Pulmonary Complications of Cancer

Original Editor - Donald John Auson Top Contributors - Donald John Auson and Kim Jackson

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Infectious Complications

Cancer patients are susceptible to infection, particularly those undergoing chemotherapy and radiation therapy. Aside from that, there are a variety of factors that predisposes the cancer patient to infection such as immune deficiencies, organ dysfunction, concurrent illness and past infections, nutritional status, psychological stress, surgery and diagnostic and invasive procedures.

Bacterial Infection

Bacterial infection in cancer patients present in the form of pneumonia. The severity of bacterial pneumonia depends on the underlying immunologic defect, the duration of the immunocompromised state, whether the infection is community acquired or hospital acquired and the pathogen involved.

Common bacterial pathogens:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Pseudomonas aeruginosa
• Escherichia coli
• Klebsiella species
• Legionella pneumophila
• Mycoplasma pneumoniae
• Nocardia and Actinomyces species
• Moraxella catarrhalis

Non-Infectious Complications

Cancer patients can suffer from pulmonary complications not caused by infections. these complications can be result of primary malignancy, metastasis or treatment.

Metastatic Disease

Metastatic disease pertains to the complication of cancer wherein the cancer cells have spread to either a distant site or an adjacent structure. Metastasis to the lungs can happen through hematogenous, lymphatic or direct invasion.

Obstructive Lung Disease

Acute bronchospastic reaction

Airway tumor

Pre-existing COPD

Restrictive Lung Disease

Restricive lung disease can be a result of:

• Primary malignancy
• Malignant pleural effusion
• Kyphoscoliosis- can be a result of metastatic lesions to the thoracic spine or osteoporosis from treatment of the primary malignancy
• Neuromuscular disease complications- usually associated with Lambert-Eaton Myesthenic Syndrome, which is usually associated with small cell lung cancer ~60%.
• Phrenic nerve paralysis- can be a result of extrathoracic tumors (rare), primary lung tumor (more frequent), mediastinal tumor, surgery (lung or radical neck dissection), toxicity from chemotheraphy (5-fluorouracil or doxorubicin).
• Pulmonary fibrosis- from radiation and chemotherapy

Restrictive lung disease from the said conditions can produce symptoms such as dyspnea and can lead to respiratory failure.

Drug Toxicities

Certain drugs have been shown to increase the risk for the development of pulmonary complications such as respiratory failure. This include tyrosine kinase inhibitors, mTOR kinase inhibitors, monoclonal antibody, taxanes.  A study showed that exposure to one of more of these medications was a significant risk factor in the development of respiratory failure.