Page 177 Guide to Pain Management in Low-Resource Settings

Lung Cancer with Breathing Problems 165

Case report—part three and blood vessels. Th e degree of ventilatory restriction
depends on the magnitude of resection. Surgical treat-
Mr. K. has been ill with lung cancer for 7 months now. ment needs to be conducted in a specialized clinical de-
Four weeks ago, he lost his appetite, and he feels sick partment. Postoperative rehabilitation is possible in the
quite often. He has lost weight continuously (about 30% outpatient setting and must not be disregarded. Palliative
of his initial body weight within one and a half years). surgery is done to remove metastases of extrathoracic
Although carbamazepine has been stopped, the blood tumors or local relapse as well as for draining of second-
tests show high values for liver transaminases, accompa- ary infection such as empyema. Endoscopic or vascular
nied by upper abdominal pain. A physical examination interventions help with the reopening of airways and
reveals an upper abdominal mass, and ultrasonography vessels by stenting or by laser or cryoextraction.
detects multiple metastases in the liver and also in both Radiotherapy alone cannot be used with a cu-
adrenal glands. rative intention. In combination with chemotherapy, it

The oncologist recommends chemotherapy, may reduce the size of the tumor (downstaging), which
which would have to be conducted in the regional hos- might open the route to successful surgery (neoadjuvant
pital. Mr. K. is reluctant to return to the hospital in strategy) and to an extension of survival time. Palliative
Atbara, the capital, and asks his friends and relatives radiotherapy intends to reduce the activity of metasta-
for information on traditional treatment options they ses, which may result in reduction of pain (bones, liver,
might have heard of. CNS, and pleura), blood congestion (superior vena cava
syndrome caused by lymph node metastases of the me-
What are the treatment options diastinum), or neurological disorders (CNS).
in advanced lung cancer? Systemic pharmacological therapies (chemo-
therapeutic, antihormone therapy, and others) work
Treatment options include: in a palliative way to reduce the bulk mass or the tu-
• Surgical therapy (curative or palliative) mor growth rate, allowing prolongation of survival.
• Radiotherapy (neoadjuvant, palliative, or symptom- Th eir application usually weakens the general condi-
targeted) tion of the patient. It is therefore necessary to consid-
• Chemotherapy and other pharmacological therapy er the quality of life of individual patients from their
(palliative) personal perspective.
• Naturopathy (palliative)
• Palliative care (adjuvant) Are there therapeutic alternatives
Of course, the very best therapy would be the
prevention of risk factors, but primary prevention pro- to surgery, chemotherapy,
cedures are not established. Diagnostic evaluation at the and radiotherapy?
earliest time is crucial for the course of the illness.
Alternative (or complimentary) treatment strategies are
Curative surgery needs the diagnosis of a low
based on traditional and empirical concepts. Th ey may
stage of disease (0–IIIa) in order to make eradication of
be looked at as palliative and should not replace sci-
the tumor possible by resection. Potential techniques
entifi c medical eff orts. Using a palliative perspective,
include lobe resection, (pleuro-) pneumonectomy, or
these strategies may very well be of great meaning and
bronchial reconstruction. Additional options are dissec-
eff ectiveness within the individual disease trajectory. It
tions of lymph nodes and reconstruction of pericardium

Box 3. Common general disorders in lung cancer patients
Neurological: Limb palsy, hemiparesis, paraparesis, pain, delirium, epileptic seizures
Metabolic: Diabetes mellitus, SIADH (syndrome of inappropriate antidiuretic hormone
hypersecretion), anemia, thrombocytosis, thrombopenia, hypercalcemia
Cardiovascular: Hypotension, thrombosis, superior (or inferior) vena cava congestion
Gastrointestinal: Nausea, vomiting, bowel obstruction, liver failure