CANCER OF THE LUNGS
TUTOR || September 24, 2022
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Outline
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Remember
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Lecturer Book
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Heading 1
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• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
CANCER OF THE LUNGS
OVERVIEW
 Lung cancer is a leading cause of cancer-
related deaths worldwide.
 The overall 5-year survival rate for all patients
with lung cancer is only 16% because most
lung cancers are diagnosed at a late stage,
when metastasis is present.
 Lung cancers arise from a single transformed
epithelial cell in the tracheobronchial airways.
A carcinogen (cigarette smoke, radon gas,
other occupational and environmental agents)
damages the cell, causing abnormal growth
and development into a malignant tumor.
 Most lung cancers are classified into one of
two major categories: small cell lung cancer
(15% to 20% of tumors) and non–small cell
lung cancer (NSCLC; approximately 80% of
tumors).
 NSCLC cell types include squamous cell
carcinoma (20% to 30%), which is usually
more centrally located; large cell carcinoma
(15%), which is fast growing and tends to
arise peripherally; and adenocarcinoma
(40%), which presents as peripheral masses
and often metastasizes and includes
bronchoalveolar carcinoma.
 Metastasis of lung cancer occurs by direct
extension, through the blood, and by invading
lymph glands and vessels.
 Common sites of metastasis for lung cancer
are the bone, liver, brain, and adrenal glands.
 Lung cancers occur as a result of repeated
exposure to inhaled substances that cause
chronic tissue irritation or inflammation.
GERIATRIC
 Cigarette smoking is the major risk factor and
is responsible for 85% of all lung cancer
Previous
deaths.
Trans  Nonsmokers exposed to passive, or
 secondhand, smoke have a greater risk for
lung cancer than nonsmokers.
Risk Factors
 Risk factors include tobacco smoke, second-
hand (passive) smoke, environmental and
occupational exposures, gender, genetics,
and dietary deficits.
 Other factors that have been associated with
lung cancer include genetic predisposition
and underlying respiratory diseases, such as
chronic obstructive pulmonary disease
(COPD) and tuberculosis (TB).
 Lung cancer interferes with oxygenation and
tissue perfusion, including bronchial
obstruction, airway compression,
compression of alveoli, and compression of
blood vessels.
 Common manifestations of lung cancer are
associated with respiratory problems and
include dyspnea, pallor or cyanosis,
tachycardia, bloody sputum and cough.
 Pain is common when lymph nodes are
enlarged and press on nerves.
Assessment
 Obtain patient information about:
1. pack-year history and current smoking
pattern
2. Risk factors, including secondhand smoke
and environmental exposures
3. Cough presence and triggers
4. Sputum
✓ Amount
✓ Color
✓ Character
5. Chest pain, tightness or pressure:
✓ Location
✓ Severity
✓ Duration
✓ Quality
✓ Radiation
6. Dyspnea:
✓ Duration
✓ Triggers and alleviating factors
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[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 Assess for pulmonary manifestations:
1. Hoarseness
2. Wheezing
3. Decreased or absent breath sound
4. Breathing pattern abnormalities:
✓ Prolonged exhalation alternating with
periods of shallow breathing
✓ Rapid, shallow breathing
5. Areas of tenderness or masses palpated on
the chest wall
6. Increased fremitus (vibration) in areas of
tumor
7. Decreased or absent fremitus with bronchial
obstruction
8. Tracheal deviation
9. Pleural friction rub
10. Asymmetry of diaphragm movement
11. Use of accessory muscles manifested by
retraction between ribs or at sternal notch
 Assess for non-pulmonary manifestations:
1. Weight loss
2. Muffled heart sound
3. Dysrhythmias
4. Cyanosis of the lips and fingertips
5. Clubbing of the fingers
6. Bone pain
7. Fever/chills related to pneumonitis,
bronchitis, pneumonia
8. Paraneoplastic endocrine syndromes
caused by hormones secreted by tumor
cells, such as syndrome of inappropriate
antidiuretic hormone (SIADH)
 Assess for late manifestations, including
fatigue, weight loss, anorexia, dysphagia,
nausea and vomiting, lethargy, confusion,
and personality changes.
