Bangsamoro Autonomous Region in Muslim Mindanao

Commission on Higher Education

Mindanao Institute of Healthcare Professionals, Incorporated
Marawi City, 9700, Philippines

NCM 112: (Surgery, CD, I&I, Cellular aberration)

Report

LUNG CANCER
(Bronchogenic Carcinoma)

Reported by:
PASCAN, JUHAINAH O.

PROF. JAMAL ALAWIY, MAN’c, LPT, RN

1. Brief discussion of Anatomy & Physiology 

A. Upper respiratory tract:

 Nasal cavity: Inside the nose, the sticky mucous membrane lining the nasal cavity traps
dust particles, and tiny hairs called cilia help move them to the nose to be sneezed or
blown out.
 Sinuses: These air-filled spaces alongside the nose help make the skull lighter. 
 Pharynx: Both food and air pass through the pharynx before reaching their appropriate
destinations. The pharynx also plays a role in speech.
 Larynx: The larynx is essential to human speech.
B. Lower respiratory tract
 Trachea: Located just below the larynx, the trachea is the main airway to the lungs.
 Lungs: Together the lungs form one of the body’s largest organs. They’re responsible for
providing oxygen to capillaries and exhaling carbon dioxide.
 Bronchi: The bronchi branch from the trachea into each lung and create the network of
intricate passages that supply the lungs with air.
 Diaphragm: The diaphragm is the main respiratory muscle that contracts and relaxes to
allow air into the lungs.
  The lungs are located in the chest on either side of the heart in the rib cage. They are
conical in shape with a narrow rounded apex at the top and a broad base that rests on
the diaphragm.
 The apex of the lung extends into the root of the neck, reaching shortly above the
level of the sternal end of the first rib.
 The front and outer sides of the lung face the ribs, which make light indendations on
their surfaces.
 The bottom of the lungs is smooth and rests on the diaphragm, matching its
concavity.
 
2. Brief discussion of Lung Cancer.

What is Lung Cancer?

o Lung cancer is the leading cancer killer among men and women in the United States, with
almost 162,000 deaths estimated in 2008. It is estimated that 31% of cancer deaths in
men and 26% in women are related to lung or bronchus cancers.
o Cancer: An abnormal growth of cells which tend to proliferate in an uncontrolled way
and in some cases, to metastasize (spread).

o Lung cancer begins in the lungs and may spread to lymph nodes or other organs in the
body, such as the brain. Cancer from other organs also may spread to the lungs. When
cancer cells spread from one organ to another, they are called metastases.

 Types of lung cancers:

a) Small cell lung cancer

-is a disease in which malignant (cancer) cells form in the tissues of the lung.
o Small Cell Carcinoma
-15% to 20% Of all of tumours.
b) Non-Small Cell Lung (NSCLC)
-80% of tumours

Types:
o Squamous Cell Cancer
- more centrally located and rises more commonly in the segmental and sub
segmental bronchi.
o Adenocarcinoma
-is the most prevalent carcinoma of the lung in both men and women.
o Large Cell Carcinoma
 -is the fast-growing tumour that tends to arise peripherally.
o Bronchoaleveolar Cell Cancer
-is found in the terminal bronchi and alveoli.

Risk Factors
Tobacco Smoke
Tobacco use is responsible for more than one of every six deaths in the United States from
pulmonary and cardiovascular diseases.
 
 Second hand Smoke
Passive smoking has been identified as a possible cause of lung cancer in non-smokers (U.S.
Department of Health and Human Services, 2006).

 Environmental and Occupational Exposure

Various carcinogens have been identified in the atmosphere, including motor vehicle emissions
and pollutants from refineries and manufacturing plants.
Radon is a colourless, odourless gas found in soil and rocks. 
 
 Genetics
Some familial predisposition to lung cancer seems apparent, because the incidence of lung
cancer in close relatives of patients with lung cancer appears to be two to three times that in the
general population regardless of smoking status.

3. Pathophysiology

Lung cancer/ Bronchogenic Carcinoma

Modifiable
Tobacco smoking
Frequent exposure to second hand smoke Non-Modifiable
o Occupational Exposure Genetics factors
to certain workplace o Age
totins(asbestos, random,
arsenic, chromium, o Hx of CAa
nickel PAHs
o Radiation, air
pollution

Carcinogen binds to DNA of epithelial
Passing of damaged DNA to daughter cells
DIAGNOSTIC TESTS:
chest x- ray
sputum cytologic studies
computed tomography
fiberoptic bronchoscopy
biopsy
Inhaled carcinogen
Tracheobronchial airway
Cellular changes
Abnormal cell growth
Malignant cell
Duplication
Further changes in DNA
Unstable DNA
TREATMENT
Malignant transformation of the
pulmonary epithelium For all types of early- stage lung
carcinoma, the proffered treatment is
surgical resection.
Once metastasis has occurred,
adjunctive radiation and chemotherapy
may improve outcomes
New treatment modalities such as dose
intestefied radiation radiofrequency
ablation and microwave ablation, may
be available as primary or palliative
treatment for those for whom surgical
removal is not an option.
4. Clinical Manifestations
 
