Lung Cancer: Pathophysiology, Pharmacokinetics, and Treatment

Running head : LUNG CANCER
Name of the Student
Name of the University
Author Note

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Introduction:
With the global burden of the disease, lung cancer is highlighted as one the majority
non- communicable disease which increased the morbidity rate. In Australia, lung cancer is the
fifth most common form of cancer which affects a significant number of individuals in Australia.
Each year, approximately 11,500 Australians are diagnosed (O'byrne et al. 2016). Considering
the prevalence of the disease, it more common in men compared to female where smoking is one
of the common contributors to the development of lung cancer (Kubota et al. 2017). The world
health organization suggested that each year 1350000 new cases are reported in the clinical
setting. The most common symptoms of the disease are chest pain, cough, unexpected loss of
appetite, shortness of breath and prevalence of lung infection such as pneumonia and bronchitis
(O'byrne et al. 2016). Every number the number of the new cases are increasing exponentially,
indicating poor prognosis and high prevalence of the disease. The researchers suggested that in
men, the common form of lung cancer is non-small cell lung cancer where epithelial cells of
lungs become affected. This paper will focus on a case study where a 78 years old man, Nigel
was diagnosed with primary stage 4 non-small lung cancer which further caused metastasis to the
liver. He was experiencing pain which further made him uncomfortable. He was administrated
with an active regimen of a combined drug such as Cisplatin and docetaxel using intravenous
infusion every three weeks. He was administrated with morphine to reduce the pain he was
experiencing. This paper will provide critical analysis of the pathophysiology of cancer,
pharmacokinetic effect of intravenous chemotherapeutic, mechanism of chemotherapeutic drugs,
adverse effects of morphine and management.

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Discussion:
Pathophysiology of lung cancer associated with the symptoms:
While lung cancer can be classified into two groups such as small cell lung cancer and
non-small cell lung cancer, the highest prevalence of non-small cell lung cancer is higher in men
compared to women. As discussed by Muller et al. (2016), there are certain risk factors evident
in the lung cancer patients such as smoking, exposure to asbestos, tar and soot, chromium,
arsenic and nickel, genetic factors are the contributor of non-small cell lung cancer. In patients
exhibiting these risk factors are often live with non-small lung cancer where epithelium cell line
of lungs produce tumor and damaged lung tissues (Böttger et al. 2019). The damage of the lung
tissues is manifested as an array of symptoms where shortness of breath and live metastasis are
highlighted, inpatient. Taking in an insight into the situation it can be said that the tumor
produced in the lung cancer narrow the down or airway resulted in lack of adequate oxygen level
in lungs and eventually facilitate the enlargement of the right side of the heart (Böttger et al.
2019). Hence, the patient was experiencing dyspnea or shortness of breath and makes him
uncomfortable.
Considering secondary cancer, the patient was experiencing liver metastasis which
affected his pharmacological interventions. The metastatic tumors of the lungs are the cancers
which are developed at other places when spread from lungs. As discussed by böttger et al.
(2019) in the advance or last stages of lung cancer, the malignant cells break cell to cell
junctions and spread through the blood or lymphatic system. In the current context, since the
lungs are situated close the lungs in the right upper quadrant in stage four metastatic cells
spread through blood or lymphatic system to the liver and damage the tissues of the liver

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(O'byrne et al. 2016). Hence, the patient was suffering from substantial liver metastasis which
resulted in pain in the right upper quadrant.
Impact on the pharmacokinetics of chemotherapeutic drugs:
The case study highlighted the primary stage four non-small lung cancer of patient which
has been spread to the liver, developing liver metastasis. While metastatic cells can affect any
organs, the liver was affected in the case of Nigel which further affects the normal metabolism
process of the body. As discussed by Zhang, et al. (2016) since the liver is the crucial organ
which facilitates the process of metabolism of the pharmacokinetics of drugs have a major
impact when drugs enter the liver. The process by which drug metabolized to active form is
defined as first pass metabolism and the hepatic system is the key player in the successful
accomplishment of drug metabolism. In the current context, the patient was administrated with
chemotherapeutic drugs such as Cisplatin and docetaxel in order to cure cancerous lungs (Kubota
et al. 2017). If these drugs were orally administrated to the patients then these drugs had to pass
through hepatic first metabolism. After oral administration of drugs, by following ADME
principle, every drug is absorbed by the gastrointestinal tract which further travels immediately
to the hepatic system through the portal vein (Sodhi et al. 2017) . In the hepatic system, the
significant amount of drugs is metabolized into an active form of drug which is sufficient for
performing localized action (Muller et al. 2016). Hence, when the drug is metabolized through
the liver, the bioavailability of drugs reduced to 20% to 30 % (O'byrne et al. 2016). However,
considering the secondary liver cancer of patient where the normal function of the liver was
disrupted, the health professionals administrated these two chemotherapeutic drugs using the
intravenous infusion. As discussed by Gazdar et al. (2017), the intravenous infusion process is
undertaken in patient to avoid the first pass metabolism of drugs. In intravenous infusion, the