Stage 4 Lung Cancer And Dementia

Lung Cancer And Palliative Care

Lung cancer begins when cells in the lung change and grow uncontrollably, forming a mass called a tumor, a lesion, or a nodule. A lung tumor can begin anywhere in the lung. A tumor can be cancerous or benign. Once a cancerous lung tumor grows, it may or may not shed cancer cells. These cells can be carried away in blood or float away in the fluid, called lymph, that surrounds lung tissue.

Lymph flows through tubes called lymphatic vessels that drain into collecting stations called lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes are located in the lungs, the center of the chest, and elsewhere in the body. The natural flow of lymph out of the lungs is toward the center of the chest, which explains why lung cancer often spreads there first. When a cancer cell moves into a lymph node or to another part of the body through the bloodstream, it is called metastasis.

Who Gets Mental Confusion Or Delirium

Confusion is the most common sign that cancer or treatment is affecting the brain. It is a common problem for people with any advanced illness including advanced cancer or those at the end of life. A person with mental confusion will think and act very differently from normal. The condition can be difficult and stressful for the person affected as well as their loved ones. It may also make it harder for the health care team to care for other symptoms.

The Risk Of Cancer In Dementia Patients And The Risk Of Dementia In Patients With Cancer

Literature shows intriguing findings about the association between cancer and cognitive problems, with multiple studies showing cancer patients at an increased risk of developing longterm cognitive problems. Dementia is often preceded by cognitive impairment, in which pathophysiological processes underlying dementia may already be present. Since a shared pathology between cognitive problems and cancer has been hypothesised, a logical question emerges whether cancer and cancer treatment are also associated with an increased risk of dementia.

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What Is Stage 4 Lung Cancer

Stage 4 lung cancer is an advanced disease. At this stage, the cancer is metastaticmeaning it has spread from the lung, where it originated, to other parts of the body.

Metastasis occurs when cancer cells separate from the original tumor and move through the body via the blood or lymph system. The cancer cells often travel to the brain, bones, liver and adrenal glands where they may form new metastatic tumors. At that point, any metastatic tumors that develop in another area of the body are still considered lung cancer, because they are made up of lung cancer cells.

This article will cover:

• Frequent infections such as bronchitis and pneumonia

Other symptoms that may develop as a result of the cancer metastasizing to other parts of the body include:

• Headaches, weakness or numbness in a limb, dizziness, balance issues or seizures
• Pain in the bones of the back or hips
• Swollen lymph nodes in the neck

These symptoms may be caused by a less serious condition. Still, its important to visit your doctor if youre experiencing these symptoms, because many are serious, and your doctor may help you determine what is causing them.

Stages Of Lung Cancer

After lung cancer has been diagnosed through a biopsy , staging of the cancer needs to be completed. Staging refers to determining how far cancer has spread in the body.

Stages are numbered from stage 0 to stage 4. This number will be included in the diagnosis. There can be slight differences in the staging between small cell lung cancer and non-small cell lung cancer, but generally, it follows the same pattern. The stage of cancer is made at the initial diagnosis, even if it progresses beyond that in the future.

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Successful Home Palliative Care Of A Patient With Terminal Lung Cancer And Severe Dementia

Junichi Danjo1*, Sonoko Danjo1 and Yu Nakamura1

1Department of Neuropsychiatry, Kagawa University School of Medicine, Japan

2Miki Clinic, Kagawa University School of Medicine, Japan

*Corresponding Author:

Dr. Junichi Danjo, MD, PhDDepartment of NeuropsychiatryKagawa University School of Medicine1750-1 Ikenobe, Miki, Kita E-Mail:

Received Date: April 01, 2018 Accepted Date: April 12, 2018 : April 21, 2018

Citation: Danjo J, Danjo S, Nakamura Y Successful Home Palliative Care of a Patient with Terminal Lung Cancer and Severe Dementia. Cancer Biol Ther Oncol. Vol.2 No.1:3

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Options For Early Stage Lung Cancer

For people of any age with lung cancer, being diagnosed in the early stages offers the chance to cure the disease or reduce the risk of recurrence with surgery and/or stereotactic body radiotherapy.

While there may be a concern that surgery could be dangerous for older adults, research shows that survival rates for older patients are comparable to younger patients for various types of surgery for lung cancer.

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Changes Of Brain Structure In Patients With Metastatic Non

• 1Huaxi MR Research Center , Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
• 2Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
• 3Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
• 4Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, China

Purpose: Epidermal growth factor receptor-tyrosine kinase inhibitor therapy is the routine treatment for patients with metastatic non-small cell lung cancer harboring positive EGFR mutations. Patients who undergo such treatment have reported cognitive decline during follow-up. This study, therefore, aimed to evaluate brain structural changes in patients receiving EGFR-TKI to increase understanding of this potential symptom.

Method: The medical records of 75 patients with metastatic NSCLC who received EGFR-TKI therapy from 2010 to 2017 were reviewed. The modified Scheltens Visual Scale and voxel-based morphometry were used to evaluate changes in white matter lesions and gray matter volume , respectively.

