Lung CancerLung Cancer

Etiology

Leading cause of cancer-related deaths

In 2002, 25% of all female deaths were estimated to be due to lung cancer

Most commonly occurs in individuals over 50 and with a history of cigarette

smoking

Etiology Smoking is responsible for 80 to

90% of all lung cancers Tobacco smoke contains 60

carcinogens that interfere with cell development

Cigarette smoking causes a change in bronchial epithelium

Etiology

Lung cancer is related to total exposure to cigarette smoke measured by

• Total number of cigarettes smoked

• Age of smoking onset • Depth of inhalation • Tar and nicotine content • Use of unfiltered cigarettes

Etiology

Environmental tobacco smoke (ETS) inhaled by nonsmokers poses 35% increased risk in developing lung cancer

Children are more vulnerable to ETS than adults

Etiology

Other carcinogens pose risk for developing lung cancer

• Asbestos • Radon • Nickel • Iron/iron oxides

Etiology

Other carcinogens pose risk for developing lung cancer

• Uranium • Polycyclic aromatic

hydrocarbons • Arsenic • Chromates • Air pollution

Pathophysiology

90% of cancers originate from epithelium of bronchus

It takes 8 to 10 years for a tumor to reach 1 cm; smallest lesion detectable on x-ray

Occur primarily on segmental bronchi and upper lobes

Pathophysiology

Pathologic changes in bronchial system • Hypersecretion of mucus • Desquamation of cells • Reactive hyperplasia of basal cells • Metaplasia of normal respiratory

epithelium to stratified squamous cells

Pathophysiology

Primary lung cancers categorized into two subtypes

• Non-small cell lung cancer (NSCLC)

• 82% • Small cell lung cancer (SCLC) • 18%

Lung cancer pathology

Types of Non-small cell (NSCLC)–82% Squamous cell—32% usually undifferentiated Invades surrounding tissue early then mets Adenocarcinoma- 40- 42% Increasing in women Can appear in non smokers Slow-growing –early invasion of the

lymphatics Large cell(undifferentiated) 12 %

Lung cancer pathology

Lung Cancer Pathology Squamous Cell

Adenocarcinoma Large Cell Carcinoma

Pathophysiology

Lung cancers metastasize by direct extension, blood circulation, and lymph system

Common sites for metastatic growth • Liver • Brain • Bones • Lymph nodes • Adrenal glands

Clinical Manifestations

Symptoms appear late in disease Depend on type of primary lung

cancer, location, and metastatic spread

Clinical Manifestations

Pneumonitis Persistent cough with sputum Hemoptysis Chest pain Dyspnea

Clinical Manifestations

Later manifestations • Anorexia • Weight Loss • Fatigue • N/V • Hoarse voice • Unilateral paralysis of

diaphragm

Diagnostic Studies

Chest x-ray CT scan Magnetic resonance imaging

(MRI) Positron emission tomography

(PET)

Diagnostic Studies

Diagnosis identified by malignant cells

Sputum specimens obtained for cytologic studies

• Fiberoptic bronchoscope • Mediastinoscopy • Video-assisted

thoracoscopy (VATS) • Pulmonary angiography

Diagnostic Studies

Staging • NSCLC staged according to TNM

system • T umor size, location, and degree of

invasion • N ode indicates regional lymph node

involvement • M etastasis represents

presence/absence of distant metastases

Staging non-small cell

Stage I-one lobe without lymph node involvement

Stage II- one lobe with involvement of lymph node inside the lung

Stage III- lung ca with lymph nodes in the mediastinal region or outside the chest

Stage IV-spread outside of the chest

Lung Cancer Staging Diagnostic Studies

Staging • SCLC • Not been useful due to cancer

metastasized before diagnosis is made

Collaborative Care

Surgical Therapy • Surgical resection is

contraindicated for small cell carcinomas

• Squamous cell carcinomas are likely treated with surgery

• Usually stage I or II

Surgical Management

If complete resection is not possible, removes the bulk of the tumor & risk of

metastatic extension Thoracotomy (opening thoracic cavity)

–Pneumonectomy- remove all or part of lung

Lobectomy-removes a lobe of the lung Wedge resection or segmentectomy-

removes a small part of a lobe of lung

Surgical Management

Following lobectomy for lung cancer, a client receives a chest tube connected to a three-chamber

chest drainage system. The nurse observes that the drainage system is functioning correctly

when she notes tidal movements or fluctuations in which compartment of the system as the client

breathes?

Preoperative Care Aimed at relieving anxiety &

promoting client participation Encourage client to express fears &

concerns Reinforces physician’s explanation of

procedure Teach anticipated location of

incision,if known, shoulder exercises, and about chest tubes (except pneumonectomy)

Collaborative Care

Radiation therapy • Curative approach in individual

with resectable tumor and poor surgery risk

• Some cancer cells are more radiosensitive than others

• Used in combination with chemotherapy

Collaborative Care

Chemotherapy • Treatment of nonresectable

tumors or adjuvant to surgery in NSCLC with distant metastases

• Used in combination with multidrug regimen

• Improved survival rate with NSCLC and SCLC

Collaborative Care

Other therapies • Biologic therapy • Prophylactic cranial therapy • Bronchoscopic laser therapy • Phototherapy • Airway stenting • Cryotherapy

Nursing ManagementNursing Diagnoses

Ineffective airway clearance Anxiety Acute pain

Nursing ManagementEvaluation

Expected outcomes • Adequate breathing patterns • Minimal to no pain • Realistic attitude about

prognosis

Psychosocial Preparation

If CA resectable, encourage optimism and gradual return to normal

activities • If prognosis is poor, facilitate

expression of fears & concerns, maintain

open lines of communication & stress quality of as defined by client

Home Care Management

References to community agencies, home health nursing or hospice

Hospice provides physical and psychological support to client & family

American Cancer Society