Diagnosis Of Bacterial Pneumonia In The Cancer Patient
While the clinical syndrome of pneumonia is well characterized in the general population, this diagnosis may be challenging in the cancer patients. Most of the cardinal clinical features of pneumonia represent host response elements that may be impaired or absent in immunocompromised cancer patients. Conversely, when present, cough, fever and radiographic infiltrates may be manifestations of the malignancy itself or complications of therapy. Nevertheless, the correct diagnosis of pneumonia and identification of an infecting pathogen are both associated with better outcomes. Thus, a high clinical suspicion and appropriate testing are essential. Further, given the severe immune impairment and frequent health care exposures experienced by cancer patients, it important to consider the possibility that pneumonias may be caused by uncommon, atypical or opportunistic organisms.
Certain CT patterns, such as lobar consolidation or peribronchial nodules, have been described as characteristic of bacterial pneumonias , as shown in . However, CT patterns are frequently nonspecific, particularly in patients with impaired immune function, and cannot be relied upon for a microbiologic diagnosis . Moreover, the patterns observed in cancer patients with bacterial pneumonia overlap substantially with competing non-infectious diagnoses, as suggested by the CT patterns shown in .
Radiographic presentations of bacterial pneumonia in cancer patients
Pneumonia In Lung Cancer Patients
Pneumonia in lung cancer is incredibly common. Research has found that of all patients battling lung cancer, as many as 70% will also have pneumonia.
Bacterial pneumonia is associated with a higher risk of lung cancer. Research found that people who have had pneumonia before were over three times as likely to develop lung cancer compared to people who never had pneumonia.
Research has also shown that when people have both diseases at the same time, their likelihood of survival decreases significantly. This can lead to complications, such as:
- Lung abscess: A lung abscess occurs when dead lung tissue turns into a liquid, mainly pus.
- Empyema:Empyema occurs when pockets of pus start to collect in the space between the lungs and the chest cavity, otherwise known as the pleural cavity.
- Fistula formation: A fistula is a hole or opening that can form between the bronchithe large airways within the lungsand the pleural cavity.
Pneumonia is the second leading cause of death in lung cancer patients.
What Are The Side Effects Of Lung Cancer Treatment
The side effects of lung cancer treatment vary according to the type of treatment involved:
- Chemotherapy: Hair loss, increased risk of infection, difficulty eating, constipation, diarrhea, extreme fatigue, bleeding and bruising, low red blood cell count
- Radiation: Inflammation, tenderness and sensitive skin near site of radiation treatment
- Surgery: Reactions to anesthesia, pain, excess bleeding, blood clots in the legs or lungs, wound infections, pneumonia, shortness of breath
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Cancer Symptoms Stage 4 Cancer And Pneumonia
What Are Symptoms and Signs?
A symptom is an indication of disease, illness, trauma, or that something is not right in their own bodies. Symptoms are felt or noticed by person or persons, but may not readily be noticed by anyone else. For example, chills, weakness, achiness, shortness of breath, and a cough are possible symptoms of pneumonia.
A sign is also an indication that something is not right in the body. But signs are defined as observations made by a doctor, harbour, or other health professionals. Fever, rapid breathing proportion, and abnormal breathing reverberates heard through a stethoscope are possible clues of pneumonia.
The presence of one evidence or sign were not able to yield enough information to suggest a begin. For example, a rash in a child could be a symptom of a number of things including lethal ivy, an infectious disease like measles, an infection limited to the skin, or a food reaction. But if the rash is heard along with other indicates and indications like a high fever, chills, achiness, and a absces throat, then a doctor can get a better picture of the illness. In many cases, a patients signeds and indications is not supply enough clues by themselves to determine the cause of an illness, and medical research such as x-rays, blood tests, or a biopsy may be needed.
How Does Cancer Produce Signs and Symptoms?
How Are Signs and Symptoms Helpful?
General Cancer Signs and Symptoms
Specific Cancer Signs and Symptoms
What Should I Expect In The Last Few Days
As the end of life approaches, you might experience a number of physical and emotional changes. These are different for everyone. You might notice changes over weeks, days or even hours. Some of the changes might be the same as signs of a flare-up, so discuss them with your doctor or nurse.
Signs to look out for include:
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Anyone Out There Living With Stage 4 Lung Cancer
Is anyone living with stg4 lung cancer? How are they doing?
Welcome to Mayo Connect. Yes, we have a lung cancer group. I am the mentor for lung cancer and health. I do have stage 4 lung cancer. Many people in the lung cancer group do. I’m horrible on my cell phone otherwise I’d put the link here. You can access it the same way you found this group.Why are you interested in stage 4 lung cancer patients? Have you been diagnosed with it?
