LUNG CANCER

The most common forms of lung cancer are squamous cell carcinoma, small cell carcinoma, adenocarcinoma and large cell carcinoma. INCIDENCE 28% of cancer deaths are from lung cancer. CAUSES Exact cause is unknown Risk factors include Tobacco smoking Exposure to industrial air pollutants ( eg.asbestos, arsenic) Diesel exhaust Radiation Genetic predisposition A diet poor in vitamins A, C & E

TYPES

LUNG CANCER

SMALL CELL LUNG CANCER(SCLS)

NON-SMALL CELL LUNG CANCER (NSCLC)

LARGE CELL CARCINOMA

ADENOCARCINO MA

SQUAMOUS CELL CARCINOMA

PATHOPHYSIOLOGY Lung cancers originate in the respiratory tract epithelium, most originate in the lining of the bronchi. Small cell carcinoma sometimes called oat cell carcinoma. It grows rapidly and has metastasized by the time of diagnosis. It is usually caused by smoking and often found centrally, near the bronchi. The patient with small cell carcinoma has a poor prognosis. Large cell carcinoma is rapidly growing cancer that can occur anywhere in the lungs. It metastasizes early in the disease, so the patients have poor prognosis. Adenocarcinoma occurs more in women, and most often in the peripheral lung fields. It is slow growing but often is not diagnosed until metastasis has occurred. Squamous cell carcinoma usually originates near the bronchi and metastasizes late in the disease. They are associated with history of smoking. STAGES OF LUNG CANCER (Tumor-node metastasis TNM Staging) CANCER TYPE Non- small cell lung cancer STAGE I CHARACTERISTICS No metastasis to lymph nodes Atelectasis or Pneumonia may be present Cancer has spread to local lymph nodes Cancer has invaded chest wall and usually has spread to lymph nodes Tumor has metastasized to distant organs and lymph nodes

II III IV

Small cell lung cancer

Limited

Cancer is limited to one side of the chest

Extensive

Cancer cells are found outside one side of the chest or in pleural fluid

SIGNS AND SYMPTOMS Cough with sputum production Repeated respiratory infections Thick, purulent sputum Hemoptysis Dyspnea if the airway becomes obstructed by the tumor Wheezing or stridor Late signs include chest pain, weight loss, anemia and anorexia

COMPLICATIONS Pleural effusion Superior vena cava syndrome Ectopic hormone production Atelectasis and Pneumonia Metastasis Hypertrophic osteoarthropathy

DIAGNOSTIC TESTS A complete medical history and physical examination Chest X-ray examination CT Scan and Lung scan Sputum analysis for abnormal cells Brain and bone scans are done to find out metastatic lesions Biopsy of the lesion

TREATMENT

SURGERY

Partial lung removal Wedge resection Segmental resection Lobectomy Radical lobectomy Total removal Pneumonectomy Radical pneumonectomy

RADIATION CHEMOTHERAPY IMMUNOTHERAPY LASER THERAPY

NURSING DIAGNOSES AND PATIENT OUTCOMES Anticipatory grieving related to poor prognosis Expected outcome: The patient will express his feelings about his diagnosis and the potential for death.

Fatigue related to hypoxia Expected outcome: The patient will employ measures to prevent and modify fatigue.

Impaired gas exchange related to pulmonary dysfunction Expected outcome: The patient will maintain his respiratory rate within 5 breaths/minute of his baseline.

NURSING INTERVENTIONS Give supportive care and provide patient teaching to minimize complications and speed patients recovery. Urge the patient to voice his concerns and provide proper explanations before doing any procedures. Prepare the patient for surgery. Encourage the patient to eat high calorie. Provide antiemetics and antidiarrheals as needed with chemotherapy. Provide skincare to minimize skin breakdown.