An increase in WMLs and loss of GMV were observed in patients with metastatic NSCLC undergoing long-term EGFR-TKI treatment. This might reflect an unknown side-effect of EGFR-TKI treatment. Further prospective studies are necessary to confirm our findings.

Benefits And Advantages Of Cancer Treatment

Some people with cancer and dementia will be offered the standard treatment for the cancer. They may sometimes have to spend time in hospital.

The person you care for is likely to have side effects from cancer treatment. These are usually temporary and can be controlled with medicines. But some people have longer-lasting side effects known as late effects. We have more information on the late effects of cancer treatment.

For some people, treatment will cure the cancer. Other people may not respond to the treatment. This means that they may have the side effects of treatment without any of the benefits.

Some people may not have standard treatment. This might be because they are not well enough or have other health problems. Other people may choose not to have the standard treatment. Instead, they might have other treatments with:

• lower doses of medicine
• fewer treatment sessions.

They will usually spend less time in hospital and have fewer side effects. These types of treatment are given to control the cancer, but they will not get rid of it completely.

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Options For Advanced Or Metastatic Lung Cancer

With stage 3B and stage 4 NSCLC, as well as extensive SCLC, surgery may be used to help manage cancer in older adults. This is not typical, however. Instead, healthcare providers will usually focus on systemic treatments that help relieve symptoms, extend life, and, when appropriate, act as palliative care.

How Brain Metastases From Lung Cancer Are Treated

If diagnosed and treated early, brain metastases usually respond to therapy. Your treatment plan will depend on the size and number of tumors, where theyre located in the brain, and their genetic characteristics the extent of disease outside the brain and your overall health. Treatment may include:

Surgery Surgery may be an option for people with only one or two brain metastases that are easy to access and remove or a larger tumor thats causing compressive symptoms, according to Johns Hopkins Medicine.

It may involve complete or partial removal of a tumor to help alleviate symptoms and is typically followed by whole-brain radiation.

Radiation This therapy involves the use of X-rays or other high-energy beams to kill cancer cells, and different methods of radiation are used to treat brain metastases.

People with fewer than five lung cancer metastases in the brain may be good candidates for stereotactic radiation, in which advanced imaging and computer guidance are used to deliver large doses of radiation directly to tumors.

This approach can effectively treat metastases with little radiation exposure to other parts of the brain and with minimal side effects, says Dr. Goldman. If you have many tumors throughout your brain or a large tumor deep in the brain, your doctor may recommend whole-brain radiation, in which radiation is applied to the entire brain to kill tumor cells.

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Factors In Decision Making

Chronological age alone should not be what dictates one’s lung cancer treatment plan. Still, there are age-related realities that do need to be considered when you and your healthcare provider are reviewing options.

• Lack of clinical studies: Most drugs and treatments have been studied in clinical trials on younger patients, so it’s not always clear how they will work for adults who are in their 70s, 80s, or 90s.
• Comorbidities: This refers to other medical conditions you may have in addition to lung cancer. Older patients tend to have more coexisting medical conditions than younger patients. For example, conditions that limit lung function, such as emphysema, could make lung cancer surgery less optimal.
• : Older patients are more likely to have these problems, which may make some drug treatments problematic if they are filtered through the kidneys or liver.
• Less lean body mass: A decrease in lean body mass is common among older adults. This can make you less tolerant of weight loss that occurs with certain treatments and make you more at risk for cachexia, unintended weight loss, loss of appetite, and wasting of muscle mass.
• Less bone marrow reserve:When this occurs among older patients, it can raise the risk of complications related to bone marrow suppression from chemotherapy.

While these conditions may cause some challenges for some mature patients, they should not preclude anyone from seeking treatments that are able to be tolerated.

Planning For The Future

If someone has dementia, it is likely their ability to make decisions will be affected in the future. There may be a time when they are no longer able to make decisions or communicate easily.

The person you care for may already have an idea of how they would like to be treated at the end of their life. If they are able to plan ahead, it can help you and the health professionals caring for them.

There are different ways the person you care for can plan ahead. This is sometimes known as advance care planning. Usually, this is an opportunity for them to make decisions about:

If the person you care for identifies as LGBT, this may have an impact on the treatment and care they would like to receive. An organisation called Compassion in Dying has written a guide called Your treatment and care: Planning ahead for the LGBT community that may be helpful.

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Ability To Tolerate Treatment

Cancer treatment options are usually broken down into stages of non-small cell lung cancer or small cell lung cancer .

Early-stage treatment options are considered for stage 1 and some stage 2 NSCLC, as well as some limited-stage small cell lung cancer .

Locally advanced lung cancer treatment options are used with some stage 2 and stage 3 NSCLC and extensive SCLC.

Treatment for advanced lung cancer is offered for those with metastatic lung cancer, which occurs in some stage 3 and stage 4 NSCLC, and in extensive SCLC.

