People who vape had worrisome changes in cardiovascular function, even as young adults
What To Know About Small Cell Lung Cancer And Pneumonia
Small cell lung cancer (SCLC) may increase the risk of pneumonia due to a weakened immune system or structural changes to the lungs.
SCLC is one of the two main types of lung cancer. Pneumonia is an infection of the lungs due to bacteria, viruses, or fungi.
This article looks at the link between SCLC and pneumonia, and the diagnosis, treatment, prevention, and outlook of pneumonia in people with SCLC.
A 2019 article notes pneumonia occurs in 50% to 70% of people with lung cancer.
People with SCLC may be more vulnerable to developing infections because cancer and cancer treatments can weaken the immune system.
Although effective treatments for SCLC, radiotherapy and immunotherapy can increase the risk of developing pneumonia. Chemotherapy can also weaken the immune system and increase the risk of infections.
Pneumonia can also be a common complication of major surgery for cancer. Surgery for lung cancer can be highly invasive and can lead to severe complications, including pneumonia.
Lung cancer can also cause changes to the structure of the lungs which can increase the risk of infections.
Post-obstructive pneumonia is a type of pneumonia that occurs due to a blockage in the airways. This causes fluid and mucus to build up behind it, leading to infection. A blockage of the airways, or bronchial obstruction, is more common with SCLC than some other types of tumors.
Both SCLC and pneumonia can cause shortness of breath and fatigue. However, the other symptoms differ.
Other symptoms of pneumonia include:
Other symptoms of SCLC include:
To diagnose pneumonia in people with SCLC, doctors may carry out the following tests:
Treating pneumonia in people with SCLC may depend on the severity of the pneumonia and a person's overall health.
Home treatmentIf the pneumonia is mild, people may be able to treat it at home. A doctor may advise prescription or over-the-counter (OTC) medications, such as:
For people with severe cases of pneumonia, they may need treatment in a hospital. Doctors will give people intravenous (IV) antibiotics and fluids.
People may also receive oxygen therapy, which increases oxygen levels in the blood. Some people may need a ventilator to assist with breathing.
Taking steps to prevent pneumonia is important for those with SCLC. Steps that may help prevent pneumonia include:
Reducing the risk of infections is important. Professional oral care and hygiene around the time of surgery may help reduce the risk of pneumonia in people with cancer.
The outlook of pneumonia with SCLC may depend on the severity of the pneumonia, the stage of SCLC, and factors, such as age and the person's overall health.
A large-scale 2023 study found the risk of death due to pneumonia was higher in people with a cancer diagnosis, and the risk increased with lung cancer.
A weakened immune system and respiratory failure due to cancer treatment may worsen the outlook of pneumonia in people with cancer.
Can a person with cancer survive having pneumonia?Pneumonia can be serious in people with cancer, but early diagnosis and treatment may improve outlook.
What lung cancer mimics pneumonia?Lung adenocarcinoma, a subtype of non-small cell lung cancer, can mimic the appearance of pneumonia on CT scans and cause similar symptoms.
Small cell lung cancer (SCLC) may increase the risk of pneumonia due to a weakened immune system, cancer treatments, and changes in lung structure.
Cancer can increase the risk of serious complications with pneumonia, so prevention or early diagnosis and treatment are important.
8 Early Signs Of Lung Cancer You Shouldn't Ignore
Lung cancer, the most common cancer worldwide, is responsible for more cancer-related deaths than any other type. In India, it accounts for about 6 percent of all cancer diagnoses and over 8 percent of cancer-related deaths. Smoking remains the leading cause, with around 80 percent of lung cancer cases occurring in current or former smokers.
Over 95 percent of lung cancers in India are identified at either advanced stage or after they have spread to other parts of the body. Says Dr Sredharan M., Consultant, Surgical Oncology, Manipal Hospital Goa, "This is because in early stages, lung cancer shows either vague symptoms or no symptoms at all. With the increasing stage of the cancer, the chance of survival drops significantly."
Story continues below Advertisement
While the symptoms of lung cancer can vary and may not always be apparent in the early stages, some common signs could indicate the disease, Dr Sredharan says, and shares 8 early signs of this deadly disease:
Persistent cough: A cough that doesn't go away after several weeks or worsens over time, especially if it's different from your usual smoker's cough, is concerning. Lung cancer irritates the airways and can cause persistent coughing as the tumor grows and obstructs airflow. If a cough lasts more than three weeks, especially if it produces blood or changes in nature, it's critical to see a doctor. Chronic cough is a common early symptom, particularly in non-small cell lung cancer (NSCLC).
Coughing up blood: Even a small amount of blood or rust-coloured sputum in your cough is a red flag. This can occur when lung cancer tumours erode nearby blood vessels, leading to bleeding in the airways. Hemoptysis is a serious symptom that requires immediate medical evaluation. It's not just a sign of lung cancer but can also indicate other conditions like bronchitis, tuberculosis, or pulmonary embolism.
