Cancer — Respiratory System — Precision Clinical Education

Pathophysiology

Lung cancer — NSCLC (~85%): Squamous cell carcinoma, adenocarcinoma, large-cell carcinoma
Lung cancer — SCLC (~15%): "Oat cell" carcinoma. Fast-growing. Almost always metastasized at diagnosis
Laryngeal cancer: Primarily squamous cell carcinoma of the glottis (vocal cords). Can affect supraglottis or subglottis
Paraneoplastic syndromes: Lung cancers produce hormonally active products causing hypercalcemia, Cushing syndrome, or SIADH
Metastatic pathways: Lungs to liver, bones, and brain. Cervical lymph nodes are sentinel nodes for head/neck cancers
Phrenic nerve involvement can paralyze the diaphragm
Superior Vena Cava Syndrome: Tumor pressure on SVC causes facial/neck swelling and dilated veins

Lung: Persistent smoker's cough. Hemoptysis (coughing up blood). Chest pain. Wheezing. Dyspnea
Laryngeal: Persistent hoarseness. Feeling of something "stuck" in the throat. Pain swallowing
Cough or hoarseness lasting >2-3 weeks
SVC Syndrome: Facial/neck swelling and dilated veins from tumor pressure
Pancoast tumor symptoms: Mimics TOS — upper extremity pain, weakness, Horner syndrome
Unexplained weight loss, drenching night sweats, persistent low-grade fever

Persistent hoarseness or cough >2-3 weeks: Standard referral trigger to rule out malignancy
SVC Syndrome (facial swelling, dilated veins): Indicates tumor pressure on major vessels
Symptoms mimicking TOS: May indicate Pancoast tumor pressing on brachial plexus
Hemoptysis: Blood-stained sputum — key red flag
Cervical lymph nodes (sentinel nodes for head/neck cancers): Fixed, firm, nontender = malignancy concern
Stoma presence: Indicates previous laryngectomy — accommodate positioning and communication

Goal: Palliative support to reduce pain, anxiety, nausea, fatigue, and depression
Local contraindications: Active tumor sites, recent radiation areas, undiagnosed lumps
Medical equipment: Accommodate stomas, catheters, and ports. Stomas are vulnerable to disruption and contamination
Bone fragility: If cancer has metastasized to bones, use very conservative pressure
Respiratory compromise: Advanced tumors pressing on phrenic nerve can paralyze diaphragm. Clients may not tolerate lying flat
Positioning: Semi-supine, side-lying, or seated for respiratory comfort
Analgesic masking: Patients on narcotic analgesics may have reduced pain sensitivity
Lymphedema: Cervical or axillary node removal creates fluid accumulation risk in arm or neck
Treatment side effects: See chemotherapy and radiation-therapy

Persistent hoarseness or cough >2-3 weeks is a standard referral trigger
SVC Syndrome (facial swelling, dilated veins) indicates tumor pressure on major vessels
NSCLC vs. SCLC: SCLC has almost always metastasized by diagnosis
Cervical lymph nodes are sentinel nodes for head/neck cancers
Symptoms mimicking TOS may indicate Pancoast tumor

Lung cancer is the leading cause of cancer death worldwide. Smoking causes 85-90% of cases
SCLC has almost always metastasized by diagnosis, often to the brain
Persistent hoarseness or cough >2-3 weeks requires medical referral
SVC Syndrome and symptoms mimicking TOS are important red flags for respiratory malignancy
Accommodate stomas, position for respiratory comfort, and monitor for bone fragility