Cancer Survivorship: Small-Cell Carcinoma

1 Health Challenges: Cancer Survivorship Introduction Small-cell carcinoma is an aggressive and extremely malignant lung cancer and is also known as oat cell cancer. Roughly 10% to 15% of lung cancers are of the small cell carcinoma type (Fletcher, 2013). It grows and metastasizes faster than several other forms of cancer, therefore is often only diagnosed in its more advanced stages when it has already affected other parts of the body. Unless discovered in its early stages small cell carcinoma usually has a low survival rate. This paper provides an analysis of the case study of Richard, a 59-year-old man who has small cell carcinoma. It describes the illness, its symptoms, treatment and side effects, and also describes how Richard may manage it.

The Nature of Small Cell Carcinoma The main risk factors of small-cell carcinoma are smoking, exposure to secondhand smoke, a genetic disposition to lung cancer, air pollution and continuous exposure to air pollution. The chances of developing small-cell carcinoma increase when heavy cigarette or pipe smoking is combined with other factors. Additionally, the longer the period of cigarette smoking, the higher the risk of contracting lung cancer becomes. Old age also increases the risk of developing cancer. In Richard's case, he has been at risk of developing lung cancer because he is 59 years old and has been smoking twenty cigarettes a day for the last forty years. He is, therefore, a long term heavy smoker.

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The symptoms he presented were typical of small-cell carcinoma, these are; severe weight loss in less than a month, breathlessness, fatigue and coughing up blood. Other indicators of his heavy smoking were his nicotine-stained fingers and a lack of lymphadenopathy. A chest x-ray showed a right-sided mass, which led to suspicion of lung cancer. Small-cell carcinoma was diagnosed following a bronchoscopy where a biopsy was conducted on the lesion. Being a highly malignant cancer, it is also common for other body parts to be affected, therefore tests are done to find out which organs it has spread to. In Richard’s case, a CT scan revealed that the small-cell carcinoma had metastasized to his liver.

The severity of his symptoms and the level of metastasis indicated that Richard’s cancer was discovered at a very advanced stage.

Treatment There are four treatment options for small-cell carcinoma, these are; chemotherapy, surgery, radiation therapy, and laser therapy. Richard’s treatment plan involved four cycles of chemotherapy, which required in-patient treatment every three weeks. This was done to inhibit the growth of cancer cells. In addition to the chemotherapy, radiation treatment is recommended for parts of the body where the cancer has metastasized. Small-cell carcinoma often spreads to the brain, therefore, radiation therapy to the brain is recommended for patients who respond positively to treatment to prevent the spread (Hendrick, Baker, & Helvie, 2019). The treatment helped to clear Richard's chest lesion, however, the fatigue persisted to the extent that he could no longer resume his labour-intensive construction job.

The goal of Richard’s cancer treatment should not only be to prolong his life by eliminating the cancer cells, but also to improve his quality of life.

3 Side Effects Chemotherapy aims to kill cancer cells and is, therefore, a very aggressive and invasive form of treatment, which leads to various side effects. Throughout chemotherapy, Richard had very low energy and was extremely fatigued. Other side effects that he may have experienced include diarrhoea, hair loss, vomiting, nerve damage and loss of appetite.

It affects the tissues of the lung by entering the submucosa and results in the narrowing of the bronchial airways. It presents itself in a variety of ways, the most common being weight loss, coughing, shortness of breath, and severe chest pain. Due to the severity of the cancer, the patient’s health may continue to deteriorate despite the current treatment.

Living with Small Cell Carcinoma Cancer patients, especially for those whom the illness is diagnosed at an advanced stage, often experience severe physical and mental challenges. The patient will have to cope with extensive treatment that often causes them to lose some of their body functions and to develop other new illnesses. Discovering that one has a terminal illness causes grief and anxiety; as a result, during treatment and even afterwards, cancer patients need oncological as well as psychological support (Tanoue, & Detterbeck, 2018). The patient needs to receive full and clear information about their condition, their treatment options and the side effects of each. Cancer is a grave illness that causes major physical and lifestyle changes, therefore for many patients and their families, a cancer diagnosis may cause anxiety and depression. It is important to seek healthy ways of expressing their emotions, such as journaling, music, inspirational books and seeing a therapist (Mettler, 2014). The patient should also ensure that they take care of themselves physically by eating a healthy diet, and mentally by engaging in activities that they enjoy.

