conclusion of lung cancer essay

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Cancer Control: Knowledge Into Action: WHO Guide for Effective Programmes: Module 4: Diagnosis and Treatment. Geneva: World Health Organization; 2008.

Cancer Control: Knowledge Into Action: WHO Guide for Effective Programmes: Module 4: Diagnosis and Treatment.

A plan for the diagnosis and treatment of cancer is a key component of any overall cancer control plan. Its main goal is to cure cancer patients or prolong their life considerably, ensuring a good quality of life. In order for a diagnosis and treatment programme to be effective, it must never be developed in isolation. It needs to be linked to an early detection programme so that cases are detected at an early stage, when treatment is more effective and there is a greater chance of cure. It also needs to be integrated with a palliative care programme, so that patients with advanced cancers, who can no longer benefit from treatment, will get adequate relief from their physical, psychosocial and spiritual suffering. Furthermore, programmes should include a awareness-raising component, to educate patients, family and community members about the cancer risk factors and the need for taking preventive measures to avoid developing cancer.

Where resources are limited, diagnosis and treatment services should initially target all patients presenting with curable cancers, such as breast, cervical and oral cancers that can be detected early. They could also include childhood acute lymphatic leukaemia, which has a high potential for cure although it cannot be detected early. Above all, services need to be provided in an equitable and sustainable manner. As and when more resources become available, the programme can be extended to include other curable cancers as well as cancers for which treatment can prolong survival considerably.

This module on diagnosis and treatment is intended to evolve in response to national needs and experience. WHO welcomes input from countries wishing to share their successes in diagnosis and treatment. WHO also welcomes requests from countries for information relevant to their specific needs. Evidence on the barriers to diagnosis and treatment in country contexts – and the lessons learned in overcoming them – would be especially welcome (contact at http://www.who.int/cancer ).

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob ). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep ).

• Cite this Page Cancer Control: Knowledge Into Action: WHO Guide for Effective Programmes: Module 4: Diagnosis and Treatment. Geneva: World Health Organization; 2008. CONCLUSION.
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Among terminal diseases humanity has not yet learned to treat, cancer is probably one of the most feared illnesses. Unlike AIDS or other diseases widely spread in countries with low standards of living, cancer’s geography is much wider, including both rich and poor countries equally. Among the variety of different types of cancer, one of the most common is lung cancer; the environment in which people live in the 21st century greatly contributes to the development of this type of cancer.

The first and the most popular cause of lung cancer is smoking cigarettes. By numerous estimates, smoking cigarettes causes approximately 86% of lung cancer cases, including cases caused by passive exposure to smoke exhaled by other smokers. These chances increase if a person started smoking tobacco at a young age. Passive smoking poses a lesser threat, but is still dangerous—it is known that passive smokers (who are usually exposed to smoke at work or at home) have a 25% higher risk of lung cancer compared to people who are not exposed to the smoke of cigarettes. Regular heavy exposure to environmental tobacco smoke can increase the risk of lung cancer by 50% ( National Cancer Institute ).

Genetics and lung diseases in one’s genetics can also become significant risk factors of lung cancer. For example, if a person’s mother, father, sibling, aunt, uncle, or grandparent has had lung cancer, the chances of this person developing lung cancer slightly increases. At the same time, it has not been yet researched whether genes indeed increase cancer chances, or they increase individuals’ susceptibility to this disease. As for lung diseases, some of them are known to affect the chances of cancer development. In particular, among such diseases are tuberculosis and chronic obstructive pulmonary disease. Other illnesses like chronic bronchitis and emphysema can cause scarring in the lungs, which means the increase of the amount of tissue in them—and as it is known, cancer is an uncontrolled division of cells, and the respective multiplication of tissues ( Healthline ).

As for other environmental factors , one of the most significant among them is the exposure to asbestos fibers and similar materials. Usually, a person is exposed to these silicate materials at the workplace: technical works, such as thermal and acoustic insulation, involve the usage of asbestos. Nowadays, asbestos is limited or even prohibited from usage, since it has been proven that asbestos materials can cause both lung cancer and mesothelioma (cancer of the lungs’ pleura, as well as cancer of peritoneum—a lining of the abdominal cavity). Even non-smoking asbestos workers have a five times higher risk of developing lung cancer; as for the smoking asbestos workers, their chances to get cancer are up to ninety-fold greater than nonsmokers ( MedicineNet.com ).

As it can be seen, lung cancer does not develop on its own, but is triggered by a number of factors. The first and foremost of them is smoking tobacco, both active and passive. Exposure to asbestos materials also increases a person’s chances to get lung cancer. Also, genetics and past lung illnesses can lead to the development of this type of cancer. The cure for lung cancer is not finalized, and remains an epidemic.

“Lung Cancer Symptoms, Causes, Treatment.” MedicineNet. N.p., n.d. Web. 12 Aug. 2015.

“Lung Cancer Risks and Causes.” CancerResearch UK. N.p., n.d. Web. 12 Aug. 2015.

“Lung Cancer Causes.” Healthline. N.p., n.d. Web. 12 Aug. 2015.

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Lung Cancer Research Results and Study Updates

See Advances in Lung Cancer Research for an overview of recent findings and progress, plus ongoing projects supported by NCI.

The results of the clinical trial that led to FDA’s 2023 approval of repotrectinib (Augtyro) for lung cancers with ROS1 fusions have been published. The drug shrank tumors in 80% of people receiving the drug as an initial treatment.

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For people with lung cancer and medullary thyroid cancer whose tumors have changes in the RET gene, selpercatinib improved progression-free survival compared with other common treatments, according to new clinical trial results.

In the ADAURA clinical trial, people with early-stage lung cancer treated with osimertinib (Tagrisso) after surgery lived longer than people treated with a placebo after surgery. Despite some criticisms about its design, the trial is expected to change patient care.

For certain people with early-stage non-small cell lung cancer, sublobar surgery to remove only a piece of the affected lung lobe is as effective as surgery to remove the whole lobe, new research shows.

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Atezolizumab (Tecentriq) is now the first immunotherapy approved by FDA for use as an additional, or adjuvant, treatment for some patients with non-small cell lung cancer. The approval was based on results of a clinical trial called IMpower010.

Quitting smoking after a diagnosis of early-stage lung cancer may help people live longer, a new study finds. The study, which included more than 500 patients, also found that quitting smoking delayed the cancer from returning or getting worse.

NCI scientists and their international collaborators have found that the majority of lung cancers in never smokers arise when mutations caused by natural processes in the body accumulate. They also identified three subtypes of lung cancer these individuals.

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Osimertinib (Tagrisso) improves survival in people with non-small cell lung cancer with EGFR mutations, updated clinical trial results show. People treated with osimertinib lived longer than those treated with earlier-generation EGFR-targeted drugs.

A large clinical trial showed that adding the immunotherapy drug durvalumab (Imfinzi) to standard chemotherapy can prolong survival in some people with previously untreated advanced small cell lung cancer.

The investigational drug selpercatinib may benefit patients with lung cancer whose tumors have alterations in the RET gene, including fusions with other genes, according to results from a small clinical trial.

