LUNG CANCER

MR. POORAN SINGH BHATI

ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
SMT. D.S.S.N.I
 INTRODUCTION
• Lung cancers can arise in any part of the lung but 90-95% of cancers of the lungs
are thought to arise from the epithelial cells, the cells lining the larger and smaller
airways (bronchi & bronchioles), so lung cancers are sometimes called
Bronchogenic cancers or Bronchogenic carcinoma.
• Lung carcinoma is 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 tissues or other parts of the body.
INCIDENCE-
• About 14% of all new cases are lung cancers.
• About 224390 new cases of lung cancer (117920 in men & 106470 in women).
• More than 85% of lung cancers are caused by the inhalation of carcinogenic
chemicals, most commonly cigarette smoke.
 TYPES
Lung cancer
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Small cell lung cancer non small cell lung cancer
(20-25% of all lung cancer) (most common 80%)
(Affect bronchi & whole lung) |
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Squamous cell adenocarcinoma large cell carcinoma
 ETIOLOGY & RISK FACTORS
• The exact cause is unknown.
• Smoking & passive smoking (active-85-87% and passive- 3-5%)
• Prior history of lung cancer.
• Lung disease like T.B.
• Older age.
• Air pollution
• Genetic predisposition.
• Industry work due to asbestos fibers, mines, mills & textiles.
• Diet- (low in fruits & vegetables)
2 large studies found that smokers who took beta carotene supplements actually had
an increased risk of lung cancer.
Top 5 cancer causing foods are- sweetened beverages, French fries, hotdogs, donuts &
PATHOPHYSIOLOGY
Due to any etiological factors
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Damage to the cell
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Carcinogens bind to damaged cells & DNA
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Cellular changes
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Passed to the daughter cell
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Eventually malignant cell
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Malignant transform from normal epithelium
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 STAGES OF LUNG CANCER (TNM CLASSIFICATION)
T- Tumor size
• To- There is no evidence of a primary tumor
• T1- The tumor is no larger than 3cm & not reached pleura
• T2- The tumor has 1 or more larger than 3cm across but not larger than 7cm,
bronchus
• T3- The tumor has 1 or more of the following features. It is larger than 7cm across
chest wall
• T4- The cancer has 1or more. A tumor of any size has grown into the space
between the lungs
 STAGES OF LUNG CANCER (TNM CLASSIFICATION)
N- Lymph node involvement-
• No- There is no spread to nearly lymph node
• N1- The cancer has spread to lymph node within the lung, bronchus enters the
lung
• N2- The cancer has spread to lymph nodes around the carina, mediastinum
• N3- The cancer has spread to lymph nodes near the collarbone on either side.

M- Metastasis-
• Mo- No spread to distant organs or areas
• M1a- The cancer has spread to the other lung. Cancer cells are found in the fluid
around the lungs.
• M1b- The cancer has spread to distant lymph nodes or to other organs.
 STAGES OF LUNG CANCER
Stage-1: Tumor is small & localized to lung, no lymph node involvement
1a- Tumor <3cm
1b- Tumor >3cm & involving surrounding local area
Stage-2:
2a- Tumor <3cm with invasion of lymph nodes
2b- Tumor >3cm involving the bronchus & lymph nodes on the same side of chest
& tissue of local organs.
Stage-3:
3a- Tumor spread to the nearby structures & regional lymph nodes
3b- Tumor involving heart, trachea, esophagus, mediastinum & lymph nodes
Stage-4: Distant metastasis
 CLINICAL MANIFESTATION
There are two types of sign and symptoms of lung cancer.
1. Localized- Involving the lung
2. Generalized- Involves other areas throughout the body if the cancer has spread

3. Localized sign and symptoms-

 Cough & fatigue
 Breathing problems
 Blood in phlegm
 Hemoptysis
 Hoarseness, hiccups
 Weight loss
 Chest pain & tightness
 Pleural effusion
 Shortness of breath
 Wheezing sound
 CLINICAL MANIFESTATION
2. Generalized sign and symptoms-
Bone pain
Headache
Mental status changes
Abdominal pain
Blurred vision
Seizures
Anorexia
Cachexia (weakness & wasting of the body muscles due to severe chronic illness)
Jaundice
depression
 DIAGNOSTIC EVALUATION
• History collection.
• Physical examination.
• Chest X-ray
• Sputum cytology
• MRI
• PET Scan
• CT Scan
• Fibroptic bronchoscopy
• Transthoracic fine needle aspiration
• ThoracoscopY
• PFT
• Blood test- CBC
 MANAGEMENT
The three main cancer treatment are:
1. Radiation therapy
2. Chemotherapy
3. Surgery (lung resection)
Other types of treatment that are used to treat certain cancers are hormonal therapy, biological therapy
or stem cell transplant.

RADIATION THERAPY-
• It generally shrinks a tumor or limit its growth when given as a shock therapy yet 10-15% of people it
leads to long term remission (reduction) & palliation of the cancer.
CHEMOTHERAPY-
• It refers to the administration of drugs that stop the growth of cancer cells by killing them or preventing
them from dividing.
• It is the treatment of choice for small cell lung carcinoma.
Example- Cisplatin, Carboplatin, Paclitaxel, Cyclophosphamide.
 MANAGEMENT
SURGICAL MANAGEMENT-
• Lobectomy- a single lobe of lung is removed.
• Bi-lobectomy- 2 lobes of the lungs are removed.
• Sleeve resection- Cancerous lobe is removed & segment of the main bronchus is resected.
• Pneumonectomy- Removal of entire lung
• Segmentectomy- Removal of a segment of lung.
• Wedge resection- Removal of a small, pie shaped area of the segment.
• Lymphadenectomy- Sometimes lymph node in the region of the lungs also are removed.
PREVENTION-
• Avoid the use of tobacco smoke.
• Consuming vita- A, E & C
• Know the environmental carcinogens that increase risk of lung cancer
 NURSING MANAGEMENT
Observe & record patient TPR & B.P. hourly.
Maintain patient airway patency through the removal of excess secretions.
Provide deep breathing exercise, chest physiotherapy.
Administer bronchodilator medication to promote bronchial dilation/reduce
bronchospasm.
Encourage the patient to assume comfortable position to promote lung expansion.
Encourage patient to have a high calorie, high protein diet & adequate fluid intake
(1.5-2 l/day).
Monitor sputum for sign of infection.
Give prophylactic antibiotics as prescribed.
Provide regular oral hygiene to prevent oral mucosa becoming dry.
NURSING DIAGNOSIS
1. Ineffective breathing pattern related to obstructive & restrictive respiratory
processes association with lung cancer as evidence by over exertion of patient
during respiration & dyspnea.
2. Impaired gas exchange related to excessive or thick secretion as evidence by
decreased spo2 level of patient.
3. Chronic pain related to stage-IV non small cell lung cancer diagnosis tumor
effect as evidenced by client reporting pain in chest & lower ribs.
4. Risk for infection related to altered immune system secondary to efforts of
cytotoxic drugs.
5. Fatigue related to chemotherapy or radiation therapies evidenced by client
reporting he ha no longer energy or walk.
6. Imbalance nutrition less than body requirement related to hypermetabolic state,
taste aversion, anorexia secondary to radiation/chemotherapy as evidenced by
weight loss, fatigue, vertigo etc.