Treatment is appropriate for older adults at any of these stages. There are some who think that adults in their 80s or 90s are too “fragile” to pursue aggressive treatments for late stages, or that lung cancer treatment, in general, offers little benefit. Fortunately, even older adults can see positive results from therapies.

That’s not to say that every lung cancer treatment option is equally appropriate or safe for people of all ages or health profiles. But as treatments become more advanced, they’re often better tolerated by adults of every age when compared with options available in previous decades.

Definitions And Acquisition Of White Matter Lesion And Gray Matter Volume

WMLs are regions of white matter that have an abnormal white matter fiber tract, which present as hyperintense regions on MRI T2-FLAIR sequence images with different shapes categorized as: periventricular caps, rims, or halos subcortical multiple punctuates or patchy lesions and partially or completely confluent lesions. They are often divided into two broad categories, namely, periventricular WMLs and deep WMLs .

WMLs from axial T2-FLAIR images were evaluated using the modified Scheltens Visual Scale , with which periventricular and white matter hyperintensities are semi-quantitively rated. The modified SVS is used to rate WMLs in the periventricular region on a 7-point scale and those in the subcortical region on a 25-point scale according to the size and number of lesions . The modified SVS was used to evaluate the WMLs seen on T2-FLAIR images at baseline and after 12 months and 24 months of EGFR-TKI therapy .

Gray matter is a major component of brain parenchyma and consists of neuronal cell bodies, neuropils , glial cells, and capillaries. It is distinguished from white matter in that it contains numerous neuronal cell bodies and relatively few myelinated axons. GMV is determined using optimized voxel-based morphometry , a computational neuroanatomy method that measures the number of voxels of gray matter after separating them from white matter using T1WI.

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Do Cancer Screenings Need To Start Earlier

Researchers presenting at ASLC World Conference on Lung Cancer in Vienna say success in older patients is likely due to the era of lung cancer screening, Americas decade-long roll-out of early screenings to catch cancers before symptoms appear. However, the yearly screenings are only for high-risk adults over 50, such as those who smoke daily for over 20 years, leaving young people to fall through the cracks.

Study authors note that lung cancer does not usually cause noticeable symptoms until it spreads through the lungs or into other parts of the body. This means the outlook for the condition is not as good as many other types of cancer.

Researchers are calling for new ways to boost lung cancer detection in young people who are ineligible for a screening. They also fear that without improvement, the age disparity will widen. The team found around 1,328 lung cases in 20 to 29-year-olds, 5,682 in 30 to 39-year-olds, and 39,323 in 40 to 49-year-olds during the study period. The Boston team examined data from patients between 20 and 79 diagnosed with non-small-cell lung cancer, according to U.S. cancer databases.

In this national analysis, we found that younger patients with lung cancer are significantly more likely than older patients to be diagnosed with later stages of disease, says study author Alexandra Potter, Program Director of the American Lung Cancer Screening Initiative at Massachusetts General Hospital in Boston, in a media release.

Characteristics Of Stage 4 Lung Cancers

Lung cancer is staged to classify the severity of the disease. The staging of NSCLC helps doctors choose the most appropriate course of treatment based on the likely outcome or prognosis.

The stage of lung cancer is determined using the TNM classification system, which categorizes the severity of the disease based on three conditions:

• The size and extent of the primary tumor
• Whether nearby lymph nodes have cancer cells in them
• Whether distant metastasis has occurred

With stage 4 lung cancer, all three of these conditions will have occurred. With that said, the extent of metastasis can vary along with the prognosis.

For this reason, the 2018-released TNM classification system broke down stage 4 NSCLC into two substages:

• Stage 4a lung cancer, in which cancer has spread within the chest to the opposite lung or to the lining around the lungs or the heart or to the fluid around the lungs or heart
• Stage 4b lung cancer, in which cancer has spread to one or multiple places in one or more distant organs, such as the brain, adrenal gland, bone, liver, or distant lymph nodes

Stage 4 lung cancer is incurable. Treatments, therefore, are focused on slowing the progression of the disease, minimizing symptoms, and maintaining an optimal quality of life.

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Back Or Shoulder Pain

A Pancoast tumor is a type of lung cancer that grows in the upper part of your lung and spreads to your ribs, vertebrae in your spine, nerves, and blood vessels. Because of where these tumors grow, they rarely affect your respiratory system. They’re more likely to make your shoulder blade, upper back, and arm hurt instead.

Survival Rates By Disease Extent

A second method estimates survival rates based on the extent of cancer in the body. This is the approach used by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. The SEER system classifies cancer in one of three broader categories:

• Localized: Cancer limited to the lungs
• Regional: Cancer that has spread to nearby lymph nodes or structures
• Distant: Metastatic cancer

Under the SEER classification system, distant disease and stage 4 cancer are synonymous.

The one drawback to the SEER approach is that stage 4a and 4b lung cancer are melded into one category. This generalized approach returns a much lower five-year survival estimate . It also fails to reflect the wide variability in stage 4 survival rates, particularly in people with limited metastases.

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