco use, secondhand smoke, radon or asbestos exposure, etc.) and should have a degree of suspicion when a patient presents with vague symptoms. CT lung screening of appropriate asymptomatic individuals (>30 pack-years of tobacco use, age >55, less than 15 years since quitting) will identify an otherwise undiagnosed neoplasm in one out of 320 patients screened. This compares extremely favorably with other cancer screening. For example, almost 2000 asymptomatic women need to be screened with mammography to detect one patient with breast cancer.

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