11 Lung Cancer

Lung cancer
Objective
To provide a general overview of lung physiology
To explore the types and classifications of lung cancer
To provide causes and risk factors of lung cancer
To present the signs and symptoms of lung cancer in
throughout its progression
To explore assessment and diagnostic information of lung
cancer
To introduce diagnostic staging specific to lung cancer
To discuss treatments and side effects of lung cancer
To present post-op complications for clients with lung cancer
To explore the nurses role and nursing interventions for a
client with lung cancer
To explain preventive health strategies regarding lung cancer
General Overview of Lung Physiology:
Breathing
Types of Lung Cancer
• Two main Types of Lung Cancer:
• Small Cell Lung Cancer (20-25% of all lung

cancers)
• Non Small Cell Lung Cancer (most common

~80%)
Small Cell Lung Cancer
Small Cell Lung Cancer
• Small Cell Lung Cancer is the most aggressive form of
lung cancer.
• It usually starts in the bronchi which is problematic
because post-pneumonia and atelectasis often occur.
• These cancer cells are small and are considered to be
quite aggressive in nature and they have a large
growth factor. Because of these reasons, at the time of
diagnosis, (60% of the time), these tumors have often
metastasize to other parts of the body (brain, liver,
and bone marrow)
Non-small cell lung cancer
• 1. Squamous cell carcinoma
• 2. Adenocarcinoma
• 3. Large cell carcinomas
Squamous cell carcinoma
• Moderate to poor differentiation
• makes up 30-40% of all lung cancers
• more common in males
• most occur centrally in the large bronchi
• Uncommon metastasis that is slow effects the liver,
adrenal glands and lymph nodes.
• Associated with smoking
• Not easily visualized on xray (may delay dx)
• Most likely presents as a Pancoasts tumor
Adenocacinoma
• Increasing in frequency. Most common type of Lung
cancer (40-50% of all lung cancers).
• Clearly defined peripheral lesions (RLL lesion)
• Glandular appearance under a microscope
• Easily seen on a CXR
• Can occur in non-smokers
• Highly metastatic in nature
• Pts present with or develop brain, liver,
• adrenal or bone metastasis
Large cell carcinomas
• makes up 15-20% of all lung cancers
• Poorly differentiated cells
• Tends to occur in the outer part (periphery) of
lung, invading sub-segmental bronchi or larger
airways
• Metastasis is slow BUT
• Early metastasis occurs to the kidney, liver organs
as well as the adrenal glands
• http://www.youtube.com/watch?v=3wzjqbhbesI.
Signs and Symptoms of Lung Cancer
• Sometimes lung cancer does not cause any symptoms and is
only found in a routine x-ray.
• If a person with lung cancer does have symptoms, they will
depend on the location of the tumour in their lung.
• It is also imperative to note that the same symptoms can be
caused by other conditions, so may not necessarily mean
cancer.
• Therefore it is important to consult a doctor when symptoms
are present.
• Signs and symptoms also depend upon the location, size of
the tumor, degree of obstruction and existence of metastases
Signs and Symptoms of Lung Cancer
• There are two types of signs and symptoms of

lung cancer:
• 1) Localized – involving the lung.
• 2) Generalized – involves other areas

throughout the body if the cancer has spread.
Localized Signs and Symptoms
• Cough
• Breathing Problems, SOB, stridor
• Change in phlegm
• Lung infection, hemoptysis
• Hoarseness, Hiccups
• Wt loss
• Chest Pain and tightness
• Pancoats Syndrome
• Horner’s Syndrome
• Pleural Effusion
• Superior Vena Cava Syndrome
• Fatigue
Generalized Signs and Symptoms
• Bone pain
• Headaches, mental status changes or
neurologic findings
• Abdominal pain, elevated liver function tests,
enlarged liver, gastrointestinal disturbances
(anorexia, cachexia), jaundice, hepatomegaly
r/t liver involvement
• Weight loss
Early/late Signs and Symptoms Of Lung
Cancer
Diagnostic Tests
• CXR
• CT Scans
• MRI
• Sputum cytology
• Fibreoptic bronchoscopy
• Transthoracic fine needle aspiration
Laboratory Tests
• Blood Tests
• *CBC-to check red/white blood cell & platelets
• -to check bone marrow and organ function
• *Blood Chemistry Test-to assess how organs

