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The patient in this case study was one of three brothers diagnosed with lung cancer in the
left lung. This patient was a 56-year-old male of Russian descent and was referred to a regional
hospital for further workup for diagnosis and medical management. The patient presented with a
productive cough associated with occasionally bloody sputum. There were no significant
comorbidities or significant past medical history, as well as no significant social history or
occupational exposure hazards.
Lung cancer's pathophysiology is complex, influenced by both genetic and environmental
factors. Smoking is a major contributor to most types of lung cancer, causing DNA
misreplication and mutation. However, exposure to harmful environmental toxins like radon,
asbestos, and viral infections can also lead to lung cancer. In this case study, the patient was
diagnosed with squamous cell carcinoma via biopsy, a non-small cell carcinoma squamous cell
carcinoma is the second most prevalent form of lung cancer, following adenocarcinoma. It
comprises 82% of all lung cancer cases. and is strongly associated with smoking (Cancer Facts &
Figures 2022). According to the world health organization (WHO) there are four primary types
of carcinoma: papillary, clear cell, small cell, and basaloid. Squamous cell carcinoma starts in
epithelial cells that line the bronchi to the terminal alveoli and often presents as a mass near the
hilum or perihilar region. (Nicholson et al., 2022). In 2022, an estimated 236,740 new cases of
lung cancer were diagnosed in the US, with 130,180 individuals projected to die from the disease
(American Cancer Society 2022).
Lung cancer is a complex disease that is heavily influenced by genetics. It has a distinct
genetic pattern that can also be associated with various hereditary syndromes such as Lynch,
Louis-Bar, and Li-Fraumeni. Those possessing these specific mutations can be identified as
germinal with somatic alterations, as seen in Li-Fraumeni syndrome where TP53 and EGFR
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mutations are combined. Additionally, several other mutations, including BRAF, KRAS, PDL-1,
and ROS1 expression, have also been discovered in lung cancer (Nicholson et al., 2022). In the
case of this individual and their brothers, their family's history with lung cancer raised concerns
about potential genetic correlations. As both siblings had already been diagnosed with the same
disease, they were referred to a geneticist for further testing and counseling. Despite testing
several genes, there was no indication of genetic correlation for their similar diagnoses. This
highlights the complexity of lung cancer and the need for thorough genetic testing and
counseling to better understand the disease and its possible hereditary factors (Zhao 2023).
To diagnose squamous cell carcinoma, a CT scan is usually performed. The CT scan can
show various findings such as ground-glass opacities, rounded masses, local nodal involvement,
or intraluminal obstruction. In this case, a CT scan was used to diagnose a 7-cm lesion in the left
lower lobe. A preoperative endoscopic biopsy was also performed, which confirmed the presence
of squamous cell carcinoma.
The medical recommendations for treating squamous cell cancer include the use of
immunotherapy and tyrosine kinase inhibitors, taking into account any specific gene mutations
(Zhu 2023). Surgery is typically the most effective treatment for lung cancer, with options like
pulmonary lobectomy, pneumonectomy, or lung resection. In this particular case, the patient
underwent a left-sided pneumonectomy as well as four rounds of neoadjuvant chemotherapy
with etoposide and cisplatin. The specific dosing for etoposide involved intravenous
administration of 35mg/day for 5 days, with up to 50mg/day every 3 to 4 weeks. Cisplatin was
administered at a dose of 100mg/day on day 1 every 4 weeks, in combination with etoposide
(Kaprin, 2022).
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It is of importance to take note of the fact that lung cancer makes up 11.6% of all
malignant tumors worldwide, a statistic that warrants serious attention. What is even more
worrisome is that the 1-year mortality rate for this disease stands at an alarming 48.4%. Recent
studies conducted by the International Cancer Consortium in 2021 have revealed a 1.5-fold
increase in lung cancer among first-degree relatives, underscoring the crucial importance of early
screenings and preventative measures (Sung 2021). These findings highlight the need for
heightened awareness and proactive efforts to reduce lung cancer incidence and mortality rates.
While various treatments are available for lung cancer, chemotherapy is often a primary course
of action. However, this treatment method carries potential risks, including neurotoxicity,
nephrotoxicity, and peripheral neuropathies, mainly when using platinum-based compounds.
Moreover, other chemotherapy agents can cause side effects such as hair loss, loss of appetite,
nausea, vomiting, diarrhea, or constipation. It's important to consider all of these factors when
making decisions regarding treatment options.
When it comes to providing care for patients undergoing treatment for lung cancer, it is
crucial to consider the comprehensive range of factors that can impact their well-being. This
includes not only the intensity and duration of therapy but also how it affects their quality of life.
To ensure that patients receive the best possible care, it is essential to adopt a multidisciplinary
approach that incorporates palliative care from the outset of diagnosis through the entirety of the
treatment and recovery process. This can involve consulting with a qualified dietitian to manage
gastrointestinal issues stemming from long-term chemotherapy administration. Additionally, it
can be beneficial to provide spiritual guidance and resources to help patients navigate their
cancer journey in a way that is consistent with their personal beliefs. In this regard, I would
highly recommend the National Cancer Institute's Spirituality in Cancer Care PDQ as an
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invaluable resource for patients and their families seeking information on religious and spiritual
coping strategies in the context of cancer care (National Cancer Institute 2023).
References
Cancer facts & figures 2022. American Cancer Society. (2022.).
https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-
facts-figures-2022.html
Kaprin, A., Pikin, O., Ryabov, A., Aleksandrov, O., Toneev, E., Lubchenko, L., & Zelenova, E.
(2022). Case report: A rare case of familial lung cancer requiring pneumonectomy in three
male siblings. Frontiers in Oncology, 12. https://doi.org/10.3389/fonc.2022.947210
Nicholson, A. G., Tsao, M. S., Beasley, M. B., Borczuk, A. C., Brambilla, E., Cooper, W. A.,
Dacic, S., Jain, D., Kerr, K. M., Lantuejoul, S., Noguchi, M., Papotti, M., Rekhtman, N.,
Scagliotti, G., van Schil, P., Sholl, L., Yatabe, Y., Yoshida, A., & Travis, W. D. (2022).
The 2021 who classification of lung tumors: Impact of advances since 2015. Journal of
Thoracic Oncology, 17(3), 362–387. https://doi.org/10.1016/j.jtho.2021.11.003
Spirituality in cancer care. National Cancer Institute. (2023.). https://www.cancer.gov/about-
cancer/coping/day-to-day/faith-and-spirituality/spirituality-pdq
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F.
(2021). Global cancer statistics 2020: Globocan estimates of incidence and mortality
worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3),
209–249. https://doi.org/10.3322/caac.21660
Zhao, T., Shao, J., Liu, J., Wang, Y., Chen, J., He, S., & Wang, G. (2023). Glycolytic Genes
Predict Immune Status and Prognosis Non-Small-Cell Lung Cancer Patients with
Radiotherapy and Chemotherapy.IBioMed Research International, 1–24.
https://doi.org/10.1155/2023/4019091
Zhu, Y., Lin, Z., & Wu, C. (2023). Apatinib plus Radiotherapy on the Expression of CEA and
VEGF in Advanced Oligometastatic Non-Small-Cell Lung Cancer.IEvidence-Based
Complementary & Alternative Medicine (ECAM), 1–6.
https://doi.org/10.1155/2023/4242346
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