LUNGS

The lungs are sponge-like organs in chest. Their job is to

bring oxygen into the body and to get rid of carbon dioxide.
When we breathe air in, it goes into your lungs through
your windpipe (trachea).
The trachea divides into tubes called bronchi, which enter
the lungs. These divide into smaller branches called
bronchioles.
At the end of the bronchioles are tiny air sacs called
alveoli.
The alveoli move oxygen from the air into your blood.
They take carbon dioxide out of the blood. This leaves your
body when you breathe out (exhale).
REVIEW:
Cancer is a disease when cells in the body change and
grow out of control. The human body is made up of tiny
building blocks called cells. Normal cells grow when body
needs them, and die when your body does not need them
any longer.
Cancer is made up of abnormal cells that grow even
though body doesn't need them. In most cancers, the
abnormal cells grow to form a lump or mass called a
tumor. If cancer cells are in the body long enough, they
can grow into (invade) nearby areas. They can even spread
to other parts of the body (metastasis).
 LUNG CANCER

GUIDED BY
PRESENTED BY
MRS. RENUKA DASH MR. PANKAJ KUMAR JENA
VICE-PRINCIPAL M.SC NURSING
COLLEGE OF NURSING 1ST YEAR
VIMSAR, BURLA. COLLEGE OF NURSING, VIMSAR , BURLA.
INTRODUCTION
Lung cancer is cancer that starts in
the cells that make up the lungs.
Many other types of cancer, such as
breast or kidney, can spread
(metastasize) to the lungs. When this
happens, the cancer is not called lung
cancer.
This is because cancer is named
for--and treatment is based on--the
site of the original tumor. For
example, if breast cancer spreads to
the lungs, it will be treated as
metastatic breast cancer, not lung
cancer.
DEFINITION:-
• Lung carcinoma, is a malignant lung
tumor characterized by uncontrolled
cell growth in tissues of the lung. If left
untreated, this growth can spread beyond
the lung by the process of metastasis into
nearby tissue or other parts of the body
INCIDENCE OF LUNG CANCER:-
• Lung cancer mainly occurs in older people.
About 2 out of 3 people diagnosed with lung
cancer are 65 or older.
• About 14% of all new cancers are lung
cancers.
• About 224,390 new cases of lung cancer
(117,920 in men and 106,470 in
women)
TYPES OF LUNG CANCER:-

LUNG CANCER

NON-SMALL CELL
SMALL CELL LUNG
LUNG
CANCER(SCLS)
CANCER(NSCLC)
Non-small cell lung cancer (NSCLC) :
Most common type
About 80-85% are NSCLC
Grows more slowly
• It is further classified into the following:-

Epidermoid carcinoma or Squamous cell

carcinoma:
30-35% of lung cancer
Arise from bronchial epithelium
Cavitation may also occur
Slow growth, metastasis not common
 Adenocarcinoma:
25-30% of lung cancer
Arise from bronchiole mucus gland
Slow growth,
Rarely cavity
Strongly linked to cigarette smoking

 Large cell caracinoma:

10-20% of lung cancer
Cavitation common
Slow, metastasis may occur to kidney, liver and
adrenals
May be located centrally, mid lung or
peripherally
Small cell carcinoma :
• It generally starts in one of the larger breathing
tubes, grows fairly rapidly, and is likely to be
large by the time of diagnosis.
Spreads more quickly and aggressively
 Accounts for 15% of cases
Found mostly in heavy smokers
ETIOLOGY:
- • Tobacco smoke:-
▫ Smoking is by far the leading risk factor for lung
cancer. About 80% of lung cancer deaths are
thought to result from smoking.

• Exposure to other cancer-causing agents

in the workplace :
▫ Radioactive such as uranium
▫ Inhaled chemicals such as beryllium, silica , coal
products, mustard gas.
• Certain dietary supplements :-
▫ 2 large studies found that smokers who took beta
carotene supplements actually had an increased
risk of lung cancer.
• Exposure to asbestos:-
▫ People who work with asbestos (such as in mines,
mills, textile plants, places.
• Talc and talcum powder:
▫ Talc is a mineral that in
its natural form may
contain asbestos.
PATHOPHYSIOLOGY
DUE TO ETIOLOGICAL FACTORS

