Complications
Pneumonia is common in lung cancer patients and is often caused by a large, central, obstructing tumour. Patients may not present with classic symptoms of pneumonia such as fever, dyspnoea, and productive cough. Chest x-ray findings can sometimes be difficult to interpret secondary to tumour-related changes (atelectasis).
Antibiotics should be initiated. Relieving the obstruction is essential, and multiple modalities can be used such as external beam radiotherapy, brachytherapy (temporary insertion of a radioactive source at the site of obstruction), stent placement, laser debulking of obstructing tumour, photodynamic therapy, and/or surgical resection. Photodynamic therapy is a minimally invasive modality that involves the interaction of light, a photosensitising agent, and oxygen. Briefly, the photosensitising agent is administered intravenously and is absorbed by cells throughout the body. Via a flexible bronchoscope, a laser beam at a predetermined wavelength is focused on the endobronchial tumour. The photosensitising agent absorbs photons of the appropriate wavelength, creating reactive oxygen species that are toxic to cancer cells.
Treatment should be instituted relatively quickly for patients with severe pulmonary compromise.
Most patients develop some degree of lung fibrosis after radiotherapy, but this is usually asymptomatic unless pretreatment lung function was poor, in which case dyspnoea can be a major problem. Rare complications include oesophageal stricture and bronchial stenosis, which are more common when higher doses of radiation are used.[78][284][285]
The most common cause of SVCS is lung cancer. Bulky mediastinal adenopathy or medial extension of a right upper lobe tumour can compress the superior vena cava (SVC), impeding the return of blood from the face and arms to the heart. Numerous collateral pathways develop when the SVC is compressed. The acuity and severity of symptoms depend on the speed of obstruction. The syndrome is characterised by facial and upper extremity oedema, dyspnoea, cough, and orthopnoea. Physical examination demonstrates facial plethora and distended neck, chest wall, and occasionally abdominal wall veins.[4]
SVCS is rarely a medical emergency and every effort should be made to obtain a diagnosis before initiating therapy. Supplemental oxygen and head elevation are often helpful. Treatment depends on the clinical scenario and stage of disease. Most patients will improve with radiotherapy and/or chemotherapy, but the response may take several days. Patients with marked symptoms should have treatment initiated relatively quickly. Endovascular stents may be effective with more rapid symptomatic relief. Surgical intervention is rarely required.[4]
Treatment of the underlying tumour often alleviates symptoms from paraneoplastic syndromes. Other supportive measures depend on the underlying syndrome.
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