Lung Cancer. Etiology Leading cause of cancer-related deaths In 2002, 25% of all female deaths were...
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Lung CancerLung Cancer
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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
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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
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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
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Etiology
Environmental tobacco smoke (ETS) inhaled by nonsmokers poses 35% increased risk in developing lung cancer
Children are more vulnerable to ETS than adults
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Etiology
Other carcinogens pose risk for developing lung cancer
• Asbestos • Radon • Nickel • Iron/iron oxides
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Etiology
Other carcinogens pose risk for developing lung cancer
• Uranium • Polycyclic aromatic
hydrocarbons • Arsenic • Chromates • Air pollution
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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
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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
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Pathophysiology
Primary lung cancers categorized into two subtypes
• Non-small cell lung cancer (NSCLC)
• 82% • Small cell lung cancer (SCLC) • 18%
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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 %
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Lung cancer pathology
Lung Cancer Pathology Squamous Cell
Adenocarcinoma Large Cell Carcinoma
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Pathophysiology
Lung cancers metastasize by direct extension, blood circulation, and lymph system
Common sites for metastatic growth • Liver • Brain • Bones • Lymph nodes • Adrenal glands
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Clinical Manifestations
Symptoms appear late in disease Depend on type of primary lung
cancer, location, and metastatic spread
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Clinical Manifestations
Pneumonitis Persistent cough with sputum Hemoptysis Chest pain Dyspnea
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Clinical Manifestations
Later manifestations • Anorexia • Weight Loss • Fatigue • N/V • Hoarse voice • Unilateral paralysis of
diaphragm
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Diagnostic Studies
Chest x-ray CT scan Magnetic resonance imaging
(MRI) Positron emission tomography
(PET)
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Diagnostic Studies
Diagnosis identified by malignant cells
Sputum specimens obtained for cytologic studies
• Fiberoptic bronchoscope • Mediastinoscopy • Video-assisted
thoracoscopy (VATS) • Pulmonary angiography
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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
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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
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Lung Cancer Staging Diagnostic Studies
Staging • SCLC • Not been useful due to cancer
metastasized before diagnosis is made
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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
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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
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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?
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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)
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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
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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
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Collaborative Care
Other therapies • Biologic therapy • Prophylactic cranial therapy • Bronchoscopic laser therapy • Phototherapy • Airway stenting • Cryotherapy
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Nursing ManagementNursing Diagnoses
Ineffective airway clearance Anxiety Acute pain
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Nursing ManagementEvaluation
Expected outcomes • Adequate breathing patterns • Minimal to no pain • Realistic attitude about
prognosis
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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
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Home Care Management
References to community agencies, home health nursing or hospice
Hospice provides physical and psychological support to client & family
American Cancer Society