Lung cancer

LUNG CANCER
(bronchogenic
carcinoma)
Background
- May be or

(Primary)
- Within the lung, chest wall,
mediastinum
- Metastasis

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 Leading cancer killer among &
- 1 out of 4 cancer deaths
- Each yr, more people die
- 57% of patients with the Dse. Has
spread to regional lymphatics and other
sites by the time of diagnosis
- Long term survival rate is
5-year survival rate

17%
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PATHOPHYSIOLOGY -
-
(cigarette smoke - >85%)
Others (radon gas)
- Occupational agents
Most common Inhaled carcinogens - Environmental agents
cause:
DNA is damaged
Single transformed
epithelial cell
Cellular changes
Abnormal Cell Growth
Mutation (Pulmonary epithelium)
From previous scarring (TB
Development of Malignant Cell fibrosis)
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PATHOPHYSIOLOGY

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PATHOPHYSIOLOG
Y METASTASIS
Liver CNS
Asymptomatic Headache Visual
elev. of liver Jaundice Seizure
Disturbance
enzymes
Obstruction & Inflammation Cough

Occlusion of Compression of Pleural Chest Wall Heart Fever Head &

airway mediastinal involvement involvement involvement
structures
neck
edema
Hoarseness
Dyspnea Pleural Chest pain Pericardial
Dysphagia Effusion & tightness Effusion
Weight loss 7
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 ✘ NON-SMALL CELL LUNG CANCER
CLASSIFICATION (NSCLC)
& ○ 85% of tumors
○ Squamous Cell (20%)
■ More centrally located
STAGING
✘ SMALL CELL LUNG CANCER (SCLC) ■ Arise in segmental &
○ 15% of tumors subsegmental bronchi
○ 2 Gen. Cell Types: ○ Large Cell (5%-Undifferentiated)
■ Small Cell ■ Fast growing
■ Combined Small Cell ■ Arise peripherally
○ Adenocarcinoma (38%)
■ Most prevalent carcinoma in
men and women
■ Occurs peripheral masses or
nodules
■ Often metastasize
○ Others (cannot be classified -18%)
○ Bronchoalveolar
■ Found in terminal bronchi and
alveoli
■ Slow growing

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 ✘ Refers to the size of the tumor, its
CLASSIFICATION location, LN involvement and spread

& STAGING
✘ NON-SMALL CELL LUNG CANCER
(NSCLC)
○ Stage I
■ Earliest & has highest cure rate
■ Found in the lung , no spread
○ Stage II
■ Lung and nearby LN
○ Stage IIIA
■ Lung + LN + middle of the chest
■ 1 side is affected
○ Stage IIIB
■ Tumor spread to the LN of other
side or LN above collar bone
○ Stage IV
■ Cancer has spread to both lungs,
areas around lungs or distant
organs
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CLASSIFICATION
& STAGING

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CLASSIFICATION
& STAGING
✘ SMALL CELL LUNG CANCER (SCLC)
○ Limited Stage
■ Cancer is limited to one side
■ Treated with single radiation
field
○ Extensive Stage
■ Cancers that has spread widely
throughout the lung, LN & other
side of chest or other parts of the
body

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SURVIVAL RATES

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 RISK FACTORS
- CIGARETTE SMOKING
- Second-hand smoke (Passive smoking)
-75%
- Radon Gas
- Occupational and environmental agents
- Respiratory illness (TB, COPD)
- Genetic predisposition
- Dietary deficits (high-dose retinoid b-
carotene supplement
- Asbestos exposure
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 Tobacco Smoke

-23X higher in & 13X higher in

-determined by pack-year history, age of
initiation of smoking, depth of -inhalation,
ta & nicotine levels
Younger age (higher risk)
-smokers of smokeless products increase
their risk
- Almost all of SCLC (most aggressive
form
- Grows quickly
- Starts in airways (center)
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 Electronic cigarettes

- from electronic nicotine delivery

system
- Amount of nicotine & other substances
a person gets from each cartridge is
questionable and vary

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 Second-hand smoke

- Aka Passive Smoking

- Cause of cancer in non-smokers
- Involuntary exposure in an enclosed
environment
- Higher risk of developing lung cancer

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 Environmental & occupational exposure

- Motor vehicle emissions & pollutants

from refineries & manufacturing plants
- Radon
- Colorless, odorless gas found in the
soil & rocks
- Arsenic, Asbestos, mustard gas,
chromates, coke oven fumes, nickel, oil
& radiation

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 GENETIC MUTATIONS

- Inherited gene changes

- Acquired gene changes
- Often results to factors in the
clinical envi
- TP53 or p16 tumor suppressor
genes
- K-RAS or ALKoncogenes (NSCLC)

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CLINICAL MANIFESTATIONS
 Develops insidiously
 Asymptomatic until late course
 S&sx depend on the location and
size, degree of obstruction &
presence of mets
 M. freq sx
 cough/change in chronic cough

