Neoplastic Disease

By Capt. Samer H. Al Shabatat, RN, MSN

 Anatomic Alterations of the Lungs
• Cancer is a general term that refers to abnormal new tissue growth
characterized by the progressive, uncontrolled multiplication of cells
• New cells is called a neoplasm or tumor.
 Anatomic Alterations of the Lungs
Benign tumors
• do not endanger life unless they interfere with the normal functions of
a vital organ.
• They grow slowly and push aside normal tissue but do not invade it.
• They are usually encapsulated, well-demarcated growths.
• They are not invasive or metastatic;
 Anatomic Alterations of the Lungs
Malignant tumors are
• Composed of embryonic, primitive, or poorly differentiated cells.
• They grow in a disorganized manner and so rapidly that nutrition of
the cells becomes a problem.
• They also invade surrounding tissues and may be metastatic.
• Malignant changes may develop most commonly originate in the
epithelium of the tracheobronchial tree.
 Anatomic Alterations of the Lungs
Bronchogenic carcinoma
• Tumor that originates in the bronchial mucosa, the terms lung cancer
and bronchogenic carcinoma are used interchangeably
 The major pathologic or structural changes
associated with bronchogenic carcinoma are as
follows
• Inflammation, swelling, and destruction of the bronchial airways and alveoli
• Excessive mucous production
• Tracheobronchial mucous accumulation and plugging
• Airway obstruction (either from blood, from mucous accumulation, or from a
tumor projecting into a bronchus)
• Atelectasis
• Alveolar consolidation
• Cavity formation
• Pleural effusion (when a tumor invades the parietal pleura and mediastinum)
 Etiology
• Cigarette smoking1 is the most common cause of lung cancer.
• Exposure to secondhand smoke or environmental tobacco smoke
(ETS) is associated with as much as a 30% increase in the risk for lung
cancer.
• A genetic predisposition toward developing lung cancer also plays a
role in the incidence of lung cancer
A, Squamous cell carcinoma B, Adenocarcinoma
C, Large cell carcinoma D, Small cell (oat cell) carcinoma.
 Symptoms associated with lung cancer
(1) a progressively worsening cough, often includes blood or rust-colored
sputum;
(2) chest pain—especially with deep breathing, coughing,
(3) laughing hoarse voice.
(4) poor appetite and weight loss.
(5) dyspnea.
(6) fatigue.
(7) frequent bronchial infection or pneumonia episodes.
(8) the sudden onset of wheezing
RADIOLOGIC FINDINGS
Chest Radiograph
• Small oval or coin lesion
• Large irregular mass
• Alveolar consolidation
• Atelectasis
• Pleural effusion
• Involvement of the mediastinum or diaphragm
Right lung squamous cell carcinoma of the bronchus
 The Tumor Node Metastasis (TMN)
Staging System
Joint Committee on Cancer TMN staging The stage of a patient’s
cancer is determined by a combination of all of the following factors:
• T :represents the size and location of the primary tumor
• N :denotes the regional lymph node involvement
• M :signifies the extent of metastasis (e.g., common sites are the
brain, bones, adrenal glands, liver, kidneys, and other lung)
 Screening and Diagnostic Tests for Lung
Cancer
• Chest radiograph
• Computed tomography (CT) scan
• Positron emission tomography (PET) scan: used to help determine if an abnormal
area on the chest x-ray or CT scan might be cancer.
• Magnetic resonance imaging (MRI) scan
• Bone scan
 Screening and Diagnostic Tests for Lung
Cancer
• Sputum cytology: viewed under the microscope to determine cancer cells
• Bronchoscopy
 Needle biopsy
 Bronchial brushing
 Bronchial washing
• Endobronchial ultrasound (EBUS): Tissue samples are viewed under the microscope.
• Endoscopic esophageal ultrasound
 Screening and Diagnostic Tests for Lung
Cancer
• Mediastinoscopy and mediastinotomy: small incision in the front of the neck,
which allows a thin, hollow, lighted tube to be inserted behind the sternum and in front of the
trachea.

• Thoracentesis: insertion of a hollow needle between the ribs to aspirate the fluid for
microscopic study
• Video-assisted thoracoscopy surgery (VATS)
 Screening and Diagnostic Tests for Lung
Cancer
• Immunohistochemistry: This test entails treating the tissue sample with certain
antibodies designed to attach only to specific substances found in certain cancer cells
• Molecular tests: identification of specific gene changes in the cancer cells may help pinpoint
certain targeted drugs
• Complete blood count (CBC)
Screening and Diagnostic Tests for Lung
Cancer
Bronchoscopic view of a small cell carcinoma tumor
 General Management of Lung Cancer
Surgery
• Pneumonectomy: the entire lung is removed in this surgery.
• Lobectomy: an entire section (lobe) of a lung is removed in this surgery.
• Segmentectomy or wedge resection: a part of a lobe is removed in this
surgery.
• Sleeve resection: entails removal of some tumors in the large airways
General Management of Lung Cancer
Radiation Therapy
Other Local Treatments
Radiofrequency ablation (RFA)
Photodynamic therapy (PDT)
Laser therapy
General Management of Lung Cancer
• Chemotherapy and Common side effects include:
• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)
General Management of Lung Cancer
Respiratory Care Treatment Protocols
• Oxygen Therapy Protocol
• Bronchopulmonary Hygiene Therapy Protocol
• Lung Expansion Therapy Protocol
• Aerosolized Medication Protocol
 Review question
• Which of the following is or are associated with bronchogenic carcinoma?
1. Alveolar consolidation
2. Pleural effusion
3. Alveolar hyperinflation
4. Atelectasis
a. 2 and 3 only
b. 1 and 4 only
c. 2 and 3 only
d. 1, 2, and 4 only