Lung Cancer for NP
Lung Cancer for the Nurse Practitioner Licensing Exam
Lung Cancer Overview
- Epidemiology:
- Lung cancer is the leading cause of cancer-related death globally.
- Most common in individuals over 50 and is strongly associated with smoking.
- Risk Factors:
- Smoking: Primary risk factor, with greater risk linked to higher pack-years.
- Environmental Exposures: Radon, asbestos, air pollution, and secondhand smoke.
- Genetic Factors: Family history and mutations in genes such as EGFR and KRAS.
Types of Lung Cancer
- Non-Small Cell Lung Cancer (NSCLC) (~85% of cases):
- Adenocarcinoma: Most common type, particularly in nonsmokers and women; often peripheral.
- Squamous Cell Carcinoma: Linked to smoking, typically central, and may cavitate.
- Large Cell Carcinoma: Rare, usually peripheral, and associated with rapid growth.
- Small Cell Lung Cancer (SCLC) (~15% of cases):
- Highly aggressive and strongly associated with smoking; tends to be central.
- Commonly presents with paraneoplastic syndromes such as SIADH and ectopic ACTH production.
Clinical Presentation
- Respiratory Symptoms:
- Cough: Persistent and progressive.
- Hemoptysis: Especially with central tumors.
- Dyspnea: From tumor obstruction, effusion, or lung parenchymal involvement.
- Chest Pain: Dull and often worsens with deep breathing.
- Systemic Symptoms:
- Weight Loss and Fatigue: Common in advanced disease due to metabolic demands of the tumor.
- Paraneoplastic Syndromes:
- SIADH: Causes hyponatremia, more common in SCLC.
- Hypercalcemia: Seen in squamous cell carcinoma due to PTHrP secretion.
Diagnostic Evaluation
- Imaging:
- Chest X-ray: First-line; may show mass, nodule, or pleural effusion.
- CT Scan: Defines tumor size, location, and extent of disease.
- Biopsy:
- Bronchoscopy or CT-Guided Needle Biopsy: Used for tissue diagnosis.
Treatment
- NSCLC:
- Surgery: First-line in early stages (Stage I-II).
- Radiation: For non-surgical candidates or advanced disease.
- Chemotherapy: Used in later stages or as adjuvant therapy.
- SCLC:
- Primarily treated with chemotherapy and radiation, as it typically presents at an advanced stage.
Key Points
- Lung cancer, mostly due to smoking, is the leading cause of cancer death.
- NSCLC is the more common type, with adenocarcinoma often found in nonsmokers and females.
- SCLC is aggressive, frequently presenting with paraneoplastic syndromes like SIADH.
- Diagnosis requires imaging (X-ray, CT) and biopsy.
- Treatment depends on the type and stage, with surgery for early-stage NSCLC and chemotherapy/radiation for advanced disease or SCLC.