Page 175 Guide to Pain Management in Low-Resource Settings

Chapter 21

Lung Cancer with Breathing Problems

Th omas Jehser

Why is important to know about (burning pain). Mr. K. sought consultation with his doc-
pain in lung cancer? tor, who established a successful medication regimen with
a combination of tramadol and carbamazepine. Being
Lung cancer is the most common lung tumor and the able to move a lot better, Mr. K. became more aware of
most common malignant disease. Th e incidence in his dyspnea and exhaustion following relatively short dis-
Europe is estimated by the World Health Organiza- tances of walking. His wife also noticed that he had sig-
tion (WHO) to be 38/100,000 inhabitants (in Africa nifi cant weight loss and a constant cough during the last
9/100,000). It causes about 1.2 million deaths per year couple of months. An X-ray of the thorax showed a prom-
worldwide. Since 1953 it has been the most common inence of the right hilum of the lung. He was sent to Atba-
cause of death by cancer within the male population, ra for further examination. Unfortunately, the CT detect-
and since 1985 within the female population. ed a central tumor of the right bronchial system, which by
bronchoscopy was histologically classifi ed as a non-small-
Case report—part one cell lung cancer. Furthermore, scintigraphic and X-ray ex-
aminations reveal scattered bone metastases, such as in
Mr. Tarik Al-Khater is a 65-year-old man with an ath- the lumbar spine and the right knee.
letic constitution. He used to work as a postman in Bar-
bar, Northern Sudan, and remained active doing fi tness What are the causes and risk
exercises until a year ago. Twenty years ago, he had quit factors for lung cancer?
smoking, having accumulated 10 “pack years” (one “pack
year” means smoking 20 cigarettes per day throughout
Th ere are endogenous factors for the onset of lung can-
one year). Up to 2 years ago, he had never been ill, though
cer (genetic disposition, active HIV infection, pulmo-
he had undergone an appendectomy and osteosynthet-
ic surgery for a tibial fracture. Th en at the age of 63, he nary fi brosis, and scarring following parenchyma injury
received a diagnosis of pulmonary emphysema and dia- or tuberculosis). Exogenous conditions considered as
betes mellitus. Nine months ago, he suff ered a herniated risk factors are smoking in the fi rst place (partly respon-
lumbar disk and underwent surgery because of muscle sible in 90% of lung cancer deaths) as well as exposure
weakness of the right thighs. Furthermore, there remained to dust and particles such as asbestos, chromates, and
a mixed pain syndrome of the lower back, right hip, and polycyclic aromatics or to radiation from uranium, ra-
right knee, with a dominating neuropathic component don, or even medical radiation therapy.

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 163
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
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