There are two main types of lung cancer - small cell carcinoma and large cell carcinoma. The type of lung cancer can be determined by the appearance of the cancerous cells under a microscope. Small cell lung cancer is sometimes called oat cell cancer, because the cancer cells look like oats when they are viewed under a microscope. It develops most often in the bronchial submucosa (a layer of tissue beneath the epithelium - the lining of the lungs) and is found in people who are heavy smokers. This type of cancer spreads rapidly and is more likely than other types to have metastasized. Large cell carcinomas are found most often in the smaller bronchi.
Clinical features
Signs and symptoms of primary lung cancers are similar to pneumonia which includes coughing up blood, chest pain, and shortness of breath. A new cough in a smoker or a former smoker could also raise concern for lung cancer. Shortness of breath usually results from a blockage in part of the lung, collection of fluid around the lung, or the spread of tumor through the lungs. Repeated cases of pneumonia, and cases where the disease persists, can signal a serious underlying condition, such as lung cancer. This means that repeated communicable diseases experienced by an individual, can be a sign of a non- communicable disease.
Many lung cancers have a rich blood supply. The surface of the cancer may be fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be coughed up.
Similar to pneumonia, many of the symptoms of lung cancer are nonspecific; in the elderly, this may be due to other illness. In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of metastasis include the bone, such as the spine which can cause back pain.
The causes and distribution of communicable and non-communicable diseases
The lungs are continuously exposed to airborne particles, such as bacteria and viruses which can cause lung disorders such as pneumonia. Diseases are not always caused by micro-organisms. Disease can be degenerative, inherited from parents, deficiency related or associated with lifestyle or the environment. There are many factors that affect the cause of disease; I have identified some of these factors for each disease below.
Pneumonia
The most common causes of pneumonia are bacteria and viruses. Relating to these causes are the most common types of pneumonia bacterial pneumonia and viral pneumonia.
Pneumonia bacteria are present in some healthy throats, when body defenses are weakened in some way, by illness, old age, malnutrition, general debility or impaired immunity, the bacteria may multiply and cause serious damage. Usually when a person’s resistance is lowered, bacteria work their way into the lungs and inflame the alveoli resulting in pneumonia.
Being bedridden due to old age or illness, may also put an individual at higher risk of pneumonia. Lying flat can allow mucus to collect in the lungs, providing grounds for bacteria to reproduce.
An individual’s lifestyle can also put them at risk of pneumonia, for example Smoking. Millions of microscopic hairs cover the surface of the cells lining the bronchial tubes. The hairs clear your airways of normal emissions, but irritants such as tobacco smoke paralyze the hairs, causing emissions to build up. If these emissions contain bacteria, they can develop into pneumonia. Another lifestyle factor such as alcohol consumption interferes with a persons normal gag reflex as well as the action of the white blood cells that are needed to fight the infection.
Pneumonia is common worldwide. It is a major cause of death among all age groups. In children, the majority of deaths occur in the newborn, with over two million deaths a year worldwide. The World Health Organization estimates that one in three newborn deaths are due to pneumonia estimating that up to 1 million of these deaths are caused by the bacteria Streptococcus pneumoniae, and 90% of these deaths take place in developing countries. Mortality from pneumonia generally decreases with age. However, Elderly individuals are at particular risk for pneumonia and related death. More cases of pneumonia occur during the winter months. Pneumonia occurs more commonly in males than females, and more often in Blacks than Caucasians. Individuals with other illnesses such as Alzheimer's disease, cystic fibrosis, emphysema, tobacco smoking, alcoholism, or immune system problems are at increased risk for pneumonia. These individuals are also more likely to have repeated pneumonia. People who are hospitalized for any reason are also at high risk for pneumonia.
Lung cancer
Like pneumonia, smoking causes the majority of lung cancers, in the smokers themselves and people exposed to secondhand smoke. Lung cancer also occurs in people who never smoked. In these cases, there may be no clear cause of lung cancer. Other causes include exposure to certain chemicals and substances, such as asbestos, uranium, chromium and nickel. These have all been linked to lung cancer but are very rare.
Pneumonia often leaves scarred areas on the lung. This scarring increases the risk of the person developing lung cancer. This again signifies that a communicable disease can put people at greater risk of developing a non- communicable disease.
Close family to people who have lung cancer have an increased risk of lung cancer themselves. However, it is difficult to say how much of this risk is due to inherited factors and how much is due to environmental tobacco smoke.
