Ashley Coffey

Case Presentation: Lung Cancer

Lung cancer is the most deadly type of cancer to suffer from and is the second
highest in incidence both men and women. With many possible factors causing lung
cancer, smoking cigarettes is the first and most common offense. Exposure to
secondhand smoke, radon, diet, and family history all partake in the increased possibility
of lung cancer. Most lung cancer is not detected until is has already spread to other parts
of the body causing metastasis or heavy lung damage; the symptoms include wheezing,
difficult or painful breathing, shortness of breath, persistent cough, and weight loss.
The patient with lung cancer I chose to examine is a 58-year-old white female
who was treated with radiation therapy. She was diagnosed with extensive stage small
cell cancer, which is a very aggressive and incurable form of lung cancer. She presented a
persistent cough, painful breathing, and weight loss; she smoked half a pack of cigarettes
every day for thirty years. After

Mediastinum

a CT scan, a
superhiler/mediastinal mass
measuring 8 by 7.5 cm was
measured in the right upper
lobe of her lung; metastasis was
also found to the pancreas,
liver, kidney, and possibly

breast. They expected her survival to be about seven months if she continued with
chemotherapy and radiation therapy.

Both sides of the lung provide the body with oxygen needed to function. The
lungs are made of a spongy material known as the parenchyma and are made of multiple
lobes. The right lung has three lobes while the left has two due to the heart sitting in the
bottom medial part of that side. The trachea is the airway that travels from the oral cavity
down into the chest and branch into the left and right bronchi, which enter into each lung.
The opening of each lung that allows the bronchi through is called the hilum; the hilum
also allows blood vessels, lymph nodes, and nerves to enter into the lung. The bronchi
continue to branch into much smaller branches known and bronchioles which contain
alveoli, which allow the exchange of air in the lungs. The mediastinum is the middle
region between both lungs. In the mediastina area of the lung sits largely important
structures such as the heart, trachea, and various lymph nodes and major vessels of the
body.
This patient also presented with a very interesting syndrome known as Superior
Vena Cava Syndrome, which is caused by obstruction of the vena cava. It chest. The
mass was large and central enough to
have an effect on the most important
vein in the body, which returns blood
back to the heart. Since it is affecting
the superior vena cava, the blood return
from the upper structures of the body is

SVC Syndrome
purple discoloration of skin.

obstructed and slowed, causing the

The best way to shrink this mass in the mediastinum is the use radiation therapy.
This patient was treated at the James Cancer Center using 30 Gy in ten equal treatments.
Since the disease was already extensive, it was used as a palliative, or symptom relieving,
treatment versus as curative treatment. The treatment fields were anterior and posterior
opposed fields; the goal was to shrink the tumor and to relieved the symptoms of SVC
syndrome as well as the pain involved from the mass.

Coronal View of Tumor

Sources
American lung association. (n.d.). Retrieved from http://www.lung.org/lungdisease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html
Kelley, L. L., & Petersen, C. M. (2007). Thorax. Sectional anatomy for imaging
professionals (2nd ed., ). St. Louis, Mo.: Mosby/Elsevier.
Hackworth, R. Lung Cancer
Tan, W. (2012, December 27). Small cell lung cancer. Retrieved from
http://emedicine.medscape.com/article/280104-overview