Pathophysiology
- Non-Small Cell Lung Cancer (NSCLC, ~85%): Includes squamous cell carcinoma (bronchial lining), adenocarcinoma (mucus glands), and large-cell carcinoma
- Small Cell Lung Cancer (SCLC, ~15%): "Oat cell" carcinoma. Fast-growing, highly malignant. Almost exclusively associated with smoking. Typically metastasized at diagnosis
- Rich blood and lymph vessel supply allows early metastasis to lymph nodes, liver, bone, and brain
- Paraneoplastic syndromes: Lung tumors (especially SCLC) can secrete hormones causing Cushing syndrome, hypercalcemia, or SIADH
- Pancoast tumor: Tumor at lung apex pressing on brachial plexus, mimicking TOS symptoms
- Phrenic nerve involvement can paralyze the diaphragm
Signs and Symptoms
Hallmark Indicators
- Persistent smoker's cough or chronic cough that changes over time
- Hemoptysis: Blood-stained sputum or coughing up blood
- Dyspnea and audible wheezing
- Chronic chest pain. May refer to back, shoulder, or abdomen
- Chronic hoarseness or dysphagia
- Clubbing and cyanosis: Indicators of chronic hypoxia
- Virchow's node: Enlarged left supraclavicular node — classic sign of malignant spread
- Bone pain, confusion, or balance problems (indicates skeletal or brain metastasis)
Red Flags and Rule-Outs
- Hemoptysis: Blood-stained sputum — key red flag for lung cancer. Immediate referral
- Virchow's node (left supraclavicular): Classic sign of malignant spread
- New headaches, seizures, or confusion in a lung cancer patient: Possible brain metastasis — emergency referral
- Symptoms mimicking TOS: May indicate Pancoast tumor pressing on brachial plexus
- Clubbing and cyanosis: Indicate chronic hypoxia from impaired gas exchange
- Active cancer = DVT risk factor: Screen before compressive lower extremity work (Wells criteria)
MT Considerations
- Palliative role: Massage reduces pain, anxiety, fatigue, depression, and improves sleep and appetite
- Vital organ assessment: Evaluate lung, heart, and liver involvement to determine if client can safely adapt to circulatory changes from massage
- Avoid: Direct pressure on known tumor sites, undiagnosed lesions, medical equipment (ports, catheters)
- Bone fragility: Lung cancer is highly likely to metastasize to skeleton. Conservative pressure
- Positioning: For respiratory distress, use semi-supine, side-lying, or seated positions. Avoid prone/supine
- Radiation precaution: Never blur ink markings. Avoid lubricants over radiation field unless cleared (see radiation-therapy)
- DVT risk: Active cancer is a high-risk DVT factor
- Emergency trigger: New persistent headache, seizures, or confusion — report immediately (possible brain metastasis)
CMTO Exam Relevance
- Leading cause of cancer death for both sexes. Smoking causes 85-90%
- Hemoptysis is a key red flag. Clubbing and cyanosis indicate chronic hypoxia
- Virchow's node (left supraclavicular) is a classic sign of malignant spread
- SCLC has almost always metastasized by diagnosis, often to the brain
- Symptoms mimicking TOS may indicate Pancoast tumor
- Active cancer = high DVT risk (Wells criteria)
Key Takeaways
- Lung cancer is the leading cause of cancer death. Smoking causes 85-90% of cases
- SCLC ("oat cell") is so aggressive it has almost always metastasized by diagnosis, often to the brain
- Hemoptysis, clubbing, cyanosis, and Virchow's node are key clinical red flags
- Position clients with respiratory distress in semi-supine, side-lying, or seated — not prone/supine
- DVT screening is critical because active cancer is a high-risk factor for thrombosis