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Overview of Pathology:
The pathology is stage 1 non-small cell lung cancer, with my subtype being adenocarcinoma. It is commonly found in smokers, but it is the most common type in non-smokers. Lung carcinoma is the second leading cancer that is not sex-linked. The etiology of this patient's cancer is tobacco exposure being with filtered cigarettes and smoking more than one pack per week. More common in women, smokers, African Americans, and ages 65+ are typically diagnosed with this condition.

Signs and symptoms:
Signs and symptoms for NSCLC include: a cough that doesn’t go away or gets worse over time, coughing up blood, chest pain or discomfort, wheezing, hoarseness, weight loss, fatigue, and swelling in the face and/or veins in the neck. The typical onset is chronic.

Patient specific: cough that doesn’t go away, fatigue, and chest discomfort

Patient/Family perspective:

What do they feel? They feel scared and almost hopeless, as if they have been almost guaranteed death to come. The can become depressed or even in denial. They can mentally and physically feel the cancer overcoming them.

What do they see? Some see no hope, with no light in the tunnel of this terrible disease. They can begin to see/notice people or family to try and spend more quality time with them.

What do they hear? They hear two things, one is their family and friends being supportive and telling them to keep their head up and don’t give up hope. The second is the medical side, we have our oncology team telling the patients the facts and what is truly happening.

What are their fears/concerns? Their fears and concerns can include, how will this effect my life? Can I still do physical activities? Doubt in themselves. They fear not getting the right treatment, they fear the cancer getting worse, and they fear death.

What would family members observe? A family member would observe their own family member on most likely a small decline of sickness and over time see them go from physically fit, to a complete mess. They see their own family members life get flipped upside down.

References:
https://www.yalemedicine.org/conditions/small-cell-lung-cancer

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Sources:

1. https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00875-6#:~:text=Minimally%20invasive%20adenocarcinoma,-Minimally%20invasive%20adenocarcinoma&text=There%20is%20no%20lymphatic%2C%20vascular,after%20surgical%20resection%20%5B12%5D.

2. https://www.youtube.com/watch?v=Cj7Eu9ZddDc&t=433s

3. https://www.dovemed.com/diseases-conditions/minimally-invasive-adenocarcinoma-lung/

4. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq#_544

5. https://www.pathologyoutlines.com/topic/lungtumoradenominimallyinvasive.html

6. https://www.youtube.com/watch?v=ln-

7. SfeGCkOohttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108452/

8. https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00875-6#:~:text=Minimally%20invasive%20adenocarcinoma%20is%20defined,after%20surgical%20resection%20%5B12%5D.

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Types of treatment plan:

Surgery: being one of the most commonly used for treatment. This can be potentially curative.

The surgical options include:

Wedge resection: Wedge resection is a partial removal of the wedge-shape portion of the lung that contains cancerous cells (along with any surrounding healthy tissue)

Segmentectomy: It is the partial removal of the cancerous lung and any surrounding healthy tissue

Pulmonary lobectomy: It is a type of surgical procedure performed to partially remove a portion of a lung

Sleeve lobectomy: It is another surgical procedure to partially remove a portion of the lung and a part of the airway (bronchus)

The next option would be.
Chemotherapy and radiation may also be used for treatment, if surgery is not a viable option.

They can be used as a combination therapy. Combinational therapy increases the effects of both types of treatment. However, the side effects are cumulative.

The complications:

Dyspnea (shortness of breath): If the cancerous tumor expands to block important, large, or small airways of the chest or lung

Hemoptysis (coughing-up blood): Individuals may cough-up blood, due to excessive amounts of blood in the airways

Recurrence following a complete surgical removal of the tumor is extremely rare

There may be complications related to the methods used in treating the condition

Result:

The prognosis of Minimally Invasive Adenocarcinoma of Lung is generally excellent with adequate treatment, which is a complete surgical excision of the tumor. The survival rate in such cases is 100% and no recurrence is generally observed

When the tumor size is over 3 cm, which is very uncommon, the prognosis of the condition is not well-understood or is unclear. However, most tumors are less than 3 cm and report excellent outcomes on early detection and complete tumor excision.
Stages:
Lung cancer may be staged once or twice.

