Question

C.P. is a 71-year-old married farmer, with a past medical history of hernia surgery in 1986 and prostate surgery in 2005 for benign prostatic hyperplasia. C.P. does not drink, but he has smoked for 40 years; the past 3 years he has smoked two to three packs per day. Two weeks ago, C.P. visited the local rural health clinic with complaints of a progressive cough and chest congestion. Despite a week of antibiotic therapy, C.P. continued to worsen; he experienced progressive dyspnea and productive cough, and he began to have night sweats. C.P. refused to be admitted to the hospital because “there's no one to look after the cows,” but he agreed to go for a chest x-ray (CXR). The radiologist reads C.P.'s CXR as “left hilar lung mass, probable lung cancer.”

C.P. undergoes a fiberoptic bronchoscopy. He returns to the office to learn the results of his test. The pulmonologist tells C.P. and his wife that he has poorly differentiated oat cell lung cancer and explains that it is a very fast-growing cancer with a poor prognosis. This kind of lung cancer is directly related to C.P.'s history of smoking. C.P. undergoes a metastatic workup and is found to have disease in a number of lymph nodes. The physician tells C.P. and his wife that surgery is not an option and schedules C.P. to begin combination chemotherapy. C.P. says he doesn't know if he should take chemotherapy if he “isn't going to live anyway.” C.P. eventually agrees to receive chemotherapy.

1. List the manifestations of lung cancer.

2. What are the goals of administering chemotherapy in patients such as C.P.?

3. Neutropenia is a side effect of chemotherapy. What are the manifestations of neutropenia and what teaching would you provide to patients that develop this disorder?

4. Teletherapy (external) radiation therapy may be administered alone or combined with surgery and/or chemotherapy for some types of cancer. What teaching would you provide to patients receiving this type of radiation therapy?

Answer 1

Answer: Due to smoking, the chances of lung cancer increases and sometimes it do not cause any symptoms until they have spread widely to the respiratory tract. The cigarettes contain carcinogenic ingredients which causes cancers in the lungs. The symptoms includes:

• Shortness of breath
• Fatigue
• Hoarseness
• Coughing up blood or rust-colored sputum (spit or phlegm)
• Infections such as bronchitis and pneumonia

The main purpose of chemotherapy drugs is to kill the cancer cells as the drugs circulate in the blood to parts of the body where cancer may spread, and it aims to cure cancer, to control cancer and also to relieve symptoms caused by cancer. The low number of cells called neutrophils ( white blood cell) is known as neutropenia, where the infection occurs such as ulcer, rashes etc. Neutropenia is a side effect of chemotherapy. The patient should take care and prevent himself from having infections. Maintain proper hygiene to prevent invasion of bacteria or any kind of infections. Protective isolation can be done to prevent the infection.