FDA has approved entrectinib (Rozlytrek) for the treatment of children and adults with tumors bearing an NTRK gene fusion. The approval also covers adults with non-small cell lung cancer harboring a ROS1 gene fusion.

Clinical recommendations on who should be screened for lung cancer may need to be reviewed when it comes to African Americans who smoke, findings from a new study suggest.

Use of a multipronged approach within hospitals, including community centers, not only eliminated treatment disparities among black and white patients with early-stage lung cancer, it also improved treatment rates for all patients, results from a new study show.

In everyday medical care, there may be more complications from invasive diagnostic procedures performed after lung cancer screening than has been reported in large studies.

The Lung Cancer Master Protocol, or Lung-MAP, is a precision medicine research study for people with advanced non-small cell lung cancer that has continued to grow after treatment. Patients are assigned to different study drug combinations based on the results of genomic profiling of their tumors.

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A new study has identified a potential biomarker of early-stage non–small cell lung cancer (NSCLC). The biomarker, the study’s leaders said, could help diagnose precancerous lung growths and early-stage lung cancers noninvasively and distinguish them from noncancerous growths.

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A collection of material about the ALCHEMIST lung cancer trials that will examine tumor tissue from patients with certain types of early-stage, completely resected non-small cell lung cancer for gene mutations in the EGFR and ALK genes, and assign patients with these gene mutations to treatment trials testing post-surgical use of drugs targeted against these mutations.

Lung Cancer Cells Migrating to Other Parts of the Body

Introduction.

Lung cancer occurs where uncontrolled cell growth spreads in one or both lungs interfering with the normal body function system. The abnormal cell growth divides into masses of tissue known as tumours which interferes with the normal functioning of the lungs-which is to provide bloodstream with oxygen. In cases where cancer cells migrate to other parts of the body, more serious conditions which may be difficult to treat may arise. This case can be seen in Malina case, who is the focus of the case report. The essay will first examine the effects of Malina’s conditions in terms prediction of its occurrence and how she has managed to live with it. Secondly, the numbers of treatment methods and complementary therapies available for lung cancer management and lastly, the provision of continuity of care within a multidisciplinary team setting and Palliative care.

Basic Information

Malina is a 46 year-old white Caucasian female cancer patient living in United Kingdom. She works a full time job as an audit clerk for a construction company and lives with her husband and two teenage children. The patient Malina is case adopted from one presented by Baldwin (2006) with symptoms of fatigue from her full time job as a billing clerk for a construction company and recently had a persistence cough.

Lung cancer disease and the parameters in the prediction of its occurrence

This case study refers to Malina (Baldwin, 2006), a 46 year old non-smoker, who was diagnosed with Non-Small Cell Lung Cancer (NSCLC) and found to have adenocarcinoma. The case study used progression method to study the rapid movement of adenocarcinoma in the lung cancer for a period of two years. The results however indicated that the disease accelerated fast within a short period and even produced advanced form of cancer. It was therefore concluded that management of lung cancer can prove difficult with delayed prognosis and therefore palliative care should be the strategy to increasing quality of life (Baldwin, 2006).

At the beginning of the treatment, the Malina’s home was tested for radon levels and reported no history of asbestos or carcinogens. On diagnosis, the film chest test identified nodule in the patient’s lung and was later diagnosed with NSCLC. Malina was then booked in one month later for the removal of nodular mass that had projected in the lungs. At the time of the surgery, the cancer was discovered to be worse which was later diagnosed to Stage II-B adenocarcinoma. Soon the operation was completed the patient reported to be experiencing gastrointestinal and abdominal pains (Baldwin, 2006).

Living with Lung Cancer

A number of treatment methods have been implemented and complementary therapies including meditation and relaxation are widely used to improve the quality of life of a cancer patient. One of the treatments includes neoadjuvant chemotherapy in Non-Small Cell Lung Cancer (NSCLC) patients undergoing curative surgery in stages I, II, IIIA NSCLC to determine if the treatments can effectively manage lung cancer symptoms (Eldridge, 2009) hence improvement of patients’ quality of life. However, it is important to note that effectiveness of chemotherapy can only be achieved when combined with other treatments. The results produced different degrees of improvement when two treatments of standard radiotherapy and chemotherapy were combined. This therefore brings us to the conclusion that neoadjuvant chemotherapy combined with the best supportive care from health professionals and the family can help the patient achieve quality of life (Eldridge, 2009).

According to Eldridge (2009), about 51% of lung cancer patients experience pain during their treatments. The pain may be caused by a number of factors such as lung lining tumours that keep on pressing nerves and pleura, other diseases associated with the illness include headaches, mouth sores and coughing. Malina first presented flu symptoms in March 2004 that later graduated to fatigue and persistent cough. National Pain Cancer Institute (2008) explains that lung cancer pain may vary from one patient to the other depending on the severity of the disease. According to Eldridge (2009), lung cancer patients are also faced with fears that the pain medication will no longer work and the pain will continue to get worse. He sates that when managing cancer, a patient should be made aware that they will never become immune to the medication and if they ever do which is unlikely, many options are available to alleviate the pain. Patients also faced with fears of associated side effects relating cancer drugs should be made to understand that all medications have side effects but its fairly easy to control them. Many have complained of their inability to afford the pain medication, but the patient can be prescribed less expensive medication or directed financial help centre where they can get help (National Pain Cancer Institute, 2008).

Quality of Life (QOL)

Quality of life is a measurement that is used to evaluate the general well being of an individual, a patient for this case. In management of cancer, quality of life refers to how the disease has negatively affected the person’s degree to enjoy life. My case study will specifically highlight Malina’s case in relations to lung cancer symptoms such as wheeze, tiredness, weigh loss, breathlessness, fatigue and haemoptysis as stated in Baldwin (2006). Malina’s infection with Beijing flu back in 2004 while pregnant with her second child exposed her to ectopic pregnancy hence negatively impacting on her quality of life. The patient was later diagnosed with benign tumour which was later usefully removed following surgery (Baldwin, 2006) also compromised her quality of life. Studies have consistently found that lung cancer inherent burdens, treatments and the related toxics always revolve around patient’s quality of life. Apart from the normal medication, a patient can be referred to various interventional pain treatments such as radiation therapy, chemotherapy or surgery for cases of extreme cancer cases like pressing tumours (Christo & Mazloomdoost, 2008; Dacey et al 2005).

Various forms of treatment of Lung Cancer

In improving the quality of life and management of cancer, many hospitals and cancer centres now offer alternative approaches to control pain. The alternative approaches are used in conjunction with other lung cancer pain treatments and have been reported to effective and great substitute to pain medication in the long run. Christo & Mazloomdoost (2008) mentions the complimentary approaches as hypnosis, acupuncture, therapeutic touch and message therapies (Eldridge, 2009; Dy, 2008).

Once the diagnosis is complete, the patient should be referred to the nearest oncology specialist if possible. Pain addiction medications should also be talked about and any other concerns affecting the patients such as stigma should be approached with delicacy. Principles of care of lung cancer managements require care giver and specialists nurses to ensure a patient receives appropriate specialist support in the pre and post operations. For effective quality support, surgery units should be equipped with High Dependency facilities ready for intensive care support and treatment plans designed around successive case reviews in fully serviced multidisciplinary team meetings (Eldridge, 2009; Ripamonti & Bandieri, 2009).

