Managing pain due to lung cancer

What is lung cancer?

Lung cancer starts in the tissues of the lungs, usually in the cells that line the air passages. It’s diagnosed by looking at some of these cells under a microscope. There are two main types of lung cancer: small cell and non-small cell. Eighty percent of people with lung cancer have the “non-small cell” type; the other 20% of people with lung cancer have the “small cell” kind: It grows more quickly and spreads throughout the body.

What are the symptoms of lung cancer?

Lung cancer doesn’t usually cause symptoms at first. As the cancer grows, though, the most common symptoms are coughing, shortness of breath, a hoarse voice, coughing up blood, frequent lung infections, tiredness, and unexplained weight loss.

Treatments for lung cancer

The treatment for lung cancer depends on which type of cancer it is, and how advanced it has become. Surgery (if possible) is the main way to treat non-small cell cancer; sometimes chemotherapy and radiation therapy are also used. For small cell cancer – and non-small cell cancer that’s farther along — chemotherapy is used, sometimes with radiation therapy.

Surgery
Before surgery, the surgeon gets a sample of the lung cancer cells to help figure out the cancer’s stage (how far along it is), and the actual type of cancer. Next, the surgeon checks to see if cancer has spread to any lymph nodes. Surgery is then done to remove some, or all, of the lung that has the tumor, along with lymph nodes in the area.

Chemotherapy
Chemotherapy uses strong drugs to kill cancer cells that may be left in the body after surgery. This type of treatment tackles all stages of small cell lung cancer, and works with many cases of advanced non-small cell cancer.

Radiation
Radiation uses high-energy rays to kill cancer cells. It can be aimed right at a tumor, sparing most of the normal tissue that’s nearby. Radiation is the best treatment option for lung cancer tumors that can’t be removed by surgery, and for cancer that has spread within the chest to the lymph nodes or nearby places. It’s often used along with chemotherapy to treat small cell lung cancer.

Targeted therapy
Targeted therapy uses drugs or other substances to go after the types of cells that help cancer grow and spread. Targeted therapy doesn’t hurt normal cells. It’s sometimes used for non-small cell cancer that has spread beyond the lungs.

Lung cancer pain

Managing pain from lung cancer

Lung cancer doesn’t cause pain for everyone who has it, but it’s possible for pain to happen at different stages of the disease. A tumor that grows in the top part of the lung may press on nerves, for example, causing pain in the upper chest or shoulder. This is sometimes treated with radiation, or a nerve block: A nerve block is an injection of a drug that numbs the painful area.

Lung cancer may be more likely than other cancers to spread (metastasize) to other parts of the body, especially the brain. Metastasis to the brain can cause headaches, seizures, and problems with walking. Metastatic cancer in the bones can create a deep, aching pain from the bones breaking down. Any metastatic tumors can cause pain; prescription and non-prescription medications may help, before the person begins treatment with chemotherapy.

Managing pain from lung cancer treatment

Sometimes cancer treatments on their own can cause pain or discomfort. Surgery is one major source of pain. In a thoracotomy, a surgeon cuts through the muscles of the chest and spreads apart the ribs to reach the lungs; this is done to remove part – or all – of the lung that has cancer. Because this operation can cause a lot of pain afterwards, it’s very important to talk about pain control with your anesthesiologist before surgery. Pain can be treated with oral medications, IV medications (given into a vein), an epidural (medication placed into the space around the spinal cord), or an intracostal block (local anesthetic given in between the ribs right at the place that hurts). Sometimes people are given the option to control on their own how much pain medication they receive, by using a patient-controlled analgesia (PCA) pump.

Radiation treatments can cause burning of the skin, soreness in the neck and chest, and trouble swallowing. These problems are sometimes treated by changing the patient’s diet, and by using pain medications, antacids, and throat gels.

Surgery, radiation therapy, and some kinds of chemotherapy can also cause neuropathic (nerve) pain; this can cause burning, shooting, or stabbing pains, sometimes with numbness or tingling. There are many different treatments to help nerve pain.

When you’re in pain

Your comfort is an important part of cancer care. With so many medications and treatments on hand to take care of cancer pain, no cancer patient should have to live with untreated pain. Don’t hesitate to tell your doctor or nurse if you’re hurting. While the treatment may not work 100%, it can still make a difference.

References

American Cancer Society (2007). What is non-small cell lung cancer. Retrieved 7/1/08 from www.cancer.org.

American Cancer Society (2007). What is small cell lung cancer. Retrieved 7/1/08 from www.cancer.org.

National Cancer Institute (2008). Pain Control. Retrieved 7/1/08 from www.cancer.gov.

National Cancer Institute (2007). What you need to know about lung cancer. Retrieved 7/1/08 from www.cancer.gov.