Lung cancer remains a leading cause of cancer-related mortality worldwide and presents a significant concern in the field of respiratory care.
Understanding the pathophysiology, types, staging, and treatment options for lung cancer is crucial for respiratory therapy students.
This knowledge not only aids in effective patient care but also contributes to interdisciplinary healthcare efforts aimed at early diagnosis and treatment.
This article aims to provide a comprehensive overview of lung cancer, enriched with practice questions to test your understanding and readiness for real-world applications.
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What is Lung Cancer?
Lung cancer is a type of cancer that originates in the lungs, often in cells lining the air passages. It’s primarily caused by smoking, though non-smokers can also develop it. There are two main types: non-small cell lung cancer and small cell lung cancer. Symptoms may include coughing, chest pain, and shortness of breath. Early detection and treatment are crucial for better outcomes.
Lung cancer is primarily divided into two main categories:
- Non-small cell lung cancer (NSCLC)
- Small cell lung cancer (SCLC)
NSCLC accounts for approximately 85% of all lung cancer cases and includes subtypes like adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.
SCLC is more aggressive and makes up the remaining 15% of cases.
The leading risk factor for lung cancer is tobacco smoking, which contributes to 80-90% of lung cancer cases.
Exposure to secondhand smoke, environmental pollutants like asbestos, and occupational hazards such as exposure to certain chemicals also elevate the risk.
Genetic factors and pre-existing lung conditions like chronic obstructive pulmonary disease (COPD) can make individuals more susceptible as well.
Lung cancer is often asymptomatic in its early stages, making early detection difficult.
As the disease progresses, symptoms such as persistent cough, coughing up blood, shortness of breath, chest pain, and unexplained weight loss may appear.
Early diagnosis is crucial for successful treatment but remains a challenge. Diagnostic methods include imaging tests like X-rays and CT scans, as well as biopsies to examine cell samples.
More recently, low-dose CT scans have been recommended for high-risk individuals as a screening tool.
Treatment modalities depend on the type and stage of lung cancer. Surgical resection, chemotherapy, radiation therapy, targeted therapies, and immunotherapies are among the primary treatment options.
The choice of treatment is often tailored to the individual patient’s condition and type of lung cancer.
The prognosis for lung cancer varies significantly depending on the stage at diagnosis. Late-stage lung cancer has a notably poor prognosis, with a five-year survival rate below 20%.
However, when detected early, the chances for successful treatment are much higher.
Primary prevention strategies include smoking cessation and avoiding exposure to known carcinogens.
Public awareness campaigns and education on the risks associated with smoking and other environmental factors serve as the first line of defense against lung cancer.
Note: Understanding lung cancer’s complexities, from its types to its treatment options, is vital for both healthcare professionals and the general public. Ongoing research continues to shed light on new diagnostic and treatment avenues, offering hope for improved patient outcomes.
Lung Cancer Practice Questions
1. What is lung cancer?
Lung cancer is a major public health problem in the United States (and the world). In the US, approximately 28% of cancer deaths are due to lung cancer. Most of these deaths could be avoided if people did not smoke tobacco-related products.
3. What is the leading cause of cancer-related mortality in the United States?
4. Approximately 85% of all cases of bronchogenic carcinoma are linked to what?
5. What are the major histopathologic types of bronchogenic carcinoma?
Adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and large cell carcinoma.
6. What is the most common type of bronchogenic carcinoma?
Adenocarcinoma, which represents more than 40% of all cases.
7. The clinical manifestations of bronchogenic carcinoma result from what?
They result from the local growth of the tumor, regional spread, metastases to extrathoracic and intrathoracic organs, and paraneoplastic syndromes.
8. Lung cancer causes approximately what percentage of all cancer deaths?
It causes approximately 25% of all cancer deaths.
9. What are the most commonly used treatments for patients with non–small cell lung cancer?
Surgical resection, radiation therapy, and chemotherapy
10. The treatment of most patients with small cell carcinoma includes what?
Chemotherapy with radiation therapy
11. What is the most effective way to prevent lung cancer?
12. What is adenocarcinoma?
A type of cancer characterized by glandular structures
13. What is bronchoalveolar cell carcinoma?
A type of lung cancer characterized by tumor occurrence at the level of the small airways, often masquerading as pneumonia
14. What is large-cell carcinoma?
A type of lung cancer characterized by large cells on microscopy
15. What is a mass?
A body of matter without a definite shape
16. What is a nodule?
A small rounded lump of mineral substance
17. What is non-small cell carcinoma?
This cancer grows more slowly than small-cell lung carcinoma, and it’s not only found in smokers. It occurs in 85-87 percent of lung cancers.
18. What imaging technique is used for the diagnosis of lung cancer?
19. Who is squamous cell lung cancer most common in?
It is most common in smokers.