Radical Radiotherapy for Stage I and Stage II

A study conducted to measure the effectiveness of radiotherapy on NSCLC following a Cochrane and systematic review on the selected evidences collected from 44 retrospective case series including 3,683 patients with doses more than 50Gy/25F (Scottish Intercollegiate Guidelines Network, 2005). It was however concluded that measuring the effectiveness of the treatment was not an easy task because of the un-uniformed entry criteria or the pre-treatment prognostic criteria. The studies however suggested that the treatment was effective in prolonging survival of the patients in both stages of the cancer. Another study of RCT showed the Continuous Hyperfractionated Accelerated Radiation Therapy (CHART) is much more effective that 60Gy/6W in stage II patients (Scottish Intercollegiate Guidelines Network, 2005). A meta-analysis study however concluded that survival benefits for hyper-fractionated radio therapy were higher compared to convectional radio therapy. Another randomised controlled trails measuring how radiation can reduce mobility in combination of other agents or in altering the radiation technique were not adequately looked into. Therefore trail on reducing radiation mobility should be looked into as they may prove effective in lung cancer pain management (Jung et al, 2007; Brady et al , 2006).

Chemotherapy for Stage IIIB and IV

A meta-analysis study conducted by Scottish Intercollegiate Guidelines Network (2005) to evaluate the benefit of chemotherapy provided reports of pain improvement around the sixth week and increased survival rates of up to 10%. The combination of modern chemotherapy such as the paclitaxel, docetaxel and vinorelbine and the best supportive care such as the radiotherapy were seen to increase the quality of life.

Newer approaches for treating cancer such as blocking specific tumour growth receptors does not entirely benefit all lung cancer patients more specifically patients in stages IIIB/IV NSCLC (Scottish Intercollegiate Guidelines Network , 2005). Older patients are reported to respond differently to various treatments compared to younger patients. Older patients should not either be discriminated against chemotherapy treatments as they just may respond well to the treatment compared to single agent therapies (Scottish Intercollegiate Guidelines Network, 2005; Soon et al , 2009)

Malina received chemoradiation therapy on a weekly basis which combined Carboplaton and Pluclitaxol which started soon the patient complained of the pains for a period of 1year four months. Chemotherapy was aimed at prolonging the patient’s life and relieves the symptoms. It was reported that the patient responded well within the first four months of treatment and began exercise and diet program which improved Malina’s general health. Two years later, the patient experienced PET scan changes and small nodules were reported to appear in the trachea together with a mass of bronchoscopy which was later removed. A repeat of PET was performed while awaiting the results and the patient was offered a number of treatments options to choose from which included chemotherapy, radiation, oral Tarceva and Vorino stat for phases I/II and Brachytherapy. The repeated PET scan revealed extended invasion in the pleural space and two small nodules in the liver. This meta-analysis required the patient to review the treatment options provided (Baldwin, 2006).

Multidisciplinary teams

Consistence findings across UK and Scotland emphasised the benefits of multidisciplinary team to benefit lung cancer patients. The findings summarized that caregivers should consistently follow up on the patient to ensure maximum care is achieved. In this case, institutions should adopt patient-centre approach that will ensure effective communication throughout the treatment period (Scottish Intercollegiate Guidelines Network, 2005; Jacobson et al, 2004).

Multidisciplinary team is defined by National Institute for Clinical Excellence (2008) as the a group of health and social care professional from a range of disciplines who meet regularly to discuss and agree plans of treatment and care for people with particular type of cancer or problem, or in a particular location (148).

The benefits of the team roles were identified to be providing fast tract model in reducing waiting times and there positively impacted the nursing interventions. Reports from the Allied Health Professions Palliative Care Project concluded that team participation in lung cancer management combined with palliative care, rehabilitation and supportive interventions enhanced patient’s life (Coory et al , 2008; Moore, 2006; The British Thoracic Society Lung Cancer Working Party, 2005).

A patient should immediately be directed to a multidisciplinary team consisting of specialist nurses, pathologists, respiratory physician, radiologists, thoracic surgeon, pharmacists and allied health care professions once the diagnosis is complete. Once the plan is formulated, a specialised nurse and a physician should explain to the patient about the diagnosis, staging and management of the disease. The patient should be provided with full possessions of both verbal and written information on the subject (Scottish Intercollegiate Guidelines Network, 2005; Forrest, 2005; Barnes and Wilkinson, 2004; Harding & Murtagh, 2006).

Supportive and palliative care of family and friends

Supportive care that includes help from family members in supporting the patient cope with the lung cancer symptoms and treatment is very crucial. Family members should be encouraged to take part in the patient’s life right from pre-diagnosis, through diagnosis to treatment (Simoff & Kvale, 2005). This strategy has is reported to be widely successful in maximising the benefits of treatment. Nurses should therefore give family support an equal opportunity alongside diagnosis and treatment. In palliative care, nurses should take roles in providing holistic care of the patient by providing psychological, social and spiritual support in the best way possible. Palliative should be used in combination with other treatment for maximum efficiency. Also, the specialist palliative care will be needed in patients with far advanced illnesses and required active participation of multi professional team with adequate skills to prove psychological, spiritual, physical and social support. It is for this reason the General Medical Council and NHS Quality Improvement Scotland have provided a new treatment approach by requiring all medical team professional to acquire degree of palliative care skills to adequately care for cancer patients (General Medical Council, 2004; Clinical Standards Board for Scotland, 2005).

Lung cancer patients often experience extreme symptoms compared to other types of cancers. Since Malina’s health improved significantly following chemotherapy treatment, health professionals in this case should therefore ensure the patient attends all the treatment sessions for symptoms management appropriately. Neoadjuvant chemotherapy should be combined with the best supportive care from health professionals and the family can help the patient achieve quality of life. Multidisciplinary team combined with palliative measures should effectively be applied in improving quality of life for cancer patients. Treatment and management of cancer can be successful if the patient is diagnosed in time, therefore, physicians, specialist and doctors should make efforts to observe lung cancer symptoms and offer good prognosis on time.

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IvyPanda. (2023, November 22). Lung Cancer Cells Migrating to Other Parts of the Body. https://ivypanda.com/essays/lung-cancer-the-case-analysis/

"Lung Cancer Cells Migrating to Other Parts of the Body." IvyPanda , 22 Nov. 2023, ivypanda.com/essays/lung-cancer-the-case-analysis/.

IvyPanda . (2023) 'Lung Cancer Cells Migrating to Other Parts of the Body'. 22 November.

IvyPanda . 2023. "Lung Cancer Cells Migrating to Other Parts of the Body." November 22, 2023. https://ivypanda.com/essays/lung-cancer-the-case-analysis/.

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Lung Cancer, Essay Example

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This paper explores the medical disease of lung cancer.  The paper is split into four distinct parts: (1) Background and Introduction to the disease  (2)  Cause of the disease and medical treatments available (3) Prognosis of the disease and medical trends  (4)  Summary.  The paper addresses the question – What is lung cancer in humans ?

