Writer: Jana Chan
Current Solutions and Their Insufficiencies
Due to the high prevalence of non-small cell lung cancer (NSCLC) worldwide and its detrimental impact on the lives of patients and their loved ones, scientists have developed many ways to treat this disease. With such a large set of treatment options, a combination of different treatments may be used or sometimes only one will be implemented. Yet, the end goal in all of them is the same: to shrink and kill cancer cells to stop their rapid growth.
Used to target solid tumors contained to one area, surgery will remove part of or an entire lung. Depending on the stage, type, and location, there are various surgeries that can be performed, all of which will remove both the tumor and some surrounding lung tissue. First, it is vital to understand that parts of the lung are separated into lobes; the left lung has two lobes and the right lung has three lobes.
Figure 1. Location of lung lobes. Reprinted from Nursing Times, 2020, Jaclyn Proctor and Emma Rickards. Retrieved July 29, 2020.
The most common procedure is a lobectomy, in which the lobe of the lung affected by the cancer is removed. Each lung lobe can also be divided into three to five lung segments. Thus, a segmentectomy or a wedge resection can be performed to remove small sections of a lobe to save unaffected tissue. Another possible surgery is a pneumonectomy, which involves the removal of an entire lung. The biggest benefit to these surgeries is being able to remove the cancer completely. With the exception of a pneumonectomy, these surgeries also preserve healthy lung tissue. However, any tissue left behind could still contain some cancerous cells, meaning the cancer could come back. Complex surgeries can also result in complications, both during and after. Severe pain, blood clots, excess bleeding, and wound infections are all possible if surgery is chosen as treatment.
Like surgery, radiation therapy also deals with a localized tumor that has not spread throughout the body. However, instead of an operation, it damages cancer cell DNA and stops their internal cell functions with x-rays. As cancer cells try to divide, they fail and thus abortive mitosis happens. This can be administered in two different forms, most commonly through external radiation, where beams of radiation are aimed at the lungs or areas around the lungs. Intensity Modulated Radiation Therapy (IMRT) can also be used to shape the radiation beams to match the tumor, allowing for flexibility in intensity and more direct beams. The other form implants an internal sealed radioactive material directly into or near the tumor. A strength to this treatment is its ability to alleviate some symptoms of NSCLC, such as pain or blockage of airways by the tumor in addition to killing cancer cells. Unfortunately, this therapy has a large list of potential side effects, such as nausea, vomiting, tiredness, painful swallowing, breathing problems, headaches, and skin reactions, all of which could drastically impact the day-to-day life of the patient.
Chemotherapy, or chemo, is a treatment most often used when the cancer has spread to different areas of the body and to other organs. Unlike radiation therapy and surgery, this method will be less effective on localized tumors. Using anti-cancer drugs that can be injected or taken orally, some common drugs include cisplatin, carboplatin, paclitaxel, gemcitabine, and vinorelbine. Many studies have continued to prove the high efficacy of chemotherapy on NSCLC and chemo remains essential to cancer treatment today. The biggest advantage of chemo is its ability to attack cancer cells all over the body, even attacking cancer cells that may not have been found. However, this also means that chemo can be cytotoxic as healthy cells, like blood or nerve cells, may be damaged in the process too. And like radiation therapy, chemo also comes with a large amount of side effects that could negatively affect daily life from hair loss to nausea and vomiting.
Targeted therapy, like chemotherapy, uses drugs to kill cancer cells but these drugs have been specifically developed to target and disable the genes or proteins found in cancer cells. Because the genes and proteins of cancer cells are mutated and thus different from normal cells, targeted therapy can leave healthy cells alone. For example, EGFR inhibitors are used to block the signal from NSCLC cells with a EGFR gene change, a protein on the surface of cancer cells, and prevent it from dividing rapidly. Compared to chemo, which kills already-made cancer cells, this solution can stop the cancer cells from copying themselves. But even with all these benefits, side effects, such as skin infections, diarrhea, mouth sores, and a loss of appetite, are possible and sometimes life-threatening.
Finally, immunotherapy uses medicine to help the body’s natural defense, the immune system, recognize and fight cancer cells. An immune system does not attack healthy cells because checkpoint proteins on those healthy cells act as switches to turn on or off the immune system. Cancer cells can therefore use these checkpoints to avoid activating an immune response. Thus, this method uses immune checkpoint inhibitors to essentially prevent cancer cells from using these checkpoints to their advantage. For instance, PD-1/PD-LI inhibitors are drugs that attack proteins found on tumor cells. This will boost the immune response against cancer cells to prevent them from dividing and growing. Because immunotherapy involves the immune system, autoimmune reactions are possible on top of other typical side effects (diarrhea, rash, fatigue, trouble breathing, etc.). Since these drugs work by eliminating one element of protection on the immune system, the immune system could overreact and start attacking other parts of the body, leading to potentially life-threatening situations.
This example transitions nicely from the previous section, which describes significance of the problem, into describing the current solutions that address the problem. In fact, throughout most of this example, the author smoothly shifts from one concept to another to intertwine all pieces into one coherent piece. The author clearly and thoroughly describes what each solution does and explains how it works, while also providing detailed explanations on the strengths and weaknesses of each solution. A diagram of lung lobes is effectively integrated into the example but more diagrams or figures to further illustrate how certain treatments work might be helpful.
This example would have benefitted from the use of more statistics to represent the potential impacts, especially when describing the strengths and weaknesses of each solution. For example, highlighting what percentage of NSCLC patients will have their cancer come back after a specific treatment. If relevant to the proposal, this example could have also provided a brief history of one or more solutions to give the reader adequate contextual information.
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American Cancer Society. (n.d.). Targeted Drug Therapy for Non-Small Cell Lung Cancer. https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/targeted-therapies.htm
American Cancer Society. (n.d.). Immunotherapy for Non-Small Cell Lung Cancer. https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/immunotherapy.html
Proctor, J., & Rickards, E. (2020, January 6). How to perform chest auscultation and interpret the findings. Nursing Times [online], 116(1), 23-26. https://www.nursingtimes.net/clinical-archive/assessment-skills/how-to-perform-chest-auscultation-and-interpret-the-findings-06-01-2020/