1. Lung Cancer

2. Etiology Leading cause of cancer-related deaths In 2002, 25% of all female deaths were estimated to be due to lung cancer Most commonly occurs in individuals over 50 and with a history of cigarette smoking

3. Etiology Smoking is responsible for 80 to 90% of all lung cancers Tobacco smoke contains 60 carcinogens that interfere with cell development Cigarette smoking causes a change in bronchial epithelium

4. Etiology Lung cancer is related to total exposure to cigarette smoke measured by Total number of cigarettes smoked Age of smoking onset Depth of inhalation Tar and nicotine content Use of unfiltered cigarettes

5. Etiology Environmental tobacco smoke (ETS) inhaled by nonsmokers poses 35% increased risk in developing lung cancer Children are more vulnerable to ETS than adults

6. Etiology Other carcinogens pose risk for developing lung cancer Asbestos Radon Nickel Iron/iron oxides

7. Etiology Other carcinogens pose risk for developing lung cancer Uranium Polycyclic aromatic hydrocarbons Arsenic Chromates Air pollution

8. Pathophysiology 90% of cancers originate from epithelium of bronchus It takes 8 to 10 years for a tumor to reach 1 cm; smallest lesion detectable on x-ray Occur primarily on segmental bronchi and upper lobes

9. Pathophysiology Pathologic changes in bronchial system Hypersecretion of mucus Desquamation of cells Reactive hyperplasia of basal cells Metaplasia of normal respiratory epithelium to stratified squamous cells

10. Pathophysiology Primary lung cancers categorized into two subtypes Non-small cell lung cancer (NSCLC) 82% Small cell lung cancer (SCLC) 18%

12. Lung cancer pathology Types of Non-small cell (NSCLC)–82% Squamous cell—32% usually undifferentiated Invades surrounding tissue early then mets Adenocarcinoma- 40- 42% Increasing in women Can appear in non smokers Slow-growing –early invasion of the lymphatics Large cell(undifferentiated) 12 %

13. Lung cancer pathology Lung Cancer Pathology Squamous Cell Adenocarcinoma Large Cell Carcinoma

15. Pathophysiology Lung cancers metastasize by direct extension, blood circulation, and lymph system Common sites for metastatic growth Liver Brain Bones Lymph nodes Adrenal glands

17. Clinical Manifestations Symptoms appear late in disease Depend on type of primary lung cancer, location, and metastatic spread

18. Clinical Manifestations Pneumonitis Persistent cough with sputum Hemoptysis Chest pain Dyspnea

19. Clinical Manifestations Later manifestations Anorexia Weight Loss Fatigue N/V Hoarse voice Unilateral paralysis of diaphragm

20. Diagnostic Studies Chest x-ray CT scan Magnetic resonance imaging (MRI) Positron emission tomography (PET)

22. Diagnostic Studies Diagnosis identified by malignant cells Sputum specimens obtained for cytologic studies Fiberoptic bronchoscope Mediastinoscopy Video-assisted thoracoscopy (VATS) Pulmonary angiography

23. Diagnostic Studies Staging NSCLC staged according to TNM system T umor size, location, and degree of invasion N ode indicates regional lymph node involvement M etastasis represents presence/absence of distant metastases

24. Staging non-small cell Stage I-one lobe without lymph node involvement Stage II- one lobe with involvement of lymph node inside the lung Stage III- lung ca with lymph nodes in the mediastinal region or outside the chest Stage IV-spread outside of the chest

25. Lung Cancer Staging Diagnostic Studies Staging SCLC Not been useful due to cancer metastasized before diagnosis is made

26. Collaborative Care Surgical Therapy Surgical resection is contraindicated for small cell carcinomas Squamous cell carcinomas are likely treated with surgery Usually stage I or II

28. Surgical Management If complete resection is not possible, removes the bulk of the tumor & risk of metastatic extension Thoracotomy (opening thoracic cavity) – Pneumonectomy- remove all or part of lung Lobectomy-removes a lobe of the lung Wedge resection or segmentectomy- removes a small part of a lobe of lung

29. Surgical Management Following lobectomy for lung cancer, a client receives a chest tube connected to a three-chamber chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes?

30. ANSWER WATER-SEAL Fluctuations in the water-seal compartment are called tidal movements and indicates normal system function

31. Preoperative Care Aimed at relieving anxiety & promoting client participation Encourage client to express fears & concerns Reinforces physician’s explanation of procedure Teach anticipated location of incision,if known, shoulder exercises, and about chest tubes (except pneumonectomy)

32. Collaborative Care Radiation therapy Curative approach in individual with resectable tumor and poor surgery risk Some cancer cells are more radiosensitive than others Used in combination with chemotherapy

33. Collaborative Care Chemotherapy Treatment of nonresectable tumors or adjuvant to surgery in NSCLC with distant metastases Used in combination with multidrug regimen Improved survival rate with NSCLC and SCLC

34. Collaborative Care Other therapies Biologic therapy Prophylactic cranial therapy Bronchoscopic laser therapy Phototherapy Airway stenting Cryotherapy

35. Nursing Management Nursing Assessment Nursing Assessment Assess patient and family’s understanding of diagnostic tests, diagnosis, treatment options, and prognosis Assess level of anxiety Obtain subjective and objective data

36. Nursing Management Nursing Diagnoses Ineffective airway clearance Anxiety Acute pain

37. Nursing Management Nursing Diagnoses Imbalanced nutrition: less than body requirements Ineffective health maintenance Ineffective breathing pattern

38. Nursing Management Planning Overall goals Effective breathing patterns Adequate airway clearance Adequate oxygenation of tissues Minimal to no pain Realistic attitude toward treatment and prognosis

39. Nursing Management Nursing Implementation Health Promotion Avoid smoking Promote smoking cession programs Support education and smoking policies

40. Nursing Management Nursing Implementation Acute Intervention Offer support during diagnostic evaluation Nutritional evaluation Provide comfort Teach methods to reduce pain Educate indications for hospitalization

41. Nursing Management Evaluation Expected outcomes Adequate breathing patterns Minimal to no pain Realistic attitude about prognosis

42. Psychosocial Preparation If CA resectable, encourage optimism and gradual return to normal activities If prognosis is poor, facilitate expression of fears & concerns, maintain open lines of communication & stress quality of as defined by client

43. Home Care Management References to community agencies, home health nursing or hospice Hospice provides physical and psychological support to client & family American Cancer Society