Background and Introduction

Cancer that is diagnosed as originating from lung cells is referred to as ‘lung cancer’. It is one of the leading causes of death in men and women.  Cigarette smoking has been outlined as one of the main causes attributable to lung cancer.  The disease has increased over the last decade primarily due to the increase in female smokers.  Those most vulnerable fall between the ages of 45-70 years. A persistent cough is the most tell tale sign of lung cancer but you will require chest X rays and a biopsy to determine confirmation.  The most common forms of treatment are radiation therapy, chemotherapy, and targeted drugs or agents.  Cancer that originates from the lungs is described  as that of Primary Cancer. ” Primary lung cancer can start in the airways that branch off the trachea to supply the lungs (the bronchi) or in the small air sacs of the lung (the alveoli). Cancer may also spread (metastasize) to the lung from other parts of the body (most commonly from the breasts, colon, prostate, kidneys, thyroid gland, stomach, cervix, rectum, testes, bone, or skin” (Waun Ki Hong and Anne S. Tsao).

Cause of the disease and treatments available

The main cause of lung cancer has been pointed towards that of Cigarette smoking, It is estimated to contribute to 85% of all known cases. Statistics in addition indicate that 15% are non smoking related and often attributable to some form of genetic disorder.  Other risk factors include exposure to radon gas, asbestos, passive smoking e.g. people working in confined spaces with smokers such as bars and restaurants. In the last decade these sort of environments have been largely eliminated owing to media pressures and greater awareness in the potential harm that this causes.  There are other cacogenic agents like Copper, nickel, chromates and coke oven emissions which put people at increased risk.  Cigar and pipe smokers also fall under this risk.

The most specific symptom is coughing, although other specific side effects include loss of appetite, weight loss, fatigue, chest pains and weakness. On rarer occasions the coughing may also include bleeding.  ” Lung cancer may also spread through the bloodstream to other parts of the body, most commonly the liver, brain, adrenal glands, spinal cord, or bones. The spread of lung cancer may occur early in the course of disease, especially with small cell lung cancer. Symptoms—such as headache, confusion, seizures, and bone pain—may develop before any lung problems become evident, making an early diagnosis more complicated” (Waun Ki Hong and Anne S. Tsao).

Figure 1 : Source Merck Statistics

There are a number of treatment options available depending upon the stage of advancement of the cancer.  These include Radiation treatment, Chemotherapy, Drugs and other agents.  ” Surgery is the treatment of choice for non–small cell lung cancer that has not spread beyond the lung (early-stage disease). In general, surgery is not used for early-stage small cell lung cancer, because this aggressive cancer requires chemotherapy and radiation therapy. Surgery may not be possible if the cancer has spread beyond the lungs, if the cancer is too close to the windpipe, or if the person has other serious conditions” (Waun Ki Hong and Anne S. Tsao).

Prognosis and Medical Trends

Lung Cancer has a very poor prognosis. People who do not obtain treatment rarely survive more than 6 months. Those treated with extensive cell cancer or advanced small cell cancer have less than a 5 year survival rate. Early non small cell lung cancer are estimated to have a 5 year survival rate of 60-70%.  Cancer often returns within the first two years of treatment.  This is detected by regular check-ups i.e. X Rays, CT Scans etc.  Like most cancer patients they will be monitored for the rest of their natural lives. As most people diagnosed with lung cancer eventually die there is a need to consider planning for terminal care.  Anxiety and pain are often associated with the disease but these may be treated with drugs and this has permitted many people to die in the relative comfort of their own home. This without the more formal need for hospice services.

The Medical world continues to seek out new treatments for lung cancer and there is no doubt that medical advancements continue to make improvements in this area.  ” Scientists have identified a new drug which could be used to treat people with small cell lung cancer.

Researchers at Imperial College London and part-funded by Cancer Research UK found the drug, named PD173074, eliminated small cell lung cancer tumours in 50 per cent of cases when tested on mice. It also prevented the tumours from growing and stopped them from becoming resistant to treatment” (Pardo).

The graph in Fig 2 to the left illustrates the incidence of Lung Cancer across the countries in continental Europe.  Age standardised incidence rates of lung cancer by sex in EU 2006.

Figure 2 Incidence of ling cancer in EU

Note the high cigarette smoking countries of Hungary, Poland and Denmark.  This is also an area of high alcohol consumption which is also considered may have a contributory affect.

The position in Fig 3 shows the trends over time in the EU looking at the period of 1975-2006.  It reveals a sharp decline in men (stopped smoking) and an increase in women (increased smoking).  but the overall picture is that of a decline in smoking.

Figure 3 The trend in EU 1975-2006

Works Cited

Pardo, O., Latigo, J., Jeffery, R., Nye, E., Poulsom, R., Spencer-Dene, B., Lemoine, N., Stamp, G., Aboagye, E., & Seckl, M. Cancer Research UK. 12 11 2009. 14 4 2010 <http://info.cancerresearchuk.org/news/archive/cancernews/2009-11-12-Impressive-new-lung-cancer-drug-revealed>.

Waun Ki Hong, MD and MD Anne S. Tsao. Lunng Cancer. 1 3 2008. 14 4 2010 <http://www.merck.com/mmhe/sec04/ch057/ch057a.html>.

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Essay on Cancer for Students and Children

500+ words essay on cancer.

Cancer might just be one of the most feared and dreaded diseases. Globally, cancer is responsible for the death of nearly 9.5 million people in 2018. It is the second leading cause of death as per the world health organization. As per studies, in India, we see 1300 deaths due to cancer every day. These statistics are truly astonishing and scary. In the recent few decades, the number of cancer has been increasingly on the rise. So let us take a look at the meaning, causes, and types of cancer in this essay on cancer.

Cancer comes in many forms and types. Cancer is the collective name given to the disease where certain cells of the person’s body start dividing continuously, refusing to stop. These extra cells form when none are needed and they spread into the surrounding tissues and can even form malignant tumors. Cells may break away from such tumors and go and form tumors in other places of the patient’s body.

Types of Cancers

As we know, cancer can actually affect any part or organ of the human body. We all have come across various types of cancer – lung, blood, pancreas, stomach, skin, and so many others. Biologically, however, cancer can be divided into five types specifically – carcinoma, sarcoma, melanoma, lymphoma, leukemia.

Among these, carcinomas are the most diagnosed type. These cancers originate in organs or glands such as lungs, stomach, pancreas, breast, etc. Leukemia is the cancer of the blood, and this does not form any tumors. Sarcomas start in the muscles, bones, tissues or other connective tissues of the body. Lymphomas are the cancer of the white blood cells, i.e. the lymphocytes. And finally, melanoma is when cancer arises in the pigment of the skin.

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Causes of Cancer

In most cases, we can never attribute the cause of any cancer to one single factor. The main thing that causes cancer is a substance we know as carcinogens. But how these develop or enters a person’s body will depend on many factors. We can divide the main factors into the following types – biological factors, physical factors, and lifestyle-related factors.

Biological factors involve internal factors such as age, gender, genes, hereditary factors, blood type, skin type, etc. Physical factors refer to environmental exposure of any king to say X-rays, gamma rays, etc. Ad finally lifestyle-related factors refer to substances that introduced carcinogens into our body. These include tobacco, UV radiation, alcohol. smoke, etc. Next, in this essay on cancer lets learn about how we can treat cancer.