Compared to pneumonia, lifestyle factors can also put people at greater risk of lung cancer. An individual’s diet is one factor. Vitamin A deficiency can increase the risk of Lung cancer. However, taking an excess amount of Vitamin A may also increase Lung cancer. Alcohol consumption can also be a risk, though it is hard to tell how much of the risk in people who drink is actually due to tobacco smoke, since most people smoke and drink.
Lung cancer is the most common cancer in terms of both incidence and mortality with 1.35 million new cases per year and 1.18 million deaths, with the highest rates in Europe and North America. Individuals over fifty who have a history of smoking are more likely to develop lung cancer. Lung cancer is the second most commonly occurring form of cancer in most western countries, and it is the leading cancer-related cause of death. The rate of men dying from lung cancer is declining in western countries; however it is increasing for women due to the increased amount of smoking by this group.
Eastern Europe has the highest lung cancer deaths among men, while northern Europe and the United States have the highest deaths among women. Lung cancer incidence is less common in developing countries. With increased smoking in developing countries, the incidence is expected to increase in the next few years.
Diagnosis, treatment and facilities to support individuals with disease
Diagnosis is the process of identifying a medical condition or disease by its signs, symptoms, and from the results of various diagnostic procedures. The earlier the diagnosis the more effective the treatment of the disease will be. This is important in progressive diseases such as lung cancer where early recognition can mean the difference between life and death. Early diagnosis is also important in communicable disease such as pneumonia. This means that transmission of the disease could be reduced if the infected individuals are isolated quickly.
Diagnosis of Pneumonia and Lung cancer
Typically, someone with abnormal symptoms will consult a doctor, who will then obtain a history of the patient’s illness and examine them for signs of disease. The doctor will create a hypothesis of likely diagnosis and in many cases will obtain further testing to confirm or clarify the diagnosis before providing treatment. By placing a stethoscope on the chest, the doctor may be able to hear crackling sounds, coarse breathing, wheezing and/or the breathing may be faint in a particular area of the chest. This can mean that the lungs are inflamed or blocked. A doctor may order a chest x-ray which shows a shadow on the lung if it is affected by cancer. A blood test may determine the cause and severity of the condition.
If these tests are questionable, the doctor may perform a procedure called a bronchoscopy. In this procedure, a thin, lighted tube is inserted through the nose or mouth into the trachea and lungs after a local anesthetic has been given. The breathing passages can then be examined by the doctor and samples from the infected part of the lung can be obtained for analysis (biopsy). Alternatively, cells for biopsy maybe obtained by a needle being inserted into the chest, or the chest maybe opened up to allow removal of part of the tumour.
Another form of diagnosis is a CT (CAT) scan which will make a series of detailed pictures of areas inside the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A may be into a vein or swallowed to help the lungs or show up more clearly. A PET (positron emission tomography) scan involves a patient lying on a table that then slides through a PET machine. Like the dye, a small amount of is injected into their vein. The PET then rotates around their body and makes a picture of where glucose is being used. Malignant tumour cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
Treatment of disease
Diseases can be treated by a variety of people including the individual themselves, local health practices, local hospitals and specialist national centres. Lung cancer patients may need to use primary health care services regularly because they have a health problem that requires continuing treatment and monitoring. However, the patient’s general practitioner (GP) may have recommended them to see a consultant in a secondary care setting such as a hospital. Lung cancer treatment depends on several factors, including the type and size of the cancer, its location and the overall health of the patient. Surgery, radiation therapy and chemotherapy are the main ways of treating lung cancer and may be used alone or together.
The patients may be recommended to a specific department such as oncology or radiology which specialise in cancer. If the cancer is diagnosed early, removal of part or the entire lung can be performed. Radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain. Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally removes them.
Treatment for pneumonia varies depending on the severity of the patient’s symptoms and the type of pneumonia that they have. GPs usually treat bacterial pneumonia with antibiotics. Although patients may start to feel better shortly after beginning their medication, they must complete their entire course of antibiotics. Stopping medication too soon may cause the pneumonia to return. On the other hand, Antibiotics aren't effective against most viral pneumonias. A few viral pneumonias may be treated with antiviral medications, but the recommended treatment is to rest and drink plenty of fluids. The patient’s doctor may also recommend over-the-counter medications to reduce fever and treat aches and pains. If the pneumonia is severe, the patient will be hospitalized and treated with antibiotics inserted in the veins and put on oxygen. Patient’s may spend three or four days in the hospital receiving treatment and then continue to recover at home with oral medication.