 The signs and symptoms depend on the location and size of the tumor, the degree of
obstruction, and the existence of metastases to regional or distant sites.
o Cough o Chest or shoulder pain  
o Dyspnea o Weight loss
o Hemoptysis

5. Diagnostic Findings
 
 If pulmonary symptoms occur in heavy smokers, cancer of the lung should always be
considered. A chest x-ray is performed to search for pulmonary density, a solitary
pulmonary nodule (coin lesion), atelectasis, and infection. CT scans of the chest are used
to identify small nodules not easily visualized on the chest x-ray and also to serially
examine areas for lymphadenopathy.
 Sputum cytology is rarely used to make a diagnosis of lung cancer. Fiberoptic
bronchoscopy is more commonly used; it provides a detailed study of the
tracheobronchial tree and allows for brushings, washings, and biopsies of suspicious
areas. For peripheral lesions not amenable to bronchoscopic biopsy, a transthoracic fine-
needle aspiration may be performed under CT guidance to aspirate cells from a
suspicious area. In some circumstances, an endoscopy with esophageal ultrasound may
be used to obtain a transesophageal biopsy of enlarged subcarinal lymph nodes that are
not easily accessible by other means.
 
6. Medical Management
 
 The objective of management is to provide a cure, if possible. Treatment depends on the
cell type, the stage of the disease, and the patient’s physiologic status (particularly
cardiac and pulmonary status). In general, treatment may involve surgery, radiation
therapy, or chemotherapy—or a combination of these. 
 Other types of treatment that are used to treat certain cancers are hormonal therapy,
biological therapy or stem cell transplant.

A. Surgical Management
 
• Lobectomy
-a single lobe of the lung is removed
• Bilobectomy
-two lobes of the lung are removed
• Sleeve resectioncancerous lobe(s) is removed and a segment of the main bronchus is resected
• Pneumonectomy: removal of entire lung
• Segmentectomy: a segment of the lung is removed*
• Wedge resection: removal of a small, pie-shaped area of the segment*
• Chest wall resection with removal of cancerous lung tissue: for cancers that have invaded the
chest wall
o Radiation therapy 
- It is useful in controlling neoplasms that cannot be surgically resected but are
responsive to radiation. 
-To reduce the size of a tumor.
o Chemotherapy 
-is used to alter tumor growth patterns, to treat distant metastases or small cell
cancer of the lung, and as an adjunct to surgery or radiation therapy.
-Non small cell:

● Two drug regimen

● Cis/Carbon platin + other (Taxol/ Taxotere/ Gemcitabine)

-Small cell:
● Cisplatin/Etoposide
- other drugs involved like:
● Etoposide
● Paclitaxel
● Cyclophosphamide
● Doxorubicin
● Vinblastin

o Palliative Therapy
-may include radiation therapy to shrink the tumor to provide pain relief, a variety
of bronchoscopic interventions to open a narrowed bronchus or airway, and pain
management and other comfort measures.
 
7. Nursing Management
 
A. Nursing Diagnosis:
 Inefective breathing pattern r/t loss of adequate ventilation as evidenced by overexertion
of pt. during respiration.
  Impaired gas exchange r/t the discussion excessive or thick secretions or r/t decreased
passage of gases between alveoli of lungs and vascular system as evidenced by decreased
SPo2 level of pt.
 Chronic pain related to Stage IV NSCLC diagnosis as evidenced by client reporting “
pain in right chest and lower ribs”.
 Risk of infection related to altered immune system secondary to effects of cytotoxic
drugs as evidenced by side effects of the drug/ chemotherapy.
 Risk for disturbanced self concept related to cahnges in lifestyle.
 -Nausea related to effects of chemotherapy as evidenced by client reporting feelings nauseated.
 -Risk for deficiënt fluid volume related to gastrointestinal fluid loss secondary to vomiting.

B. Interventions:
Nursing Intervention 
 Elevate the head of the bed to ease the work of breathing and to prevent fluid collection
in upper body (from superior vena cava syndrome).
 Teach breathing retraining exercises to increase diaphragmatic excursion and reduce
work of breathing.
 Augment the patient’s ability to cough effectively by splinting the patient’s chest
manually.
 Instruct the patient to inspire fully and cough two to three times in one breath.
 Provide humidifier or vaporizer to provide moisture to loosen secretions.
 Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the
severely dyspneic patient to sleep in reclining chair.
 Encourage the patient to conserve energy by decreasing activities.
 Ensure adequate protein intake such as milk, eggs, oral nutritional supplements; and
chicken, fowl, and fish if other treatments are not tolerated – to promote healing and
prevent edema.
 Advise the patient to eat small amounts of high-calorie and high-protein foods frequently,
rather than three daily meals.
 Suggest eating the major meal in the morning if rapid satiety is the problem.
 Change the diet consistency to soft or liquid if patient has esophagitis from radiation
therapy.
 Consider alternative pain control methods, such as biofeedback and relaxation methods,
to increase the patient’s sense of control.
 Teach the patient to use prescribed medications as needed for pain without being overly
concerned about addiction.