The first staging, which all patients should undergo, is carried out when a patient is initially diagnosed; it should be completed before treatment begins. This type of staging is called clinical staging.

Clinical staging is based on the results of various tests, including imaging tests and biopsies.

The second staging, called pathologic or surgical staging, adds what is learned about the patient's cancer from surgical treatment to the determination of staging.

If the pathologic stage differs from the clinical stage (which it may, for example, if it is evident that the lung cancer has spread more than initially estimated), then the healthcare team can adjust the treatment more precisely.

Source:

https://www.dovemed.com/diseases-conditions/minimally-invasive-adenocarcinoma-lung/
https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/by-stage.html
https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/surgery.html
https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/radiation-therapy.html

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Following surgery, our patient will undergo IMRT treatment (intensity-modulated radiation therapy) in order to kill remaining cancer cells. The radiation oncologist chose IMRT treatments using high energy photons because IMRT is the only option to cover the volume of interest with narrow margins and protect immediately adjacent structures. Only IMRT can produce an acceptable dose distribution while sparing the esophagus, spinal cord, ribs, heart, and healthy lung.

Typical energy: 6x

Dose: 6000-6600 cGy

Fractionation scheme: 180 cGy x 35 fx = 6300 cGy

Treatment field for tumor involvement of the upper lobes:

Treatment field includes the primary tumor, both hilar areas, superior mediastinum, and both supraclavicular areas.

Common Side Effects:

Acute Side Effects

Erythema

Superficial reddening of the skin

@1200-2000 cGy

Don’t rub the affected skin, wash skin gently wish soap and water and then pat dry, use unscented products, utilize products like aquaphor or cetaphil cream (if approved by doctor or nurse)

Esophagitis

Inflammation of the esophagus

@6000 cGy

Try to avoid bending over and lying down after eating, stay away from foods that increase reflux, elevate your head (at least 6 inches) while sleeping, eat in small amounts

Dysphagia

Difficulty swallowing

@3000 cGy

Drink lots of water while undergoing treatment, eat foods that are easy to swallow, eat small amounts rather than large meals, utilize high calorie drinks to boost daily calorie intake, eat slowly

Chronic Side Effects

Dry cough

A cough that doesn’t produce mucus

@2500 cGy

Sleep with a humidifier if your house is dry, use cough drops, drink warm liquids

Lung fibrosis

Disease that causes lung scarring, often making it more difficult to breathe

@4500 cGy

Go to oxygen therapy and/or pulmonary rehabilitation, live a healthy lifestyle, take medication to slow the progression

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933280/

https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/treatment/types-of-treatment/radiation-therapy

https://www.uclahealth.org/medical-services/cancer-services/lung-cancer/diagnosis-treatment/radiation-therapy

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Future Patient: Luther King (67 year old) (Male)

The biggest risk factor for this type of cancer is smoking. However, it is also the most common type of lung cancer non-smokers develop.

Treatment aims to cure, or completely eliminate, lung cancer in people with stages I, II, or III.

The goal of treatment with stage IV is to prolong a person’s life.

Stage IV cancer cannot usually be cured.