DAMAGE TO THE CELL

CARCINIGEN BIND TO DAMAGED CELL DNA

CELLULAR CHANGES

PASSED TO THE DAUGHTER CELL

EVENTUALLY MALIGNANT CELL

MALIGNANT TRANSFORM FROM NORMAL EPITHELIUM

CARCINOMA
SIGN AND SYMPTOMS:
A cough that gets worse
sputum (spit or phlegm)
Chest pain that is often worse with deep
breathing, coughing, or laughing
Coughing up blood
 Hoarseness
Weight loss and loss of appetite
Shortness of breath
 Feeling tired or weak
Infections such as bronchitis and
pneumonia
• Bone pain (like pain in the back or hips)
▫ Nervous system changes (such as headache,
weakness, dizziness, balance problems, or
seizures), from cancer spread to the brain or
spinal cord.
• Yellowing of the skin and eyes (jaundice), from
cancer spread to the liver.
 HORNER SYNDROME
• HORNER SYNDROME Cancers of the
top part of the lungs (sometimes called
Pancoast tumors) sometimes can affect
certain nerves to the eye and part of
the face, causing a group of symptoms
called Horner syndrome:
▫ Drooping or weakness of one eyelid
▫ Reduced or absent sweating on the
same side of the face sometimes cause
severe shoulder pain.
• SUPERIOR VENA CAVA SYNDROME
▫ Tumors in this area can press on the SVC, which can
cause the blood to back up in the veins. This can
lead to swelling in the face, neck, arms, and upper
chest.
• PARANEOPLASTIC SYNDROMES:-
▫ Some lung cancers can make hormone-like
substances that enter the bloodstream and cause
problems with distant tissues and organs, even
though the cancer has not spread to those tissues or
organs. These problems are called paraneoplastic
syndromes.
Excess growth/thickening of certain bones, especially
those in the finger tips
Excess breast growth in men (gynecomastia)
STAGES OF CANCER
American Joint Committee on Cancer (AJCC) TNM system, which is based on:

Sr. STAGE FEACTURES

No

The size T0: There is no evidence of a primary tumor.

of the
main T1: The tumor is no larger than 3 centimeters,
(primary) not reached PLEURA
tumor T2: The tumor has 1 or more, larger than 3 cm across but
(T) not larger than 7 cm. BROCHUS

T3: The tumor has 1 or more of the following features, It is

larger than 7 cm across CHEST WALL

T4: The cancer has 1 or more, A tumor of any size has

grown into the space between the lungs
 Sr. STAGE FEACTURES

No

N0: There is no spread to nearby lymph nodes.

Whether
the
cancer N1: The cancer has spread to lymph nodes within
has
spread the lung , bronchus enters the lung
to
nearby N2: The cancer has spread to lymph nodes
(regiona
around the carina , mediastinum
l) lymph
nodes
(N). N3: The cancer has spread to lymph nodes near
the collarbone on either side
 Sr. STAGE FEACTURES

No

M No spread to distant organs or areas. This

categ- includes the other lung, lymph nodes
M0:
ories away than those mentioned in the N stages
for above, and other organs
lung
cance M1a: The cancer has spread to the other lung.
r •Cancer cells are found in the fluid around
the lung
M1b The cancer has spread to distant lymph
nodes or to other organs
DIGNOSTIC EVALUATION:-
• Medical history and physical
exam:-
• Blood tests:-
▫ A complete blood count (CBC) looks
at whether patient blood has normal
numbers of different types of blood cells.
▫ Blood chemistry tests can help spot
abnormalities in some of patient organs,
such as the liver or kidneys. For example,
e.g. high level of lactate dehydrogenase
(LDH).
IMAGING TESTS:-
• Chest x-ray
▫ This is often the first test will do to look for any
abnormal areas in the lungs.
• Computed tomography (CT) scan:-
• A CT scan uses to make detailed cross-sectional
images of patient body.
• can show the size, shape, and position of any lung
tumors and can help find enlarged lymph nodes
• CT-guided needle biopsy:
• If a suspected area of cancer is deep within patient
body, a CT scan can be used to guide a biopsy
needle into the suspected area.
• Positron emission tomography (PET)
scan:-
▫ For this test, a form of radioactive sugar (known
as FDG) is injected into the blood.
▫ This radioactivity can be seen with a special
camera. PET/CT scan.
•
• Needle biopsy:- can often use a
hollow needle to get a small sample from
a suspicious area (mass).
▫ fine needle aspiration (FNA) biopsy,
▫ core biopsy.
• Bronchoscopy:-
▫ Bronchoscopy can help the find some tumors
or blockages in the lungs.
• Thoracoscopy:-
▫ spread to the spaces between the lungs and the
chest wall, or to the linings
MANAGEMENT:-
• MEDICAL MANAGEMENT:-
• PHOTODYNAMIC THERAPY (PDT):-
▫ This type of treatment can be used to treat
very early-stage lung cancers that are only in the
outer layers of the lung airways,