 Assess for psychosocial issues of fear,
anxiety, guilt, or shame:
1. Convey acceptance; interact with patient
in nonjudgmental way.
2. Encourage the patient and family to
express their feelings about possible
diagnosis of lung cancer.
 Diagnosis of lung cancer is made on the
basis of:
1. Chest x-ray
2. CT scan
3. Fiberoptic bronchoscopy
4. Thoracoscopy or thoracentesis to view
and biopsy lung tissue
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 Other tests used to determine extent of
metastasis include MRI, PET, or radionuclie
scans of the liver, spleen, brain, and bone.
Non-surgical Management
➢ Chemotherapy is often the treatment of
choice for lung cancers, and it may be used
alone or as adjuvant therapy in combination
with surgery.
➢ The exact combination of drugs used
depends on the response of the tumor and
the overall health of the patient; however,
most include platinum-based agents.
➢ Common side effects that occur with
chemotherapy for lung cancer include:
1. chemotherapy-induced nausea and
vomiting (CIN)
2. Alopecia
3. Mucositis
4. Bone marrow suppression resulting in
immunosuppression, anemia, and
thrombocytopenia
5. Peripheral neuropathy (PN)
➢ Targeted therapy involves the use of drugs
that target specific features of cancer cells,
such as a protein, an enzyme, or the
formation of new blood vessels.
➢ These drugs cause fewer and less severe
side effects for most patients compared with
traditional anti-neoplastic agents. For lung
cancer, targeted therapy drugs include:
1. Erlotinib (Tarceva), an oral drug
2. Bevacizumab (Avastin), given IV
3. Crizotinib (Xalkori), an oral drug
➢ Radiation therapy may be used for locally
advanced lung cancers confined to the chest.
It is typically used in addition tot surgery or
chemotherapy and delivered by external
beam therapy daily over 5 to 6 weeks.
➢ Common side effects of radiation therapy for
lung cancer are:
1. Chest skin irritation and peeling
2. Fatigue
3. Wheezing from inflamed airways
4. Esophagitis and changes in taste
➢ Photodynamic therapy (PDT) may be used to
remove small bronchial tumors when they are
accessible by bronchoscopy.
Discussion: The patient is first injected with
an agent that sensitizes cells to light. This
drug enters all cells but leaves normal cells
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
more rapidly than cancer cells, allowing it to
concentrate in cancer cells.
At about 48 hours, the patient goes to the
operating room and is placed under
anesthesia and intubated. A laser light is
focused on the tumor. The light activates a
chemical reaction within the cells, retaining
the sensitizing drug that induces irreversible
cell damage.
Some cells die and slough immediately;
others continue to slough for several days.
➢ The photosensitizing drug has many effects
that require special patient teaching and care
both before and after the laser treatment.
➢ When PDT is used in the airways, the patient
usually requires a stay in the intensive care
unit (ICU) for airway management.
Surgical Management
➢ Surgery is the main treatment for stage 1 and
stage II NSCLC.
Discussions: Total removal of a non-small cell
primary lung cancer is undertaken in hope of
achieving a cure. If complete resection is not
possible, the surgeon removes the bulk of the
tumor.
➢ The specific surgery depends on the stage of
the cancer and the patient’s overall health
and functional status. Surgeries include:
1. Removal of tumor only
2. Removal of a lung segment
(segmentectomy)
3. Removal of a lobe (lobectomy)
4. Removal of an entire lung
(pneumonectomy)
➢ Procedures can be performed by open
thoracotomy or thoracoscopy with minimally
invasive surgery in selected patients.
