Treatment of Common Complications
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Bones are a common area to which lung cancer can spread. The most common symptom is pain in the bone. Some symptoms of bone metastases can be quite serious. If you have bone metastases, ask your healthcare team if there are any particular symptoms that should be brought to their attention as soon as you experience them. There are a few different treatments for bone metastases. Denosumab (Xgeva®) and bisphosphonates, such as zoledronic acid (Zometa®) are injectable drugs that slow the breakdown of bone, prevent fractures, and reduce pain. Radiation treatment and chemotherapy are used to relieve pain and shrink tumours. Surgery and bone cement are used to fix broken bones and prevent future fractures in bones weakened by cancer. A healthy diet and regular weight-bearing exercise (like walking) can help maintain strong bones. Calcium and vitamin D supplements are also recommended, especially during treatment with denosumab, bisphosphonates, or steroids. Talk to your healthcare team about whether these approaches will be helpful for you.
If your blood oxygen level is significantly low (this condition is called hypoxemia), your doctor will suggest using oxygen to supplement your breathing capacity. Breathing in extra oxygen raises low blood oxygen levels, makes breathing easier, and lessens strain on your body. Because your body cannot store oxygen, this therapy works only when you use oxygen. Like any other prescription medicine, oxygen must be used very carefully and only as prescribed. Your doctor will tailor your oxygen prescription to your needs. You should never change the flow of oxygen unless directed by your physician. When oxygen will be delivered to your home, you and your family will receive instructions on how it should be used and how to clean the equipment. See Chapter 10 for other strategies to manage shortness of breath.
Pneumonia is an infection of the lung tissue. It may be due to a weakened immune system, a complication of chest surgery, or a result of the tumour taking up space in your lung. Depending on the severity, pneumonia may be treated with antibiotics at home or at a hospital. Many of the symptoms of pneumonia overlap with those of lung cancer, such as chest pain, difficulty breathing, coughing, and coughing up pus or blood. However, pneumonia will also cause symptoms like fever, chills, headache, and confusion. If you have any of these symptoms, you should let your healthcare team know right away.
Pleural effusion is the build-up of fluid in the chest that makes breathing difficult. The fluid collects in the pleural space between the double-layered membranes lining the lungs. Because the fluid pushes on the lungs and flattens the diaphragm, they cannot expand and contract properly to move air in and out of the lungs. The excess fluid can be removed by thoracentesis, a procedure in which a needle is inserted into the chest cavity and fluid is suctioned out. Pleurodesis is a procedure in which the two membranes lining the lung are sealed to each other so that fluid can no longer collect between them. This involves putting a powder or drug in the pleural space through a flexible chest tube. After the surgery, the chest tube may be left in place for a few days to drain any new fluid that might collect. Another way to relieve pleural effusion is by using a soft tube called a tunnelled pleural catheter. The tube lies under the skin and inserts into the pleural cavity from which it drains excess fluid. The tube is inserted using local anesthetic during an outpatient procedure that last about 90 minutes. Then, a nurse can help drain the fluid at home until pleurodesis happens naturally.
People with cancer have a high risk of developing blood clots. Blood clots can be a result of the cancer, its treatments, or a range of other causes including extended bed rest. They are treated with blood thinners. There are a few different names for conditions involving blood clots. A blood clot inside a blood vessel (usually a vein) is called a thrombus. If a thrombus forms in a vein deep inside the body (usually the legs), this is known as deep vein thrombosis (DVT). Symptoms of DVT include swelling, warmth, or a cramp-like pain in the leg; discolouration of the skin; and prominent veins. Sometimes a piece of the clot, an embolus, breaks away and travels through the bloodstream. As it travels, an embolus may lodge itself in a smaller blood vessel and block blood flow. When an embolus lodges itself in the lungs, this is known as pulmonary embolism (PE). Symptoms of PE include unexplained or sudden shortness of breath; pain in the chest or upper back, especially when you cough or take a deep breath; feeling faint or actually fainting; a rapid pulse; and coughing up blood. PEs can be life-threatening. Let your doctor know as soon as you develop these symptoms.