Yes i have been diagnosed. I have had 2 rounds of chemo, and I’m wiped out. No appetite for food. Any suggestions?
Yes i have been diagnosed. I have had 2 rounds of chemo, and I’m wiped out. No appetite for food. Any suggestions?
having cancer sucks and so does chemo. I drank tons of water to help get the chemicals out of my system. One of the chemicals that I had was cisplatin and that absolutely killed my appetite. I was also wiped out.I forced myself to eat, small helpings of at least some protein. I also could handle pastries and the like.Believe it or not exercising will help with energy.What type of lung cancer do you have? Did you have any surgery?Do you have family at home to help you?
Hi , I’d like to add my welcome. You’ll notice that I modified the title of your discussion and moved it to the Lung Cancer group here:
Outcomes Of Lung Cancer Patients With Covid
In our series, 17/23 patients required admission which represents a hospitalization rate of 74%. Median hospitalization stay was 16 days . To database lock date, 12 patients are considered cured , 8 patients have died , and 3 cases remain in 30 days follow-up period . None of the 6 patients managed in ambulatory basis have died. On COVID-19 survivor patients, median time to negativizing SARS-CoV-2 PCR from 1st COVID-19 symptom was 31 days . There were 3 cases remaining PCR positive at the time of the database lock .
Figure 3. Time to negative SARS-CoV-2 PCR from 1st symptom of COVID-19. On COVID-19 survivor patients, median time to negativizing SARS-CoV-2 PCR from 1st COVID-19 symptom was 31 days . There were 3 cases remaining PCR positive at the time of the database lock .
Overall, 20/23 patients received anti-viral treatment : 20 hydroxychloroquine , 17 lopinavir/ritonavir , 3 azithromycin . In ambulatory patients, hydroxychloroquine plus lopinavir/ritonavir , hydroxychloroquine + azithromycin , or no specific treatment were used. Immunomodulators were used as follow: 6 patients received IFN- , 10 corticosteroids , and 1 tocilizumab . The only patient receiving tocilizumab was on cancer surveillance with no evidence of disease after definitive chemorradiation completion 6 months before, and was receiving local radiation therapy for local prostate cancer at the time of COVID-19 diagnosis. Most used antibiotics were ceftriaxone , meropenem , piperacilin/tazobactam .
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Lung Cancer Anxiety: How To Manage And Cope
A diagnosis of lung cancer is a life-altering event. It may leave you feeling overwhelmed, scared, stressed, or anxious.
Stress and anxiety can occur throughout the journey. Its normal to feel anxious about tests, treatments, and wondering whats next.
Even after the lung cancer has been treated, there can be lingering anxiety. Research shows higher anxiety rates in long-term cancer survivors compared to people who havent had cancer.
Our brain has a complex security system to let us know when something needs our attention. Any major life event, especially those that feel like a threat, can activate this system.
In some cases, this stress or anxiety response is useful. It helps us react quickly if we need to run away from a dangerous situation. It can create obsessive focus, which helps when youre prepping for a big meeting.
In these cases, the danger goes away and the alarm is turned off.
But when the source of stress or anxiety continues, the alarm system doesnt have a chance to shut off. This long-term stress and anxiety can cause physical and emotional issues.
Physical symptoms can include pain, digestive changes, and heart palpitations. Mood changes, irritability, trouble sleeping, and generally feeling on edge are also common.
If this is happening to you, youre certainly not alone. The tips below can help you cope.
Predictors Of Mortality In Lung Cancer Patients With Covid
The case fatality rate in our series was 35% , and was higher in patients actively receiving anti-cancer treatment compared to those that not . We aimed to analyze predictive factors of mortality based on baseline clinic-pathologic features, COVID-19 clinical presentation, and cancer treatment. Univariate analysis demonstrated a statistically significant association with mortality for oxygen saturation at diagnosis, ECOG performance status, number of comorbidities, stage IV, number of metastatic sites, progressive disease, and elevated CRP and fibrinogen . However, there was strong correlation among multiple variables and none of the predictive factors identified in the univariate analysis remained statistically significant in a multivariate model.
Table 4. Predictive factors of mortality for COVID-19 in patients with lung cancer by logistic regression .
Figure 4. Map of correlations among variables associated with the outcome of death by COVID-19 in patients with lung cancer. Positive correlations are displayed in blue and negative correlations in red color. Color intensity and the size of the circle are proportional to the correlation coefficients. Correlation coefficient is indicated in the scale on the right. ECOG, Eastern Cooperative Oncology Group scale of performance status SpO2, oxygen saturation at admission CRP, c-reactive protein.