• are functioning such as liver and kidney
• Biopsy-to determine if the tumor is cancer or not
• -to determine the type of cancer
• -to determine the grade of cancer (slow
• or fast)
Biopsy
Endoscopy
• Bronchoscopy
• Mediastinoscopy
• VATS (video assisted thoracoscopic surgery)
Bronchoscopy
Mediastinoscopy
Nursing Management for post endoscopic
procedures
Post-op complications for those with lung
cancer
• Airway obstruction, dyspnea, hypoxemia, respiratory failure
• Anesthesia side effects (N/V)
• Bleeding (hypotension, cardiogenic shock)
• Cardiac dysthymias, CHF, fluid overload
• Fever, sepsis
• Pneumonia
• Pneumothorax
• Pulmonary embolus
• Wound dehiscence
• Prolonged hospitalization
Cancer Staging
Cancer Staging Systems
• The most common staging system for lung
cancer is the TNM System developed by the
International Union Against Cancer (UICC).
• Guides best course of treatment
• Estimates prognosis
• It is only useful in staging
• NSCLC, when surgery is
• considered.
TMN Staging system for Lung Cancer
• T= Tumors : tumor size, (local invasion)

•
• N= Node : node involvement (size and type)
• M= Metastasis : general involvement in organs

and tissues
Medical Management
• The three main cancer treatments are:
• *surgery (lung resections)
• *radiation therapy
• *chemotherapy
• Other types of treatment that are used to
treat certain cancers are hormonal therapy,
biological therapy or stem cell transplant
Lung resections
• Lobectomy: a single lobe of lung is removed
• Bilobectomy: 2 lobes of the lung are removed (only on R side)
• Sleeve resection: cancerous lobe is removed and segment of
the main bronchus is resected
• Pneumonectomy: removal of entire lung
• Segmentectomy: a segment of the lung is removed
• Wedge resection: removal of a small, pie-shaped area of the
segment
• Chest wall resection with removal of cancerous lung tissue:
for cancers that have invaded the chest wall
Prevention: Primary
• Avoid the use of tobacco smoke
• Personal and family hx are important risk
factors
• Know environmental carcinogens that increase
risk
• Chemoprevention:
• Consuming carotenoids, Vit A, retinoids Vit E,
selenium, Vit C, fat
Prevention: Secondary
• Aim is to early diagnose high risk populations
via screening
• CXR, MRI, CT scans, sputum cytology
References
• Carpenito-Moyet, L.J. (2009). Nursing Diagnosis; Application to clinical
practice (13th ed.). Philadelphia, P.A.: Lippincott Williams & Wilkins
• Cassileth, B., Deng, G., Gomez, J., Johnstone, P., Kumar, N., Vickers, A.
• Day, R.A., Paul, P., Williams, B. Smeltzer, S.C., Bare, B. (2010). Brunner &
Suddarth’s Textbook of Canadian Medical-Surgical Nursing (2nd ed.).
Philadelphia, P.A.: Lippincott Williams & Wilkins.
• Otto, S. (2001). Oncology Nursing (4th ed.). St. Louis, Missouri: Mosby Inc.
• http://nursingcrib.com/nursing-notes-reviewer/lung-cancer/
• http://news.bbc.co.uk/2/hi/health/7130216.stm
• http://news.bbc.co.uk/2/hi/health/7130216.stm
• www.cancer.ca

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Lung cancer

• Small Cell Lung Cancer (20-25% of all lung

• Non Small Cell Lung Cancer (most common

• There are two types of signs and symptoms of

• 1) Localized – involving the lung.

• 2) Generalized – involves other areas

• *Blood Chemistry Test-to assess how organs

• T= Tumors : tumor size, (local invasion)

• M= Metastasis : general involvement in organs

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