LUNG CANCER/ BRONCHOGENIC

CARCINOMA
Modifiable
-

Non Modifiable

Tobacco smoking
Frequent exposure to secondhand
smoke
occupational exposures to certain
workplace toxins (asbestos, radon,
arsenic, chromium, Nickle, PAHs
radiation, air pollution

- Genetic factors
- Age
- Hx of Ca

Inhaled carcinogen
Tracheobronchial airway
Carcinogen binds to DNA of epithelial
cells
Cellular changes
Abnormal cell growth
Malignant cell

Diagnostic Tests:
1. chest x-ray
2. sputum cytologic
studies,
3. Computed
tomography
4. Fiberoptic
bronchoscopy
5. Biopsy.

Duplication
Passing of damaged DNA to daughter
cells
Further changes in DNA

Unstable DNA
Malignant transformation of the
pulmonary epithelium

Tumor hormone
secretion into
systemic
circulation

Hila & bronchi

(Squamous cell
carcinoma)

Mediastinal lymph
nodes & pleura
(Adenocarcinoma)

Pressing of nerves
leading to larynx

Mediastinal lymph
nodes & pleura
(Adenocarcinoma)

Tumor
secretion of
PTHrP
hormone

Obstructive
lesion

Increase
bone
resorption

Fluid buildup in the pleura

Infection

Ectopic hormone production

(peptide hormone
production)

Spread to
brain and
bones

Pressure on the lung

Hoarseness
of Vocie

Fever

Hypercalcemia

Lung Cannot Fully Expand

Mucosal
ulceration

Rupture of
blood vessels

Airway
obstruction

Hemoptysis

x
Narrowing of
Airway

Invasive Carcinoma

Ischemia

ACTH Production

DOB

Irritation of
bronchial mucosa

Pleural
Effusion

Adrenal gland
stimulation

Chest/Shoulder
pain

Hyponatremia

Release of cortisol
to the
bloodstream

Nonproductive
cough

Productive cough

H2o Retention

Pneumonia

Sputum Production
High pitched
sound (wheezing)

Elevated ADH
production

Cushings
syndrome

Excessive cortisol
production

SIADH

Acute Pain/Chronic
Pain

Ineffective
airway clearance

Demonstrate patent airway

with fluid easily
expectorated, clear breath
sounds, and noiseless
respiratons.

Assist patient and instruct in

deep breathing and coughing
in upright position and
splinting chest wall.
Suction if cough is weak or
breath sounds not cleared by
cough effort.
Encourage oral fluid intake (at
least 2500mL/day0 within
cardiac tolerance.
Administer bronchodilators ,
expectorants, and/or
analgesics as indicated.

Impaired Gas
Exchange

Demonstrate improved
ventilation and adequate
oxygenation of tissues by
ABGs within patients
normal range.

Reports pain relief/

controlled pain.

Provide comfort measures

such as frequent changes of
position, back rubs and
pillow support and etc.
Schedule rest periods and
provide quiet environment.
Assist with self-care
activities, breathing, arm
exercises and ambulation
Administer analgesia as
prescribed.

Note respiratory rate, depth, and ease

of respirations.
Auscultate lungs for air movement and
abnormal breath sounds.
Maintain patent airway by positioning,
suctioning, use of airway adjuncts.
Reposition frequently, placing patient in
sitting positions and supine to side
positions.
Administer supplemental oxygen via
nasal cannula, partial rebreathing mask,
or high-humidity face mask, as
indicated.
Assist with/encourage use of incentive
spirometer.
Monitor/graph ABGs, pulse oximetry
readings. Note hemoglobin (Hb) levels.

The current accepted system for the staging of nonsmall cell cancer is the TNM
classification
The only proven way of reducing the risk for lung cancer is the cessation of
smoking, although chemopreventative measures are being explored.
Chemotherapy and radiation can significantly prolonglife and relieve symptoms,
but relapse is inevitable
In advanced disease, palliative procedures (comfort measures) may be used to
relieve obstructive pneumonitis or prevent recurrence of pleural effusion.
The only proven way of reducing the risk for lung cancer is the cessation of smoking,