Treatment of Cancer

Early diagnosis and immediate medical care in cancer are of utmost importance. When diagnosed in the early stages, then the treatment becomes easier and has more chances of success. The three most common treatment plans are either surgery, radiation therapy or chemotherapy.

If there is a benign tumor, then surgery is performed to remove the mass from the body, hence removing cancer from the body. In radiation therapy, we use radiation (rays) to specially target and kill the cancer cells. Chemotherapy is similar, where we inject the patient with drugs that target and kill the cancer cells. All treatment plans, however, have various side-effects. And aftercare is one of the most important aspects of cancer treatment.

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Understanding the Incidence and Mortality of Lung Cancer

Introduction.

The lungs are made up of 2 sponge-looking tissues in the chest. The right lung consists of 3 parts, referred to as lobes, while the left has two lobes. Given that the heart is located on the left side and takes some space, it means the left lung is smaller. The alveoli are tiny air sacks that are responsible for the absorption of oxygen into the blood. Additionally, the alveoli get rid of the carbon dioxide during exhalation. The primary function of the lungs is to take in oxygen and dispense carbon dioxide. Typically, lung cancer begins in the bronchi cell lining and segments of the lungs, like the alveoli and bronchioles. This essay will highlight the risk factors for lung cancer, the incidence rates, and mortality rates of the disease.

Risk factors

Tobacco (firsthand and secondhand smoke).

The leading cause of lung cancer is tobacco smoking. Approximately 80% of deaths related to lung cancer are believed to be a result of tobacco, with the figure probably being greater for small cell lung cancer (SCLC). Lung cancer risk for smokers is significantly higher than for nonsmokers. The more one smokes, and the more cigarette packets one smokes, the higher the risk for diagnosis. Pipe smoking and cigar smoking have an almost equal likelihood of cigarette smoking causing lung cancer. Smoking “light” or low-tar cigarettes also has an equal likelihood of causing lung cancer as smoking regular cigarettes. Menthol cigarettes might exacerbate the risk of lung cancer compared to regular cigarettes because menthol may make it easier for smokers to inhale even more deeply (American Cancer Society, 2023). For nonsmokers, inhaling the smoke from smokers (referred to as secondhand smoke) has the likelihood of increasing one’s risk of being diagnosed with lung cancer. Secondhand smoke is the USA’s third most frequent cause of lung cancer.

Radon exposure

Radon is a radioactive gas that naturally occurs and is an outcome of uranium breakdown in rocks and soil. It is invisible to the naked eye and cannot be smelled or tasted. The US Environmental Protection Agency (EPA) asserts that the second most common risk factor for nonsmokers in the US is radon. There is an insignificant amount of radon outside that is unlikely to cause any danger, although this gas might be highly concentrated indoors. Inhaling radon subjects the lungs to minor radiation amounts, thus heightening the individual’s risk of lung cancer (American Cancer Society, 2023). Houses, among other buildings in almost every location of the USA, could potentially have elevated amounts of radon indoors.

Asbestos Exposure

People whose work involves contact with asbestos, such as insulation jobs, mills, mines, shipyards, and textile plants, have a higher likelihood of dying from lung cancer. There is a greater risk for lung cancer diagnoses among workers subjected to environments with asbestos who smoke as well. Individuals subjected to great amounts of asbestos are at a higher risk of acquiring mesothelioma, a form of cancer that begins in the lungs’ surrounding lining known as the pleura (American Cancer Society, 2023). Government regulations have, in recent years, considerably reduced asbestos use in industrial and commercial products. Asbestos still remains present in many houses, although it is regarded harmless as long as there is no renovation, demolition, or deterioration that might cause its release into the atmosphere.

Lung cancer has, in the last several decades, been the most frequently diagnosed form of cancer globally (Bray et al., 2018). Statistics from 2018 on lung cancer showed an approximated 2.1 million novel cases of lung cancer diagnosis, which was 12% of the world’s total cancer affliction. Lung cancer still continues to be the most popular cancer diagnosis among men, with an estimated 1.37 million diagnoses. Regions with the highest incidents include Eastern Asia, Micronesia, Eastern and Central Europe, and Polynesia. Rates of incidence among women are largely lower compared to men, with an estimated 720,000 novel diagnoses in 2018. There are differences in the geographical rates of incidences for women in comparison to men. Such variations can be credited to cigarette smoking’s historical differences. The highest rates of incidences among women appear in North America, Western Europe, and Eastern Europe (Schabath & Cote, 2019).

Among men, lung cancer in the US is the second highest prevalent cancer after prostate cancer, while in women, it is the second highest prevalent cancer after breast cancer (Siegel et al., 2019). There were a projected 228,150 novel incidents of lung cancer in 2019. The rate of occurrence among women is 52 for every 100,000 and 71 for every 100,000 among men. Despite the dwindling rate among men beginning in the mid-1980s, rates of occurrence for women did not begin to go down until the mid-2000s due to historical sex-centered disparities of uptake in smoking as well as its consequent cessation. The fall in occurrence has seen a momentum gain in the last decade, with a decrease in rates from 2011 to 2015 at 1.5% annually in women and 3% annually in men. The occurrence of lung cancer is geographically higher in the South, Midwest, and the East (Schabath & Cote, 2019).

The geographical patterns worldwide regarding deaths caused by lung cancer are close to the ones in incidence as a result of this disease’s high rate of fatality and poor survival. Lung cancer is the number one cause of cancer mortality among males and the second most common cause of cancer deaths among females. The approximate number of deaths that occurred in 2018 was 1.8 million, which made up 1 out of 5 global cancer mortalities. The disparities in terms of geography and between women and men can mostly be ascribed to tobacco smoking’s historical patterns as well as the tobacco epidemic maturity (Bray et al., 2018).

Lung cancer is the number one cause of death caused by cancer in the US among both women and men (Siegel et al., 2019). There were an approximated 142,670 mortalities that were projected to occur in 2019, which accounts for 23.5% of every cancer-related mortality. Men’s mortality rate is around 51.6 for every 100,000 individuals and 34.4 for every 100,000 individuals for females. As a result of the decline in smoking, there has been a decrease in lung cancer mortalities by 48%, beginning with 1990 among males and by 23% among females in 2002. There was a decline in mortality rate from 2012 to 2016 by approximately 3% annually in females and 4% annually in males. Lung cancer-related deaths geographically follow a parallel trend in occurrence, inclusive of the highest rates as seen in the south (Schabath & Cote, 2019).

Overall, significant progress has been made over the past decades across the continuum for cancer control concerning prevention, etiology, diagnosis, early detection, survivorship, treatment, and end-of-life. Nevertheless, lung cancer still remains a significant global public health affliction. In terms of etiology, concerted efforts are necessary for the identification of lung cancer causal risk factors among nonsmokers and the identification of nonsmokers with the highest probability of getting lung cancer that could profit from a program for lung cancer screening.

American Cancer Society. (2023).  Lung cancer risk factors: Smoking & lung cancer . Smoking & Lung Cancer | American Cancer Society. https://www.cancer.org/cancer/types/lung-cancer/causes-risks-prevention/risk-factors.html

Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.  CA: A cancer journal for clinicians ,  68 (6), 394-424.