Shortness of breath: Experiencing breathlessness or wheezing during activities that previously didn't cause any issues may indicate lung cancer. Tumours can block air passages or cause fluid buildup in the lungs (pleural effusion), leading to breathing difficulties. Shortness of breath can be a sign of both early and advanced lung cancer.
Chest pain: Discomfort or pain in the chest, particularly when breathing deeply, coughing, or laughing, could be linked to lung cancer. This pain might be due to tumour invasion into the chest wall or pleura, the lining around the lungs. Chest pain associated with lung cancer is often dull and persistent. If the pain worsens over time or is localised in one area, it could indicate the spread of cancer to the chest wall or ribs, and a medical evaluation is necessary.
Hoarseness : A sudden, unexplained change in your voice, particularly if it becomes hoarse, could signal lung cancer. This occurs when the cancer affects the laryngeal nerve, which controls the voice box (larynx). Hoarseness can be a symptom of lung cancer pressing on the recurrent laryngeal nerve, leading to vocal cord paralysis.
Story continues below Advertisement
Unexplained weight loss: Losing weight unexpectedly without changes in diet or exercise may be a sign of lung cancer. Cancer can increase the body's metabolic rate and lead to muscle wasting (cachexia). Unexplained weight loss is often one of the first signs of cancer.
Fatigue: Feeling unusually tired or weak, even without physical exertion, can be an early warning sign. Lung cancer can cause systemic inflammation and disrupt normal body processes, leading to fatigue. Fatigue in cancer patients is often described as feeling physically, emotionally, and mentally drained.
Frequent infection: Recurring respiratory infections, such as bronchitis or pneumonia, could indicate lung cancer. Tumours can obstruct the airways, creating a breeding ground for infections. If you find yourself getting respiratory infections more often, or if they are harder to treat, it could be a sign of lung cancer weakening the immune system or blocking airways.
Other symptoms like bone pain (especially in the lower back or hips), jaundice, swollen neck lymph nodes, headaches, dizziness, balance issues, or seizures can signal advanced lung cancer. These symptoms can also be linked to less serious conditions, but if they persist or worsen, it's essential to consult a doctor. Early diagnosis and treatment are key to better outcomes.
Namita S Kalla is a senior journalist who writes about different aspects of modern life that include lifestyle, health, fashion, beauty, and entertainment.
Supporting Lung Cancer Screening In The Community
GP respiratory specialist Dr Daryl Freeman FRCGP provides an update on the UK's Targeted Lung Cancer Screening Programme and explains how nurses in the community can play a crucial role in supporting lung cancer screening and early detection
The need for early detection in lung cancer
There has been an urgent and growing need to improve early detection of lung cancer. Lung cancer remains the UK's biggest cancer killer.1 It is responsible for 21% of all cancer deaths, with 34,771 people dying of the disease each year.1 It is the third most common cancer, accounting for 13% of all new cancer cases.1
Currently, around one-third (32%) of lung cancers are diagnosed via emergency admission to hospital,2 and the five-year relative survival compares poorly with other European countries.1,3
Numerous studies have shown lung cancer screening is the best prevention method for reducing lung cancer mortality.4-6 If detected early (at stage I) 65 people out of 100 will survive lung cancer – compared to just five if diagnosed late (at stage IV).7 Diagnosing people earlier means they are generally fitter and therefore can receive treatment with curative intent.
What are the risk factors for lung cancer?
Most (72%) lung cancer cases are caused by smoking, according to latest data.1 The UK Lung Cancer Coalition (UKLCC) and its members and stakeholders have steadfastly campaigned for a Smokefree Britain. Other risk factors include workplace exposures, ionising radiation and air pollution. Older age is a significant risk factor, reflecting DNA damage accumulation over time, and genetic factors may also play a role.1 Indeed, lung cancer in never smokers is now the eighth most common cause of cancer-related death in the UK.18
Lung cancer is strongly linked to socioeconomic status. The incidence of lung cancer is 168% higher for men living in the most deprived areas of the UK compared with those in the least deprived, and 174% higher for women in the most versus least deprived areas.1 Patients with lung cancer living in more socioeconomically deprived circumstances are less likely to receive any type of treatment, surgery, and chemotherapy.9 It is therefore no surprise that while a quarter (25.3%) of people in England diagnosed with lung cancer in the least deprived group survive their disease for five years or more, less than a fifth (18.2%) do in the most deprived.1
What does the national screening programme involve?
It has now been over a year since the Government finally approved a national targeted screening programme, in June 2023. This followed the positive recommendation made by the UK National Screening Committee, and the success of NHS England's Targeted Lung Health Check (TLHC) pilot scheme.10,11 As a result, not only will many lives be saved, but it will also provide a major opportunity to address the health inequalities linked to lung cancer.