I was diagnosed with stage 1 Lung Carcinoma (adenocarcinoma). It falls under the umbrella of non-small cell lung cancer (NSCLC). Finding out that I had stage 1 lung carcinoma, felt very distressing and overwhelming. I felt  shocked, scared, sad, and even angry. I also felt uncertain about what the future held and anxious about the treatment options that were available. It was a significant diagnosis that brought me  a range of emotions and concerns. Finding out I had cancer all started when I was working on my car and I began to feel fatigued and out of breath from light work. My wife also began to notice I began to loose weight recently before that. I was a cigarette smoker for 20 years but I had stopped 16 years ago. I did have a cough for years and it was getting worse but I never really payed much attention to it. Since that day my wife insisted I go to the doctor, and that's when I had some imaging done and found out I had Cancer. Since I did have stage I (NSCLC), I was able to undergo surgery so they removed the mass.This was done by taking out a smaller piece of the lung (wedge resection). Wedge resection surgery removes the cancerous tumor, as well as a wedge-shaped section of the lung around the tumor. They also removed at least some lymph nodes in the lung and in the space between the lungs to be checked for cancer as well. The doctor gave me a choice to recover at the hospital or at home from my surgery and I chose at home with my loved ones. The doctor told me when I got discharged after my surgery, I would probably be weaker than normal and feel tired and fatigued, which is normal. In time, especially after following my doctor’s instructions, I regained my strength and begin to feel better again. My doctor gave me instructions to move around and get up and walk at least a few times per day – even if I was tired. There were many reasons to keep moving, including blood clot prevention and just keeping my lungs working. Of course I had my physical limitations, they also prescribed me my medications, how to take care of my wound, and what symptoms to watch out for that weren't normal. My wife was an angel and helped me dearly with my post surgery instructions. Since I did have stage 1 lung cancer, my doctor said that I do have a higher risk of the cancer coming back (based on its size, location, and other factors). Although my surgery may have removed all of the tumor that can be seen, microscopic cancer cells may still be left behind and may grow. Eight weeks after my surgery my doctor cleared me ready for radiation and I underwent IMRT treatment (intensity-modulated radiation therapy) in order to kill the remaining cancer cells that may not have been removed by surgery. It aims to destroy cancer cells that were not removed with surgery by stopping or slowing their growth, either by killing them or preventing them from making new cells. I did experience some acute side effects like erythema (redness of the skin), esophagitis (inflammation of the esophagus), and fatigue from the Radiation Therapy. I also experienced some chronic side effects like a bad dry cough, and lung fibrosis (lung scarring) from the radiation. These are common side effects with the IMRT treatment (intensity-modulated radiation therapy). Usually after radiation therapy these side affects resolve on their own although sometimes they may not go away completely. After getting radiation treatment for my lung cancer and having the tumor removed, my doctor recommend regular follow-up appointments and imaging tests, such as CT scans or PET scans, to monitor for any signs of cancer recurrence. In addition, my doctor also  recommend lifestyle changes to reduce my risk of developing my old cancer, or another cancer, and to improve my overall health. These include quitting smoking completely, exercising regularly, and eating a healthy diet.  I am just overjoyed to be cancer free after my battle with lung cancer (adenocarcinoma). It was a challenging experience that required me to summon all my strength and courage, but I never gave up hope. The support of my loved ones and medical team was invaluable, and I am grateful for every moment of life that I can now enjoy to the fullest. This experience has taught me to cherish every moment, take care of my health, and be grateful for every day.

Source:
https://my.clevelandclinic.org/health/articles/10257-chemotherapy-side-effects
https://www.medicalnewstoday.com/articles/non-small-cell-lung-cancer?utm_source=google&utm_medium=cpc&utm_cmpid=16989899715&utm_adgid=134505240703&utm_adid=594115241491&utm_network=g&utm_device=c&utm_keyword=&utm_adpos=&utm_gclid=CjwKCAiAmJGgBhAZEiwA1JZolimQcX1XuelUqvl9KC4EXuqNg6x1XseGXcG_CJBqqF591zCCsv-5thoCIpgQAvD_BwE&gclid=CjwKCAiAmJGgBhAZEiwA1JZolimQcX1XuelUqvl9KC4EXuqNg6x1XseGXcG_CJBqqF591zCCsv-5thoCIpgQAvD_BwE#causes
https://www.radiologyinfo.org/en/info/imrt
https://my.clevelandclinic.org/health/treatments/21868-lung-resection
https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/radiation-therapy.html