Schabath, M. B., & Cote, M. L. (2019). Cancer Progress and Priorities: Lung Cancer.  Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology ,  28 (10), 1563–1579. https://doi.org/10.1158/1055-9965.EPI-19-0221

Siegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019.  CA: A cancer journal for clinicians ,  69 (1), 7-34.

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Home — Essay Samples — Nursing & Health — Lung Cancer — The Prevention and Treatment of the Deadly Lung Cancer

The Prevention and Treatment of The Deadly Lung Cancer

• Categories: Lung Cancer The Dead

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Published: Oct 4, 2018

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Deadly Lung Cancer

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Apr. 2, 2024

Rice student making a difference in community through lung cancer research.

Priyanka Senthil is maximizing her opportunities at Rice University through her research and advocacy work related to lung cancer screening.

Senthil, a third-year student at Rice majoring in health sciences and minoring in medical humanities, has been working on clinical research related to improving lung cancer screening guidelines and treatment for the past three years.

“I’ve always been intrigued by lung cancer after I learned that it’s the deadliest cancer in the U.S. and the world,” Senthil said. “And that’s because a lot of people who are at high risk for lung cancer are not getting screened, which is the best way to catch lung cancer early. That’s what really drew me into both the research and advocacy work that I do now.”

Senthil is the executive director of the  American Lung Cancer Screening Initiative  (ALCSI), which is a national nonprofit organization of over 300 students and doctors across the country dedicated to raising awareness of and access to lung cancer screening.

Senthil is the president of ALCSI’s Rice chapter, which recently held a White Ribbon Build event where participants painted and signed wooden white ribbons for lung cancer patients.

“We have held over 490 community events and taught over 25,000 individuals about lung cancer screening,” she said. “We’ve also worked with mayors, governors and national leaders to issue proclamations and public service announcements encouraging constituents to get screened in addition to passing legislation around lung cancer screening.”

Senthil has published 10 papers related to lung cancer screening, including a first-author review  paper  that provides an update on the current lung cancer screening guidelines.

In March, she and her team published a  study  in the “Journal of Clinical Oncology” showing that using smoking duration, instead of pack-years, to determine lung cancer screening eligibility is more equitable and greatly increases opportunities for early lung cancer detection.

She also recently gave an oral presentation at the 2024 Academic Surgical Congress on a study regarding disparities in the surgical treatment of lung cancer between males and females in the United States. The study has found that females are more likely than males to receive inferior treatment for early-stage non-small-cell lung cancer.

Senthil said her research has made her passionate about finding ways to address underserved communities when it comes to accessibility of cancer treatment.

“I think it’s really important for groups to be doing research that highlights limitations and disparities in order to push for health policy change,” she said. “It goes back to trying to be a voice for people in communities that are oftentimes silenced or just not heard.”

Senthil’s time as a student at Rice has provided her with ample opportunities to pursue these passions boundlessly, she said.

“I have absolutely loved my time at Rice,” she said. “What I really liked about Rice early on was how collaborative the atmosphere is. Everyone is here to help and push everyone else up, and I really love that about Rice.

“Secondly, it’s the opportunities. We’re right next to the Texas Medical Center, which is the largest medical center in the world, so if you’re interested in research or anything related to medicine, there isn’t a better place to be.”

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Biden, Trump and Dr. Bob: the Human Realities of Aging on the Job

At 75, Dr. Bob Ross cares for the aging residents of Ortonville, Minn, even as he wonders whether he, and the presidential candidates, are up to all their tasks.

Dr. Bob Ross has been caring for the residents of Ortonville, Minn., since 1977. He’s aging alongside his patients. Credit...

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By Eli Saslow

Photographs by Erin Schaff

• April 8, 2024

He had become the local expert on what he called the “unwanted side effects of old age,” so Dr. Bob Ross, 75, rubbed arthritis cream onto his hands and walked into an exam room to see his seventh elderly patient of the day. He had been a doctor in the remote town of Ortonville, Minn., for nearly five decades, caring for most of its 2,000 residents as he aged alongside them. He delivered their children, performed their high school physicals, tended to their workplace injuries and now specialized in treating the wide-ranging symptoms of what it meant to grow old in America.

“What’s hurting you most today?” he asked Nancy Scoblic, 79.

“Let me take out my list,” she said. “Sore knees. Bad lungs. I’ve got a spot on my leg and pain in my shoulder. Basically, if it doesn’t hurt now, it’ll probably hurt later.”

She’d known him for most of her life, first as Bobby, whom her family sometimes babysat, then as Bob in high school, and now as Dr. Bob — the physician who had cared for her grandparents and also her grandchildren, and who almost everyone in Ortonville entrusted with their most vulnerable moments. It was behind the closed door of Dr. Bob’s exam room where hundreds of people filled out their advance directives, took cognitive evaluations and tested out their new walkers and hearing aids. It was Dr. Bob who delivered bad news with a farmer’s directness and then sat with families around a hospice bed for hours when the only thing left to do was to pray.

Most of his patients were white, geriatric and still largely self-sufficient — members of the same demographic as the country’s two leading presidential candidates in the 2024 election, 81-year-old Joe Biden and 77-year-old Donald Trump. The conversations at the heart of an election cycle were the same ones unfolding inside Bob’s office: What were the best ways to slow the inevitable decline of the human body? How did aging impact cognition? When was it possible to defy age, and when was it necessary to make accommodations in terms of decision-making or professional routines. These were the questions he asked his patients each day, and also himself.

He took Nancy’s hand and helped her onto the exam table, checking for circulatory problems as he felt her lymph nodes and her carotid artery for signs of swelling. He pressed his hands against her abdomen to seek out masses in the liver or enlargement of the spleen. It was the same geriatric exam he conducted at least 25 times each week, as Ortonville’s soybean farmers aged into retirement and America’s baby boomers arrived in his office showing more evidence of cancer, more bruises from falls, more diabetes, more strokes and more signs of memory loss and possible dementia.

“You have a mildly elevated blood sugar that I want to keep an eye on,” Bob said. “If your body’s healthy, that helps keep your mind sharp.”

“What causes it?” Nancy asked. “What shouldn’t I eat?

“Carbs. Sugar. If it tastes good, spit it out,” he said. “But what helps most is exercise.”

“I can walk around the yard once or twice, but anything more than that and my breathing kicks in,” she said. “I’m probably about as good right now as I’m ever going to get.”

“That’s true for a lot of us,” Bob said.

Nancy sat on the exam table as he listened to her heartbeat, using an adaptive stethoscope he’d purchased a few years earlier when his own hearing started to decline. Lately, he could detect symptoms of his aging in the weakness that overwhelmed his hands during minor procedures, and in his occasional slip-ups with patients’ names, even when he could recall decades of their medical and personal histories.

Every few months, he gathered his medical partners to ask if they’d noticed any signs of his incompetence. “You have to promise you’ll be honest with me if you ever see something that worries you,” he told them. But even as he sometimes wondered if it was time to retire, his patients refused to let him.

“If I have to get old, then you have to keep taking care of me,” Nancy said. “I’ll be 80 this summer. Can you believe that?”