➢ Provide routine preoperative care:
1. Teach the patient about the probable
location of the surgical incision or
thoracoscopy openings, shoulder
exercises, and about the chest tube and
drainage system (except after
pneumonectomy)
2. Encourage the patient to express fears
and concerns.
3. Reinforce the surgeon’s explanation of the
surgical procedure.
➢ Provide post0perative care:
1. Respiratory management:
✓ Maintain a patent airway
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✓ Assess respiratory status at least 2 hours
for the first 12 to 24 hours.
• Check the alignment of the trachea
• Assess oxygen saturation
• Assess the rate and depth of respiration
• Listen to breath sounds in all remaining
lobes
• Assess the oral mucous membranes for
cyanosis and the nail beds for rate of
capillary refill
✓ Perform oral suctioning as necessary
✓ Provide oxygen therapy or mechanical
ventilation as prescribed
✓ Assist the patient to a semi-fowler’s
position or to sit up in a chair as soon as
possible.
✓ For a patient with spontaneous
respirations, encourage the patient to use
the incentive spirometer every hour while
awake.
✓ If coughing is permitted, help the patient
cough by splinting any incision and
ensuring that the chest tube does not pull
with movement.
2. Pain management.
3. Apply closed chest drainage.
Nursing Management
Managing Symptoms
➢ Instruct patient and family about the side
effects of specific treatments and strategies to
manage them.
➢ Relieving Breathing Problems
➢ Maintain airway patency; remove secretions
through deep breathing exercises, chest
physiotherapy, directed cough, suctioning,
and in some instance’s bronchoscopy.
➢ Administer bronchodilator medications;
supplemental oxygen will probably be
necessary.
➢ Encourage patient to assume positions that
promote lung expansion and to perform
breathing exercises.
➢ Teach energy conservation and airway
clearance techniques.
➢ Refer for pulmonary rehabilitation as
indicated.
Reducing Fatigue
➢ Assess level of fatigue; identify potentially
treatable causes.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

➢ Educate patient in energy conservation 2. Pleurodesis is the deliberate development of

techniques and guided exercise as an inflammation in the pleural space to cause
appropriate. the pleura to stick to the chest wall and
➢ Refer to physical or occupational therapist as prevent formation of effusion fluid.
indicated. ➢ Pain management may be needed for chest
Providing Psychological Support pain and pain radiating to the arm. The goal is
➢ Help patient and family deal with poor to keep the patient as comfortable as
prognosis and progression of the disease possible.
(when indicated). ➢ Refer the terminal patient to hospice or other
➢ Assist patient and family with informed palliative care programs.
decision-making regarding treatment options.
➢ Suggest methods to maintain the patient’s
quality of life during the course of this
disease.
➢ Support patient and family in end-of-life
decisions and treatment options.
➢ Help identify potential resources for the
patient and family.

Palliative Interventions
➢ Treatment may focus on symptom
management, rather than cure.
➢ Dyspnea management is a priority.
Discussion: Dyspnea is reduces with
oxygen, drug therapy, radiation, management
of pleural effusion, pain relief, and positioning
for comfort.
For example, the patient with severe dyspnea
may be most comfortable sitting in a lounge
chair or reclining chair.
➢ Oxygen therapy with humidification is
prescribed to treat hypoxemia or to relieve
dyspnea and anxiety
➢ Drug therapy to improve oxygenation and
relieve dyspnea includes:
1. Bronchodilators and corticosteroids for
the patient with bronchospasm
2. Mucolytics to ease removal of thick
mucus and sputum
3. Antibiotics when bacterial infection is
present
➢ Radiation therapy helps relieve hemoptysis,
obstruction of the bronchi and great veins,
dysphagia, and pain resulting from bone
metastasis.
➢ Thoracentesis and pleurodesis relieve
pulmonary symptoms caused by pleural
effusion.
1. Thoracentesis is fluid removal by suction from
the placement of a large needle or catheter
into the intrapleural space.

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