4 Seven months after the chemotherapy treatment, Richard developed hydropneumothorax, which is a complicated pneumonia caused by the presence of both air and fluid in the lungs. His chest was drained, and this helped to alleviate his symptoms.

However, four weeks later, Richard was rushed to the emergency unit by his partner due to headache and weakness on the left side of his body. These were symptoms of the spread of cancer to the brain. Dexamethasone helped to reduce his weakness and cranial radiotherapy recommended for the brain tumour.

The Effect of Small-Cell Carcinoma on Richard’s Life Richard's small cell carcinoma is advanced, thus, before the commencement of chemotherapy, he is likely to have experienced pain when breathing, and in the upper part of the abdomen due to the liver metastasis. When treatment began, he is likely to have experienced several other side effects besides fatigue, such as nausea and vomiting. When the cancer spreads to the brain, the symptoms he may have experienced are headache, weakness, and blurry vision.

Having cancer is physically, emotionally and financially draining, not only for the patients but also family and friends of the victim (Q. Ashton Acton, 2012). Soon after Richard began chemotherapy, he had to stop working because he was too fatigued to carry out his usual activities. Being in business, this means that he does not have a source of income, therefore might have to rely on his savings or his partner’s income to cater for his treatment and other necessities. His main sources of support are most likely his partner and daughter.

Management of Activities His house has level access at the front making entry and exit easy. However, as his condition reduces his mobility, there may be need to build a ramp to make it easy for him to

5 access the lower level of the house via a wheelchair. Richard should continue engaging in activities he enjoys, for instance, the water views and garden provide pleasant scenery that facilitates his rest and relaxation. Moderate exercise and non-intensive yoga are also good for his health.

Reflections Richard’s small-cell carcinoma was discovered at an advanced stage; his lymph nodes were affected and the cancer had spread to his liver. Less than a year later, the cancer had metastasized to his brain; the comorbidity is likely to worsen his illness since now he has to undergo treatment for his liver, lung and brain concurrently. Additionally, Richard was diagnosed late and is old therefore might not respond to treatment effectively. This indicates that despite treatment, his life expectancy following diagnosis might be short. Due to the severity of his illness and its metastases to other parts of his body, Richard treatment will continue to increase in complexity and he faces an uncertain future. This causes distress to himself and his family.

Richard’s quality of life has deteriorated greatly due to the loss of his health, loss of career and income and the uncertainty that surrounds his illness. The advanced small-cell carcinoma affects Richard’s ability to perform his usual daily activities so much that he cannot exercise beyond 30 meters. He will need a lot of assistance from his partner and daughter, and if possible also require hired help to assist in caregiving activities. Despite the graveness of his illness, his quality of life can be improved through activities that help him to relax such as basking in the garden and watching the water views.

Cancer affects both the patient, family and caregivers (Siegel, Miller, & Jemal, 2019).

In Richard's case, his family might need to assist financially since he now lacks the capacity

6 to work. Additionally, as the patient's health continues to deteriorate, he will need around-theclock assistance, which will affect the family's finances because they might either not be able to perform their businesses, as usual, to care for him, thus reducing their ability to earn, or they might have to hire a caregiver, which also reduces the income they earn. Thus, it might lead to financial instability.

Cancer treatment should aim at lengthening a patient's life as well as providing a satisfactory quality of life. It is often a gruelling illness, therefore it is essential to ensure that the patient has adequate physical, emotional and mental support. When treatment fails and the prognosis seems poor, the patient should be provided quality hospice care.

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References Fletcher, C. (2013). Diagnostic histopathology of tumors. Philadelphia (Pa): Saunders/Elsevier.

Hendrick, R. E., Baker, J. A., & Helvie, M. A. (2019). Breast cancer deaths averted over 3 decades. Cancer.

Mettler, F. (2014). Essentials of radiology. Philadelphia: Elsevier/Saunders.

Q. Ashton Acton, P. (2012). Small Cell Carcinoma: New Insights for the Healthcare Professional: 2012 Edition. ScholarlyEditions.

Siegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019. CA: a cancer journal for clinicians, 69(1), 7-34.

Tanoue, L., & Detterbeck, F. (2018). Lung Cancer. Philadelphia: Elsevier.