There are also charities and support groups available who provide voluntary care, advice and support. The institute of Cancer research is an organisation that helps people who have been diagnosed with cancer. There are also cancer clinics available that are part of a local health practice, where people can be treated just for cancer. The clinic also offers advice and support. Domestic care can also be provided for both cancer and pneumonia patients meaning that people can receive care in their own homes. People who provide this domestic care are members of the primary Health care team for example district nurses or health visitors. Patients can also be cared for by informal carers such as a member of the family or friends.
Factors affecting treatment
There are many factors that can affect the availability of support and treatment regimes for a disease. Self- diagnosis and treatment can be an issue for people who have lung cancer as recognition of the symptoms is normally left to late. Sufferers also have to rely on their own self judgement of how severe their condition actually is before they decide to get treatment. This could affect the stage of the cancer and whether it has spread to other places in the body.
Many people particularly the elderly, do not like to visit their GP, they prefer to buy what medication they are aloud to over the counter. This can be costly meaning that some people especially the elderly might not be able to afford the medication that they need.
Due to high demand, the availability of specialist staff and specialised equipment may be poor. Machines cost a lot of money meaning that hospitals may only have limited supply. The hospital will also need specialist staff to operate them. These to points mean that patients will have to wait which in some cases, can result in the disease worsening.
The strategies available for the prevention of diseases and the use of epidemiological methods for tracking diseases
There are many Strategies working to reduce the risk of developing a disease. These include national, local and personal lifestyle strategies. These strategies depend on whether the diseases are communicable or non- communicable. The body can protect itself through its natural defences; non-specific defence mechanisms and the immune system. Infection Pneumonia occurs if an infecting micro- organism gets past the bodies defences or the defences break down.
National strategies are being used to prevent both pneumonia and lung cancer. The National Health Service (NHS) plays a role in preventative strategies for example; the governments anti- smoking campaign. The campaign was created by advertising agencies, shock pictures were used to put people off smoking, others emphasised the effects of passive smoking. The campaign could be seen as being more powerful than GPs in persuading smokers to quit. There are also other government campaigns run by the NHS such as Cancer research.
Individuals can increase their knowledge of certain diseases through information booklets available from local medical practices; this local strategie will make people more aware an able to prevent disease earlier. Well- woman and well-men clinics are also available for regular/general check ups meaning that blood samples taken can be used as an early diagnosis of any other disease that could be present.
Choices individuals make about how they live has effect on their health. National and local strategies educate and persuade individuals into making healthy choices. These choices include personal hygiene, the body is warm an moist from sweat making them ideal for micro- organisms to breed. Washing and changing clothes will help to reduce the number. Another individual choice is to smoke. Smoking can give a temporary feeling of well-being but can damage health, a reduction in smoking will result in a reduction in the number of related diseases such as lung cancer and pneumonia.
However, many factors can affect the prevention of disease including the public perception of the risks that they take for example; people continue to smoke because they have the wrong perception of the risks. Another reason maybe because the individual has an unrealistic optimism when it comes to their chances of developing a disease, thinking it will not happen to them. This could be due to the lack of personal experience of the disease. The media plays a huge role in affecting individual’s perception of risk, through the news, documentaries and TV dramas such as casualty. The media helps individuals to be more aware resulting in behavioral changes but if the risks are to over- dramatised people will just be too scared to find out if they have a problem.
Evaluation
In this assignment, I have explained and compared the epidemiology, treatment and prevention of two different diseases; lung cancer and pneumonia, one being a communicable disease and the other non- communicable.
I feel I have demonstrated good knowledge and understanding of the biological basis of lung cancer and pneumonia, the causes and distribution, and how this helps treatment and prevention. I have also clearly evaluated the strategies for prevention of my chosen diseases and the factors that might affect them.
However, my findings were not always successful due to the large amount of different data available which can have an impact on prevention, support and treatment.
Conclusion
From this assignment I can conclude that the importance of substantial knowledge and understanding of the epidemiology of diseases is essential to the later treatment and control of diseases.
Bibliography
www.cancerresearchuk.org
Macmillan.org.uk
www.wikipedia.org
Complete family health encyclopedia – Dr Tony Smith
www.mayoclinic.com
www.bupa.co.uk
Health and social care A2 text book