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CLINICAL MANIFESTATIONS
 Dyspnea (prominent early ) from
tumor occlusion in airway,
pleural effusion, pneumonia
 Hemoptysis
 Chest or shoulder pain (chest wall
or pleural involvement)
 Recurring fever

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 ASSESSMENT &
DIAGNOSTIC FINDINGS
CHEST X-RAY
- PULMONARY DENSITY, PULMO
NODULE, ATELECTASIS & INFXN
Ct Scan f the Chest
- Identify small nodules not
visualized on CXR &
lymphadenopathy
Sputum Cytology
- Rarely used
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 ASSESSMENT &
DIAGNOSTIC FINDINGS
Fiberoptic Bronchoscopy
- Commonly used to provide detailed
study of tracheobronchial tree
- Allows brushings, washings and
biopsies
FNAB
- under CT guidance

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 ASSESSMENT &
DIAGNOSTIC FINDINGS
Variety of scans
- Bone scans, abdominal scans, pet
scan, liver utz, ct of brain, mri,
mediastinoscopy, endobronchial utz
Preoperative
- PFT, ABG analysis, V/Q scans,
exercise testing

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 MANAGEMENT
1. Medical Management
OBJECTIVE: provide cure if
possible
Crizotinib (Xalkori)
Ceritinib (Zykadia) target
genetic alterations
2. Surgical Management
- Preferred method for localizedNSCLC,
no evidence of mets, adequate
cardiopulmonary function
- CAD, pulmo, insufficiency & other
comorbidities are contraindicated
- Bronchogenic ca are inoperable at the
time of diagnosis
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 Types of
lung
resection

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 RADIATION TXT
- MAY OFFER CURE IN SMALL
PERCENTAGE
- USEFUL IN CONTROLLING NEOPLASM
THAT CANNOT BE SURGICALLY
RESECTED
- REDUCE THE SIZE OF A TUMOR TO
MAKE IT OPERABLE OR TO RELIEVE
PRESSURE
- REDUCE SX OF SC METS & SVC
COMPRESSION
- PROPHYACTIC BRAIN IRRADIATION
(FOR MICROSCOPIC METS TO THE
BRAIN)
- LEAD TO COMPLICATIONS (esophagitis,
fibrosis, pneumonitis)

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 CHEMOTHERAP
- Y GROWTH
USED TO ALTER TUMOR
PATTERNS, TREAT DISTANT METS OR
SCLC & AS ADJUNCT TO
SURGERY/ADIATION THERAPY
- MAY PROVIDE RELIEF (PAIN)
- ACCOMPANIED BY S/E
- CHOICE OF AGENT DEPENDS ON
GROWTH OF TUMOR AND SP PHASE OF
THE CELL CYCLE
- IN COMBINATION WITH SX,
- NEOADJUVANT OR ADJUVANT

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 NURSING
INTERVENTIONS

 MONITOR PATIENT’S NUTRITIONAL STATUS

 CHECK PATIENT’S [PSYCHOLOGICAL OUTLOOK,
FATIGUE LEVEL,
 CHECK FOR SIGNS OF ANEMIA AND INFECTION

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 Palliative
Therapy
✘ concurrent with std onco care
✘ May include radiation therapy to shrink
tumor size for pain relief
✘ Bronchoscopic Interventions to open
narrowed airway
✘ Evaluation & referral for hospice care
(comfortable and dignified end-of-life
care)

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 TREATMENT-
RELATED
complications
✘ SURGICAL RESECTION
○ Respi. Failure
○ Prolonged mech. Vent
✘ RADIATION THERAPY
○ Diminished CP function
○ Pulmo fibrosis, pericarditis,
myelitis, Cor pulmonale
✘ CHEMOTHERAPY
○ Pneumonitis
○ Pulmo toxicity

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NURSING MANAGEMENT
Address the physiologic and psychological needs of the
patient
o Strategies to ensure relief of pain and discomfort
o Prevent complications
o Educate the patient and family about potential s/e of
specific treatments with strategies to manage them

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✘ Airway clearance techniques to
maintain airway patency
○ Removal of excess secretions
○ Deep breathing exercise
○ Chest physiotherapy
○ Directed cough
○ Suctioning
○ Broncodilator meds prescription
○ Supplemental oxygen ( impaired
breathing pattern and poor gas
exchange)
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✘ Nursing measures to decrease dyspnea
○ Encourage patient to assume positions
to promote lung expansion
○ Perform breathing exercises for lung
expansion and relaxation
○ Px educ ation abt energy conservation
✘ Reducing fatigue
✘ Providing Psychological support &
identifying potential resources
○ Help deal with the prognosis &
relatively rapid progression of the dse
○ Informed decision making re: txt
○ Maintain quality of life
○ End-of-life txt options
thanks!

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