“If you’ve seen one person at 80, you’ve seen one person at 80,” Bob said. “There are a million different versions of growing old.”

Bob had already exceeded the average life expectancy at birth for an American man, 73 years, which was longer than he had expected to be alive. Both his parents died before 60, his mother from cancer while Bob was still in high school and his father from a heart attack a few years later. One of his brothers served 20 years in the Army and then was killed in a motorcycle crash; another, a smoker, died of lung cancer at age 74. Bob’s wife, Mary, had gone into premature labor in the 1980s with their twin boys, and one died in the hospital two days later. The other child survived and then thrived for 15 months until the following winter, when he developed croup, and Bob found him unresponsive in his crib late one night.

He’d witnessed and grieved enough death in his lifetime to believe that it was an immense privilege to grow old, and he planned to do whatever he could to preserve it.

His version of 75 meant starting each day by taking a half dozen medications to help treat his hypertension, diabetes, arthritis and high cholesterol. It meant diet shakes for lunch, a nap each afternoon and limiting himself to two smaller cans of Coke each day. It meant taping a handwritten note from his grandchildren onto his treadmill — “this helps keep papa in Beast Mode” — and spending an hour each night doing balance exercises, cardio and strength training. It meant taking bucket list trips with Mary to Norway and Africa, even if he had to travel with a sleep apnea machine. And it meant continuing to work five days a week in the clinic when the rest of the medical staff typically worked four, because caring for his aging patients gave him purpose and community, and lately they seemed to rely on him even more.

“I’ve started to forget basic words,” a 78-year-old patient told him one morning. “Elbow. Cheddar. Broccoli. One minute they’re here, and the next they’re gone. I run through all my kid’s names before I finally land on the right one.”

“How long should it take to go to the bathroom?” asked the next patient, 84. “I’ll finish the crossword puzzle, get through sports, still nothing. Is that normal?”

“One lap around Walmart and my feet are shot for a week,” said a 71-year-old.

“I don’t want to fall again in the shower, so I just do a spit bath,” said a 96-year-old.

“I wake up in the middle of the night and I’m out of breath like I just ran a marathon,” an 81-year-old said. “Is that normal? How could that possibly be normal?”

He had been trying to answer his patients’ questions and anticipate their needs since 1977, when he began working at Ortonville’s under-resourced hospital as one of two doctors in the entire county. He and Mary took out a second mortgage on their home to help start a foundation for the hospital, which it used to recruit a half-dozen doctors and build a state-of-the-art rural health care system. The nephew who once ran a lemonade stand in Bob’s front yard was now a doctor and the hospital’s chief executive; a student he mentored in high school had become his colleague as the first female physician in Big Stone County. He’d delivered more than 1,500 babies over the years, at least 100 of whom had grown up to work alongside him at the hospital. He’d started morning sports programs for children, run fitness classes for hospital employees and referred patients to a regular dementia support group that Mary helped start at the community library.

But lately during some of his appointments, he felt as if he had few solutions to offer. All he could do was listen to his patients’ concerns, empathize and explain the inevitable reality of what happened to an aging human body. The frontal cortex of the brain started to shrink over time, which led to slower recall, shortened attention spans and difficulty multitasking. Heart valves and arteries stiffened with age, which forced the heart to work harder and increased the likelihood of high blood pressure and heart attacks. Spinal disks flattened and then compressed. The metabolism slowed. Muscles contracted, skin bruised, bones weakened, teeth decayed, gums receded, hearing diminished, eyesight deteriorated — and it was normal. It was entirely and inescapably normal.

“I don’t like getting old either, but it sure beats the alternative,” Bob told one of his patients, Keith Kindelberger, 71.

“In terms of mind-set, I never have a bad day,” Keith said. “I think you’ve got me overmedicated.”

Bob laughed, and then checked Keith’s eyesight. “Attitude sure does count for a lot,” he said.

He took his lunch break and walked to the doctors’ lounge, turning the TV on to Fox News. He drank his diet shake and played solitaire on his iPad as Senator Mitch McConnell, 81, appeared on the screen to announce he would be stepping down as the Senate Republican leader in November after a recent fall and a few public memory lapses during news conferences.

“One of life’s most underappreciated talents is to know when it’s time to move on to the next chapter,” McConnell was saying, as Bob finished his shake and lay down for a nap.

He had considered retiring at least a half dozen times in the last decade, but he always chose to scale back instead. He stopped performing surgeries, taking call shifts, working in the emergency room and serving as county coroner. But he never wanted to quit seeing his patients, and sometimes he wondered if that was because of how much they needed him, or how much he needed them. “I’m not sure exactly who I’d be without that core piece of my identity,” he said one morning, as he went to visit the patient who knew him best.

His oldest brother, Jay Ross, was 83 years old and lived with his wife a few blocks from the hospital. Sometimes, Bob stopped by on his way to work to check his brother’s lungs or monitor his back pain, but now he handed Jay a cup of coffee and the daily crossword puzzle.

“I know these are supposed to be good for my mind, but sometimes I know the answer and I can’t recall the right word,” Jay said.

“I see that in myself, and in general that’s not a significant sign of dementia,” Bob told him. “Recall slows down. It happens to all of us as we age.”

“You’re not kidding,” Jay said. “Just look at our potential presidents.”

Jay was a Democrat, and Bob was a Republican. They had argued over politics for 60 years, but lately instead of debating policy positions they often found themselves studying the physical condition of the two candidates. Who, if anyone, was still fit for office? Who had a better chance of enduring the physical, emotional and mental rigors of another four-year term?

“In some ways, I look at it almost like evaluating a patient,” Bob said. According to the reports from President Biden’s most recent physical, he was experiencing neuropathy in both feet, sleep apnea, moderate to severe arthritis, a stiff gait from degenerative changes in his spine and an irregular heart rhythm that was under good control. His doctors had determined that he was in good mental health and didn’t need a cognitive exam, but in the last several months, he had confused the president of Egypt with the president of Mexico and stumbled up the stairs onto Air Force One.

At the same time, Donald J. Trump, 77, was overweight, partial to fast food, and often said he didn’t believe in exercise. Recently, he had seemingly referred to his wife, Melania, as “Mercedes.” Twenty-seven mental health professionals had come together to publish a book in 2017 about his mental state, called “The Dangerous Case of Donald Trump.”

“My preference would be that Joe’s gone, Trump’s gone and give us two new, viable options,” Bob said.

“It’s nice to finally agree,” Jay said.

He had been thinking back over his own life, trying to pinpoint the peak of his cognitive capabilities. He raised four children, taught advanced high school math, lived in Guam and New Zealand, wrote several books on local history, served on the school board and started a foundation, but now a few hours of conversation and a crossword puzzle could leave him fatigued.

“I think my peak was probably in my 40s or early 50s,” he told Bob. “That’s when I had the best combination of energy and experience. What about you?”

“Oh, I don’t know,” Bob said. He no longer trusted his hands to perform a cesarean section, but in other ways he thought his experience was still making him a better and more empathetic doctor. “Probably 50s,” he said. “But it’s tough to admit the peak is behind you.”

“Then maybe it’s not,” Jay said. “It’s a very gradual decline.”