20. What is radiotherapy?
Treatment with radiation
21. What is screening?
Testing objects or persons in order to identify those with particular characteristics.
22. What is small-cell carcinoma?
Malignant, usually bronchogenic epithelial neoplasm consisting of small, tightly packed round, oval, or spindle-shaped epithelial cells that stain darkly and contain neurosecretory granules and little or no cytoplasm.
23. What is squamous cell carcinoma?
A type of lung cancer characterized by cells that appear “plate-like.”
24. What is a staging system?
A method used in cancer registers to identify specific and separate different stages or aspects of the disease.
25. What is TNM staging?
A staging system based on the size of the tumor (T), the presence and position of abnormal lymph nodes (N), and the presence or absence of metastasis (M).
26. What is transbronchial needle aspiration?
A technique of sampling lung tissue through a bronchoscope which involves passing a thin needle through a bronchus.
27. What is a transthoracic needle biopsy?
The technique of obtaining a biopsy of lung tissue by which a needle is passed into the chest and often guided by imaging.
28. Why is lung cancer the most common cause of cancer death?
It is found at advanced stages because there are no symptoms in the early stages, there is limited effective therapy for the advanced disease, and the absence of pop-based screening.
29. What is the treatment for lung cancer?
Surgery for early stages, chemo and radiation for regional diseases, and palliative care for advanced stages.
30. What are some other environmental causes of lung cancer besides smoking and radon?
Indoor combustion cook stoves, air pollution, vehicle exhaust, industrial emissions, solid fuel use, asbestos, chromium, and cadmium.
31. Lung cancer staging is based on what?
It is based on the primary tumor size and invasion of surrounding structures, the involvement of draining nodes, and the presence of distant mets.
32. What are the key risk factors for lung cancer?
Cigarette smoke, radon, and asbestos
33. What is necessary for the diagnosis of cancer?
A lung biopsy
34. What are two benign lesions?
(1) Granuloma and (2) Bronchial hamartoma
35. Lung carcinoma can be divided into what?
Two types; small-cell carcinoma and non-small-cell carcinoma
36. Which category of lung cancer is not amiable to surgical resection?
Small cell carcinoma cells are so small the surgeon can’t see them.
37. What are the risk factors for lung cancer?
Smoking; increases with the number of packs smoked per day and the number of years spent smoking; women are at higher risk than males; second-hand smoke; radon; ionizing radiation; occupational exposure; cancer history (lymphomas, head, and neck cancer); genetics; and coexisting lung diseases.
38. Why do women have a higher risk of lung cancer than men?
Differences in nicotine metabolism and hormonal factors.
39. How can the risk of lung cancer be reduced?
It decreases after smoking cessation; measurable difference at 5 years; and an 80-90% reduction after 15 years. For those who smoke more than 15 cigarettes/day, cutting that amount in half reduces the risk by 25%.
40. Who is at high risk for lung cancer?
People aged 55-74 and those with more than 30 pack-year history of smoking are at the greatest risk for lung cancer.
41. What are the screening recommendations for the high-risk population?
Baseline low-dose CT (LDCT) scan; annual LDCT at least x 2 years.
42. What are the routine screening recommendations for high and low-risk groups?
Routine screening is not recommended.
43. What is a unique symptom of lung cancer?
44. What are the lab abnormalities of lung cancer?
Hypercalcemia, anemia, leukocytosis, and thrombocytosis.
45. Who is adenocarcinoma most common in?
46. What tissue sampling is used in the diagnosis of lung cancer?
Tumor biopsy (gold standard), fluid cytology if pleural effusion is present, sputum cytology, mutational status, pulmonary function tests (surgical eligibility), and bone marrow biopsy (neutropenic or thrombocytopenic patient).
47. What are PFTs used for with lung cancer?
They are used to determine surgical eligibility.
48. What is the most aggressive type of lung cancer?
49. What is the survival rate without treatment in a patient with small-cell lung cancer?
50. What kind of staging does small cell lung cancer use?
Lung cancer is a complex disease that requires an interdisciplinary approach for effective management.
For respiratory therapy students, a solid grasp of lung cancer basics is vital for patient assessment, diagnostics, and therapeutic strategies.
The practice questions included in this article aim to test your knowledge and prepare you for clinical scenarios.
By staying informed and continually updating your skills, you play a critical role in improving patient outcomes in the fight against lung cancer.
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
- “Lung Cancer: Epidemiology, Etiology, and Prevention.” National Center for Biotechnology Information, U.S. National Library of Medicine, Dec. 2011.
- “Lung Cancer: Current Diagnosis and Treatment.” National Center for Biotechnology Information, U.S. National Library of Medicine, 4 Dec. 2009.