Patients with a smoking history aged 55-74 are now being invited for screening. Individuals are identified from GP records and invited to a lung health check by letter, email or text message, sent by the GP practice or Integrated Care Board (depending on local arrangements). The health check will then be conducted in person, by phone, or online, with individuals questioned about their breathing, lifestyle, and family and medical history. Height and weight measurements are also recorded.
Any concerns with a patient's lung health are referred to their GP and current smokers will be offered advice on how to stop smoking. Individuals considered high risk of developing lung cancer (assessed on factors such as: number of smoking years; age; previous malignancies; family history of lung cancer; comorbidities such as COPD and any history of pneumonia; and contact with asbestos) will be immediately referred for a low-dose CT scan and thereafter recalled for repeated scans every two years.
Any patient whose CT shows suspicion of lung cancer will be triaged by the radiology or respiratory clinic for biopsy and other further tests. The National Optimal Lung Cancer Pathway details how patients will be followed up depending on results.
Note that some people may require investigation and follow up of abnormalities that turn out to be benign, including monitoring of pulmonary nodules, which can potentially cause anxiety for these individuals. However, the National Screening Committee evaluation found that overall the benefits of early identification of cancer outweigh any risks in this population.
What has been achieved to date?
Currently, there are 43 active TLHC sites in England. Since April 2019 more than 1.5 million people have been invited for a check and over 3,600 lung cancers in total have been diagnosed – three quarters of them early (stage I or II). Previously, without screening, the rate of early-stage diagnosis was 28.9%.12,13
The TLHC projects were initially rolled out in areas of high deprivation. The latest Rapid Cancer Registration Dataset now shows that people from disadvantaged areas are now most likely to be diagnosed with lung cancer early. In addition, the screening has also led to other cancers being detected.13,14
National Lung Cancer Audit data also recently revealed that the proportion of lung cancer patients diagnosed with stage I/II disease has increased from 30.5% in 2021 to 33.8% in England – and from 24% in 2021 to 30% in Wales. Some of the increase in England can likely be attributed to the impact of the TLHC Programme.2
Are there any other national lung cancer screening programmes in the UK?
The UK Screening Committee advocated a UK-wide targeted screening programme – yet, to date, the roll out is only being implemented in England. There are no equivalent initiatives in Scotland and Northern Ireland, although a pilot lung health check is underway in Wales, which has now screened 500 people.15
More support is required for colleagues in the devolved nations to ensure they implement their own national programmes to save more UK lives.16 However, it will also be critical to monitor and evaluate the actual roll-out in England in terms of its reporting system, turnaround times, workforce, and tailoring screening to consider local population and service needs.
Challenges with uptake
While the rate of uptake by individuals has increased, the variance in uptake of different local TLHCS at last evaluation ranged range from 20%-79%.12 Also, a significant number of individuals book but fail to attend the initial screening interview. The UK Lung Cancer Screening (UKLS) Trial revealed that two main themes emerged among high-risk groups who failed to participate – reflecting both practical (related to age, geography or low socio-economic group) and emotional barriers such as cancer fear and stigma.17
Getting the service model right is key. People can either 'opt out' (where they receive a letter inviting them to attend an appointment at a specific time) – or they can 'opt in' (they receive a letter asking them to contact their local service to make an appointment). Initial data show that the opt out approach tends to be more effective – but the current TLHC Programme data has many caveats. New TLHC projects are advised to try both options to see what works best in their area.12
Case study: The Nottingham TLHC programme has invited over 35,000 people to TLHCs since April 2021. Patients are identified by primary care, but the invitations, follow up and interpretation of investigations is undertaken entirely by the TLHC team. Many primary care centres do not have the resources to actively support a programme and using this approach has seen practices engage with the 'hands off' approach, leading to uptake rates with practices up to 70% in some areas.
The success of this lies in its 'opt out' model and a detailed understanding of the local communities and the flexibility to tailor the service to all relevant groups of people. This has included an invitation approach using both letters and text messages, a mobile CT scanner located in local communities and shopping centres, and targeted communications including local radio advertising, local pharmacy promotion and a dedicated website translated into several different languages.12
What can nurses in the community do to support screening and early detection?
Nurses in the community can play a crucial role in supporting lung cancer screening – and are an important advocate for early detection. Firstly, nurses can help to educate patients about the importance of lung cancer screening, especially for those at higher risk due to smoking. They can also raise awareness about symptoms (such as persistent cough, chest pain, or unexplained weight loss) that might warrant further investigation. Practice nurses can actively promote local lung health checks and address any fears and misconceptions – navigating the patient through the process and provide any emotional and practical support. They can also promote the service among other clinicians and primary healthcare professionals within their own organisations and teams. Lastly, but not least, they can connect patients with local smoking cessation services and encourage quitting – which is crucial to the success of any screening programme.
Dr Daryl Freeman is an associate clinical director in primary care, clinical adviser, respiratory, Norfolk & Waveney ICB and a Director of the UK Lung Cancer Coalition (UKLCC): www.Uklcc.Org.Uk
References
Comments
Post a Comment