LUNG CANCER

INTRODUCTION
•A cancer that begins in the lungs and most often occurs in people who smoke.

•Two major types of lung cancer are non-small cell lung cancer and small cell
lung cancer.

•Causes of lung cancer include smoking, second-hand smoke, exposure to certain

toxins and family history.
DEFINITION

•Lung cancer is a malignant lung tumor characterized by

uncontrolled cell growth in tissues of the lung. 

•This growth can spread beyond the lung by the process

of metastasis into nearby tissue or other parts of the body.
Etiology and Risk factors
•Smoking causes the majority of lung cancers
•Exposure to secondhand smoke. 
•Previous radiation therapy. 
•Exposure to radon gas. 
•Exposure to asbestos and other carcinogens. 
•Family history of lung cancer.
Types of lung cancer

1. Small cell lung cancer

-Small cell lung cancer is also known as “oat-cell” cancer
because the cells look like oats under the microscope.
-It often starts in the bronchi, then quickly grows and
spread to other parts of the body, including the lymph nodes.
-This type of lung cancer represents fewer than 20 percent
of lung cancers and is typically caused by tobacco smoking.
Cont.
2. Non-small cell lung cancer
-Non-small cell lung cancer is the most common type of
lung cancer.
-It accounts for nearly nine out of every 10 cases, and
usually grows at a slower rate than SCLC.
-Most often, it develops slowly and causes few or no
symptoms until it has advanced.
Non-small cell lung cancer- Types

•Adenocarcinoma of the lung: Lung adenocarcinoma is the most

common form of lung cancer. Adenocarcinomas of the lung are found
in the outer region of the lung, in glands that secrete mucus and help
us breathe.
•Squamous cell carcinoma: This type of lung cancer is found
centrally in the lung, where the larger bronchi join the trachea to the
lung, or in one of the main airway branches.
•Large-cell undifferentiated carcinoma: Large-cell undifferentiated
carcinoma lung cancer grows and spreads quickly and can be found
anywhere in the lung.
Non-small cell lung cancer- Types
Stages
Non-small cell lung cancer has four main stages:

•Stage 1: Cancer is found in the lung, but it has not spread outside the lung.

•Stage 2: Cancer is found in the lung and nearby lymph nodes.

•Stage 3: Cancer is in the lung and lymph nodes in the middle of the chest.
Cont.
•Stage 3A: Cancer is found in lymph nodes, but only on the same side
of the chest where cancer first started growing.

•Stage 3B: Cancer has spread to lymph nodes on the opposite side of

the chest or to lymph nodes above the collarbone.

•Stage 4: Cancer has spread to both lungs, into the area around the
lungs, or to distant organs.
TNM CLASSIFICATION
PATHOPHYSIOLOGY
Repeated exposure to carcinogens, cigarette smoke etc.

Dysplasia of lung epithelium.

If the exposure continues, it leads to genetic mutations and affects protein synthesis.

This, in turn, disrupts the cell cycle and promotes carcinogenesis.

Lung cancer
 Clinical features
•Lung cancer typically doesn't cause signs and symptoms in its earliest stages.
•Signs and symptoms of lung cancer typically occur when the disease is advanced.
Signs and symptoms of lung cancer may include:
A new cough that doesn't go away
Coughing up blood, even a small amount
Shortness of breath
Chest pain
Hoarseness
weight loss
Bone pain
Headache
Diagnosis
History collection
Physical examination
Imaging studies
Sputum cytology
Lung biopsy
CT Scan
MRI Scan
PET Scan
Fluorescence bronchoscopy
Prevention
•Don't smoke.
•Stop smoking. 
•Avoid secondhand smoke. 
•Avoid carcinogens at work. 
•Eat a diet full of fruits and vegetables. 
•Exercise most days of the week. 
Medical Management
•Oxygen through nasal cannula based on level of dyspnea.

•Enteral or total parenteral nutrition for malnourished patient who is unable or

unwilling to eat.

•Removal of the pleural fluid (by thoracentesis or tube thoracostomy) and

instillation of sclerosing agent to obliterate pleural space and fluid recurrence.

•Radiation therapy in combination with other methods.

Pharmacological management
•Expectorants and antimicrobial agents to relieve dyspnea and
infection.

•Analgesics given regularly to maintain pain at tolerable level. Titrate

dosages to achieve pain control.

•Chemotherapy using cisplatin in combination with a variety of other

agents and immunotherapy treatments may be indicated.
Management
Surgery
◦ Lobectomy
◦ Wedge resection- a smaller sub-lobar excision
◦ Pneumonectomy
◦ Video-assisted thoracoscopic surgery (VATS)
◦ VATS lobectomy 
LOBECTOMY WEDGE RESECTION
VATS LOBECTOMY  PNEUMONECTOMY
Cont.
•Radiation therapy
•Chemotherapy
•Targeted and immunotherapy
•Palliative care
•Counselling
•Psychotherapy, Psychosocial therapy
Nursing management

•Elevate the head of the bed to ease the work of breathing and to prevent
fluid collection in upper body
•Teach breathing retraining exercises to increase diaphragmatic excursion
and reduce work of breathing.
•Augment the patient’s ability to cough effectively by splinting the
patient’s chest manually.
•Instruct the patient to inspire fully and cough two to three times in one
breath.
•Provide humidifier or vaporizer to provide moisture to loosen secretions.
Cont.
•Encourage the patient to conserve energy by decreasing activities.
•Ensure adequate protein intake such as milk, eggs, oral nutritional
supplements; and chicken, fowl, and fish if other treatments are
not tolerated – to promote healing and prevent edema.
•Advise the patient to eat small amounts of high-calorie and high-
protein foods frequently, rather than three daily meals.
•Suggest eating the major meal in the morning if rapid satiety is
the problem.
Cont.
•Teach relaxation techniques to reduce anxiety associated with
dyspnea. Allow the severely dyspneic patient to sleep in reclining
chair.
•Change the diet consistency to soft or liquid if patient has esophagitis
from radiation therapy.
•Consider alternative pain control methods, such as biofeedback and
relaxation methods, to increase the patient’s sense of control.
•Teach the patient to use prescribed medications as needed for pain
without being overly concerned about addiction.
Complications
•Pleural effusion
•High risk for infection
•Deep vein thrombosis, pulmonary embolism
•Hemoptysis
•Hypercalcemia
•Superior vena cava syndrome
•Spinal cord compression
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