Irene is a 55-year-old female who went to a primary care clinic because she has had a “cold” for
the last 2 months.She tries to eathealthyand exercises daily. She plays tennis a few times per
week and goes for a short walk every day. Irene is now a non-smoker, but she used to smoke in
her 20s and 30s. Irene tells the clinic physician that she has a cough that she cannot seem to get
rid of. She said she feels more fatigued and is short of breath after playing tennis, which is not
like her. She has also been having some chest pain when she takes a deep breath.
The doctor ordered a chest X-ray, which showed a large mass in the right lung. She was booked
for a bronchoscopy and biopsy, and the pathology reportindicatesshe has non-small cell
adenocarcinoma in the upper lobe of her right lung. She will be booked for surgery, followed by
chemotherapy. There were no targetable mutations found in the cancer cells, so Irene will receive
Cisplatin and Pemetrexed after surgery to ensure there are no cancer cells left.
1.Briefly describe the pathophysiology related tooneof her symptoms
Choose one of the following for your discussion post.
a.Persistent cough
b.Shortness of breath
c.Fatigue
d.Chest pain
(a. Persistent cough)
A persistent cough in Irene can be explained by tumour-related airway irritation and
inflammation. In non-small cell lung cancer, tumour growth can narrow or compress bronchi,
leading to retained mucus and stimulation of cough receptors located in the bronchial mucosa
(Power-Kean et al., 2023, pp. 448–450). Tumour cells also trigger local inflammatory responses,
where cytokines and immune cells cause airway wall thickening, increased mucus production,
and heightened sensitivity to mechanical stimuli. These changes activate the vagus-mediated
cough reflex, producing a chronic cough that does not resolve like a viral cold (Power-Kean et al.,
2023, pp. 451–452).
2. Briefly describe how one of the chemo drugs works to treat her cancer
Cisplatin is a platinum-based alkylating chemotherapy drug commonly used in non-small cell
lung cancer. After entering the cell, cisplatin forms cross-links with DNA, preventing DNA
replication and transcription. This leads to cell-cycle arrest and apoptosis in rapidly dividing
cancer cells (Sealock et al., 2021, pp. 838–840). Cisplatin is given after surgery to destroy
residual microscopic tumour cells and reduce recurrence risk.
References
Power-Kean, K., Zettel, S., El-Hussein, M. T., Huether, S. E., McCance, K. L., & Brashers, V.
(2023). Understanding pathophysiology (2nd Canadian ed., pp. 435–483). Elsevier.
Sealock, K., Seneviratne, C., Lilley, L., Raniforth Collins, S., & Snyder, J. S. (2021). Lilley’s
pharmacology for Canadian health care practice (4th Canadian ed., pp. 838–848). Elsevier.