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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, referred to as the 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, stage 4 NSCLC was broken down into two substages with the release of the new TNM classification system in 2018:
- 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 area outside of the chest, including a single non-regional lymph node
- Stage 4c 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.
What To Expect During End Stage Lung Cance
Clin Chest Med. 2011 Dec 32 :605-44. Lung cancer is the leading cause of cancer-related death in Canada and worldwide . Second highest cancer incidence in both sexes after prostate and breast cancers. Lung cancer has a poor prognosis, which means incidence closely matches mortality The importance of defining the cancer stage is due to the fact that lung cancer at different stages requires different treatments. Surgery has a potentially curative role in non-small cell lung cancers that are stages I to III and in very select cases of stage IV lung cancer. Table 1. Treatment of Lung Cancer by Stage Stage 4. In stage 4 lung cancer, the cancer has either spread to both lungs or to another part of the body , or the cancer has caused fluid-containing cancer cells to build up around your heart or lungs. Small-cell lung cancer
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Small Cell Lung Cancer
Small cell lung cancer grows and spreads rapidly, and in most cases, is diagnosed in heavy smokers. This type has been staged into:
- Stage 1: Here, only the underlying tissues of the lung are invaded by the cancer cells.
- Stage 2: Here the cancer spreads to the lymph nodes surrounding the lung tissues. The cancer cells also invade the chest wall, or nearby structures in this stage.
- Stage 3: This stage can be further divided into stage 3A and 3B . In 3A the cancer takes over the lymph nodes that are in the center of the chest. And in stage 3B, the disease invades the lymph nodes on the opposite side of the chest, or in the lower neck, together with the heart, blood vessels, trachea and esophagus.
- Stage 4: Stage 4 is the final stage of the cancer. Here the disease spreads to other parts of the body. In clinical terms, the cancer has metastasized.
Clinical Presentation Of Covid
All lung cancer patients had at least 1 COVID-19 related symptom cough , shortness of breath , fever , and low-grade fever were the most commonly reported COVID-19 symptoms . Time from symptoms onset to first positive SARS-CoV-2 PCR was 5.5 days . Most cases were confirmed at first SARS-CoV-2 PCR, however in 2 cases a second PCR was required to confirm diagnosis.
Table 2. Clinical Presentation of COVID-19 in patients with lung cancer .
Temperature at diagnosis was above 38°C in 8 patients , between 37.0°C and 38°C in 9 patients , and below 37°C in 6 patients . Oxygen saturation at the time of diagnosis was above 95% in 8 patients , between 90 and 95% in 6 patients , and below 90% in 8 patients . Main lab test abnormalities found were low lymphocytes count , low hemoglobin, high NLR , and elevated inflammatory markers: fibrinogen , D-dimer , CRP , and ferritin . To further evaluate the predictive value of NLR based on a dichotomous classification, we conducted ROC curve analysis. With an area under the curve of 0.804, the value that maximized the Youden’s index was 10.690. The specificity and sensitivity for this value was 0.857 and 0.750, respectively .
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Adjustments On The Treatment Of Cancer Patients With Pneumonia
- D’Or Institute for Research and Education
- Pneumonia is the most frequent type of infection in cancer patients and it is associated with high mortality rates. Researchers have analyzed the factors associated with severe pneumonia in hospitalized cancer patients and suggest that personalized treatment protocols can reduce mortality in this population. Their work indicates that the standard broad-spectrum antibiotic treatment used by physicians worldwide may not be the better choice for this group.
Cancer patients are more likely to get infections. Pneumonia is the most frequent type of infection in this group and a frequent cause of ICU admission and mortality. A study conducted by researchers from the D’Or Institute for Research and Education in partnership with Brazilian hospitals and universities analyzed the factors associated with severe pneumonia in hospitalized cancer patients and suggests that more personalized treatment protocols can reduce mortality in these patients.
Until now, there was a consensus among the medical community that the majority of pneumonia cases in cancer patients were due to the immune system debility caused by the disease and to the exposure to multiresistant bacteria which can cause the pulmonary infection. The idea was that these patients are more vulnerable to superbacteria because they spend a lot of time in hospitals.
More efficient treatment
Can You Have Pneumonia And Survuve Stage 4 Nsclc
MOm has pnuemonia and on avelox… Coughs up lots of yellow mucous. Low sodium of 127…. Took to ER and they did not keep her – instead sent her home. CT shows two 10mm opacities which I’m afraid could be cancer… they say could be infection. Oncologist pushing total CT back 3 weeks till lung clears to make proper diagnosis. Doesn’t this make things spiral?
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Can you have pneumonia and survuve stage 4 nsclc?
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