• THORACENTESIS:-
▫ This is done to drain the fluid.
• LASER THERAPY:-
▫ used to treat very small tumors in the
linings of airways.
▫ open up airways blocked by larger tumors to help
people breathe better.
• PHARMACOLOGICAL MANAGEMEN:-
• CHEMOTHERAPY
• for lung cancer Chemotherapy (chemo) is
treatment with anti-cancer drugs injected into a vein
or taken by mouth. These drugs enter the
bloodstream and go throughout the body, making this
treatment useful for cancer anywhere in the body
SR.NO NAME OF DRUGS DOSE SIDE EFFECT
Hair loss
1 • Cisplatin 75-100 mg/m² IV, 4Weeks •Mouth sores
•Loss of
2 • Carboplatin 200 mg/m2 IV on day 1 appetite
•Nausea and
vomiting
135 mg/m2, IV over 24
3 • Paclitaxel (Taxol) hours, every 3 weeks
•Diarrhea/
constipatio
Easy bruising
25 g (5% or 25% solution)
4 • Albumin-b or bleeding
IV infusion
(from having
75 mg/m² IV over 1 hour too few blood
5 • Docetaxel (Taxotere) 3Weeks platelets)
•Fatigue
25 mg/sq.meter IV Week
7 • Vinorelbine (Navelbine) with IV cisplatin 100
mg/sq.meter 4Weeks

9 Vinblastine 4 mg/sq. meter, 2week

SURGICAL MANAGEMENT:-
• • Lobectomy:
▫ In this surgery, the entire lobe
containing the tumor is removed.
• • Segmentectomy or wedge
resection:
▫ In these surgeries, only part of a lobe
is removed. This approach might be
used, for example, if a person doesn’t
have enough lung function to
withstand removing the whole lobe.
• Pneumonectomy:
▫ This surgery removes an entire lung.
This might be needed if the tumor is
close to the center of the chest.
VIDEO-ASSISTED THORACIC SURGERY
(VATS)
• Increasingly, treat early-stage lung cancers in
the outer parts of the lung with a procedure
called video-assisted thoracic surgery (VATS),
which requires smaller incisions than a
thoracotomy.
• During this operation, a thin, rigid tube with a tiny
video camera on the end is placed through a small
cut in the side of the chest to help the surgeon see
inside the chest on a TV monitor.
• One of the incisions is enlarged if a lobectomy or
pneumonectomy is done to allow the specimen to be
removed. Because only small incisions are needed,
there is usually less pain after the surgery and a
shorter hospital stay – typically 4 to 5 days.
RADIOFREQUENCY ABLATION
(RFA)
• RFA uses high-energy radio waves to heat the
tumor. A thin, needle-like probe is put through the
skin and moved in until the tip is in the tumor.
Placement of the probe is guided by CT scans. Once
the tip is in place, an electric current is passed
through the probe, which heats the tumor and
destroys the cancer cells.
• might have some pain where the needle was
inserted for a few days after the procedure. Major
complications are uncommon, but they can include
the partial collapse of a lung or bleeding into the
lung.
PALLIATIVE PROCEDURES FOR LUNG
CANCER
• Palliative, or supportive care, is aimed at
relieving symptoms and improving a person’s
quality of life.

• ISSUES ARE ADDRESSED IN PALLIATIVE

CARE:-
Physical.
Emotional and coping.
Spiritual.
NURSING MANAGEMENT:
• Assessment:
▫ Monitor S/S of respiratory failure
▫ Administer chemotherapy and other
desired medications
▫ Educate patient with their disease and its
progression
▫ Respiratory assessment
▫ Lab investigations and other diagnostic
tests
▫ Patient’s knowledge and understanding
of diagnosis and treatment,
▫ Patient’s anxiety level and support system,
▫ Exposure to carcinogen
NURSING DIAGNOSIS:
▫ Ineffective airway clearance related to
increased tracheobroncheal secretion
▫ Ineffective breathing pattern related to
decreased lung capacity
▫ Altered nutrition less then body requirement
related increased metabolic demand and
decreased food intake
▫ Anxiety related to lack of knowledge
▫ Pain related to the pressure of the tumor
Prevention
Assignment
1. Explain
pathophysioplogy of lung
cancer
2. Explain management of
lung cancer.
Summary
The above topic is summarized
by introduction, definition,
etiology, patho physiology,
stages, clinical manifestation,
diagnostic evaluation,
management and prevention
of lung cancer.
Conclusion
While lung cancer remains a very
challenging cancer to treat, new
treatments that capitalizes on
advances in our understanding of
cancer. It is likely that a more
personalized approach to treatment
using biological markers and
combinations of therapies will
provide better results in the future.
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Cont.
Lewis.Bucher, Heitkempeer, Harding, Kwong.
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https://www.cancer.gov/types/lung
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https://medlineplus.gov/lungcancer.html