“Unless it’s a cliff,” Bob said.

What Bob feared was that one day he’d be sharp and the next his mind would begin to betray him, until eventually he stopped being himself altogether. He and Mary had read in a recent study that 1 in 7 people over age 71 could expect to have some type of dementia. By age 80, it was more like 1 in 4. Bob had noticed subtle behavioral changes in hundreds of his patients over the years, and the first step was always to administer a short test called the Montreal Cognitive Assessment, which Trump had often bragged about “acing” in 2018, and which Biden’s staff said the president had no reason to take because “he passes a cognitive test at work every day.”

“Draw a clock,” one question read. “Put in all the numbers and set the time to 10 minutes after 11.”

“Name the maximum number of words in one minute starting with the letter F (normal < 11).”

“Tell me how an orange and a banana are alike.”

Usually it took less than 15 minutes for Bob’s patients to finish the test. When their scores indicated some mild cognitive impairment, he ordered an M.R.I. of the brain to rule out any treatable causes: previous strokes, thyroid malfunctions or diabetes-related complications. If all of that was negative, he braced himself for the conversation he dreaded most as a doctor. “I’m sorry, but we don’t have any good treatments or medications for negating the progress of this disease,” he’d told dozens of patients. Sometimes, all he could offer was a referral to the dementia support group that Mary hosted twice each month. So one morning about a dozen of Bob’s patients gathered in the Ortonville Public Library for a training session on caregiving as the disease progressed.

“Build a supportive connection, both verbally and physically,” the instructor said. “Let’s partner off and practice our initial greetings.”

Wayne Huselid, 73, stood up and helped his wife, Mary Jo, 70, out of her chair. It had been almost eight years since she scored below normal on a Montreal Cognitive Assessment and then went to see a neurologist at the Mayo Clinic, where brain scans showed evidence of early-onset Alzheimer’s disease. Now she was staring at the wall behind Wayne and whispering in a stream of nonsensical syllables as he took her hand, introduced himself again to his wife of nearly 50 years and asked another question she could no longer answer. “Hi, sweetie,” he said. “It’s me. It’s Wayne. How are you today?”

How was she? It was the only question he had really cared about for the last several years, ever since he first suspected that something was wrong, in 2016. He was showing Mary Jo how to operate a simple piece of equipment on their farm outside of Clinton, Minn., but for some reason she couldn’t grasp it. She’d spent her life operating a combine harvester, managing the farm, running a grocery store and raising their children. He kept trying to instruct her for almost an hour before he lost his temper. Was she trying to be difficult? A few months later, she went for a drive and called him in tears because she couldn’t find her way back. He had spent three hours on the phone directing her, and he’d been a caretaker ever since.

“Make a positive statement about the person in the moment,” the instructor said.

Wayne rubbed Mary Jo’s fingers and looked into her eyes. “Your hands are so warm and soft,” he told her.

He was always in the process of losing her to dementia, day by day in a million little ways. Words. Shared memories. Even her physical self. As her symptoms worsened, he began attaching a location tracker to her clothing, but sometimes the signal didn’t work. One night they had gone to a doctor’s appointment and Mary Jo got out of the car without her coat. Wayne went into the back seat to grab it, but when he turned around a few seconds later she was gone. He searched all five floors of a nearby parking garage. He called the police. It was 15 degrees outside, and he ran through the neighborhood shouting a name she no longer recognized, until finally a police officer said he’d found a disoriented woman standing alone and crying near the train tracks.

“Focus on the skills that remain,” the presenter was saying. “Try not to dwell on the deficits.”

Wayne raised his hand. “See, that’s the part I struggle with,” he said. “Letting go of what’s gone. Are we just supposed to give up?”

“You have to treat the person they are, not the person that they were,” the instructor told him.

“But it’s like when I taught music at the high school,” Wayne said. “Say I had a kid in my class who was a problem. Do I write them off? Give up on their deficits? You try to figure out how to get through, right? If I can’t, that’s on me.”

That was what he felt sometimes with Mary Jo: that he wasn’t getting through, that he was failing her. When he laid her into bed each night, she had a distant look in her eyes that he interpreted as fear, or maybe loneliness. She stared at the ceiling while he held her hand, thinking back over his mistakes that day. Had he spoken too harshly? Had he gripped her hand a little too hard while he was putting on her glove?

“I guess Mr. Patience gets the better of me sometimes,” he told the instructor. “I should be able to handle more than I do.”

“Caretaking requires a lot,” the instructor said. “We need room to process and grieve.”

“But she’s still here,” Wayne said.

During his daily appointments, Bob often told his patients that they could either fear death or prepare for it, so he and Mary had spent the last few years making decisions and creating their own plan. They had figured out how to retrofit parts of their home, in case they would need ramps and wheelchairs. They’d chosen one son to make their end-of-life choices and another to manage their estate. Bob wanted to be cremated, but Mary planned to be buried.

“If I die first, you might need another companion,” she told him one night, as they sat down to eat. “That would be OK with me. You know that, right?”

“That’s a little morbid, for dinner,” he said.

“I like being aware of my mortality,” she said “There’s comfort in knowing what’s coming.”

“I get plenty of reminders,” Bob said. A few hours earlier, he’d signed a death certificate for another patient, a 91-year-old who had died at 3:40 a.m. “Manner of Death: Natural.” “Immediate cause: Alzheimer’s disease.” “Physician: Bob Ross.”

It was at least the 400th death certificate he had signed in the last decade, as Ortonville’s population continued to decline by attrition. When he was the county coroner, he had attended to all manner of violent and premature deaths: car crashes, suicides, frostbites, traumatic burns, firearm accidents, drownings, overdoses and at least two murders. But what he witnessed much more often were natural deaths, which didn’t always mean that they were uncomplicated, or easy.

Most of his patients died of renal failure, cancer, congestive heart failure, Alzheimer’s or kidney disease. He had cared for hundreds of patients in their final hours, when they lost the desire to eat or drink, their eyes turned glassy and their breathing became more labored. He held their hands and fingers as the skin became cold and mottled, a sign that the body was shutting down circulation to the extremities in order to preserve the brain and the heart for a few moments longer, in a last attempt to survive.

He sometimes gave patients morphine in those final minutes, as shallow breaths gave way to involuntary gasps, moans and rattles. He monitored the pulse as it slowed and finally stopped. The airway went silent, the body relaxed and there was something in the next moments that felt to him almost like peace. He wrote down the official time of death and prayed for his patients’ eternal rest.

“Our minds and our bodies aren’t built to last forever,” he told Mary. “There’s no use pretending otherwise. We all get our turn. We grow old and we die.”

“The evil days come and the years draw near,” Mary said, quoting what she remembered from one of their favorite Old Testament passages, Ecclesiastes 12 .

“The sun and the light and the stars go dark,” Bob continued, and Mary nodded.

“The keepers of the house tremble,” she said, “and the mighty men stoop.”

Erin Schaff contributed reporting.

Eli Saslow is a Pulitzer Prize winner and a writer at large for The Times. He travels the country to write in-depth stories about the impact of major national issues on individual lives. More about Eli Saslow

Erin Schaff is a photojournalist for The Times, covering stories across the country. More about Erin Schaff

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