NCM 106 SY 2020-2021

Union Christian College

School of Health and Sciences
City of San Fernando
La Union

Case Study:
Cancer of the Lung

Submitted by:

Acena, Jobelle C.
 NCM 106 SY 2020-2021

I. Introduction
Lung cancer is a term to describe a number of malignancies that can occur anywhere
within the respiratory system. Lung cancer is initially classified into two types based on
histological characteristics: small cell lung cancer (SCLC) and non-small cell lung cancer
(NSCLC). These 2 types are treated differently. NSCLC can then be further subdivided into
adenocarcinoma, squamous cell carcinoma and large cell carcinoma. NSCLC is the most
common type of lung cancer and is responsible for approximately 80% of all lung cancers. It
most often begins in the bronchi and the smaller airways. Small cell lung cancer is responsible
for the remaining 20% of all lung cancers and generally begins in the more central locations of
the lung.

Lung cancer can also be classified into primary and secondary forms. Primary lung
cancer originates in the lung, while secondary lung cancer is a neoplastic lesion that has been
deposited in the lung from a distant location via either the lymphatic or vascular system.

Smoking is a major cause of lung cancer. Other factors that increase the risk of lung
cancer include a genetic predisposition and exposure to carcinogenic substances, such as
asbestos. A dose-relationship exists between the exposure to inhaled carcinogens and the
development of lung cancer. An individual’s risk of developing lung cancer is significantly
increased by an earlier age of starting to smoke cigarettes, the more frequently cigarettes are
smoked in a week and the number of years of smoking cigarettes. Smokers can have a risk of
developing lung cancer of up to 25 times that of a non-smoker. Women appear to have an
increased risk compared to men and require less exposure to develop lung cancer.

Carcinomas of the lung occur as a result of disordered cell growth and a failure of the
normal immune surveillance systems permitting growth of abnormal cells in the bronchi,
bronchioles and/or alveoli to mutate and proliferate. The proto-oncogenes (genes that, when
mutated, have the potential of becoming an oncogene and contributing to cancer development)
thought to be involved in lung cancer development include K-ras and c-Myc. K-ras is important
for the promotion of cell growth and proliferation, while c-Myc is important for DNA synthesis,
cell cycle regulation, proliferation and the induction apoptosis. Tumour suppressor genes, such
as p53, control neoplastic cell formation and manage cell senescence. Epidermal growth factor
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receptors influence proliferation, differentiation and apoptosis. Vascular endothelial growth

factors influence tumour angiogenesis. Mutations in and or all of these genes, receptors and
factors may contribute to tumour growth.

The clinical manifestations of lung cancer can be divided into local and regional effects.
Common local effects include chest pain, cough, dyspnea and hemoptysis. Regional effects
include numerous complications, which can be divided into metabolic, paraneoplastic, endocrine,
haematological, neurological and renal.

II. Anatomy and Physiology

Human lungs are two spongy organs located on each side of the heart. During inhalation,
air flows from the nose or mouth through the pharynx (throat) and larynx (which contain the
vocal cords) into the trachea (wind pipe). The trachea divides into two bronchi, which direct air
into the right and left lungs.

Within the lungs, the bronchi divide into several smaller bronchioles. Air flows from
bronchioles into tiny air sacs, called alveoli. A group of alveoli is referred to as a lobule. Lobules
are, in turn, grouped into lobes. The left lung contains two lobes, whereas the right contains
three.

A network of tiny blood vessels, called capillaries, surrounds the alveoli. The lining of
these blood vessels is so thin that oxygen and carbon dioxide can move between the capillaries
and the alveoli. Carbon dioxide diffuses from the capillaries into the alveoli and is released from
the body during exhalation. Oxygen diffuses in the opposite direction, from the alveoli into the
blood, and is carried throughout the body by the circulatory system.

Most lung cancers begin in epithelial cells lining the bronchi. Cancers that develop in
epithelial cells are known as carcinomas.
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III. Pathophysiology

Precipitating Factors
Predisposing Factors  Tobacco smoking
 Age  Frequent exposure to secondhand
smoke
 History of Cancer
 Occupational exposures to certain
workplace toxins (asbestos, radon,
arsenic, chromium)

Inhaled carcinogen

Single transformed epithelial cell in tracheobronchial airway

Carcinogens binds to and damages the cell’s DNA

Cellular changes, abnormal cell growth, and a malignant cell

Passing of damaged DNA to daughter cells

Unstable DNA

Malignant transformation of pulmonary epithelium

Invasive carcinoma

Bronchial tubes Pleura

Obstructive lesion Fluid build-up

Mucosal ulceration and rupture of Pressure in the lung

blood vessels

Lung cannot fully expand

Hemoptysis

Dyspnea
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IV. Laboratory and Diagnostic Tests

COMPLETE BLOOD COUNT AND SERUM CHEMISTRIES

Reference Range Interpretation

Hemoglobin (Hgb) Males: 13 – 18 g/dL Decreased in various anemias, pregnancy,
Females: 12 – 16 g/dL severe or prolonged hemorrhage and with
excessive fluid intake

Increased in polycythemia, COPD, failure of

oxygenation because of CHF, and normally in
people living at high altitudes
Red Blood Cell M: 4.6 – 6.2 x 1012/ L Increased in severe diarrhea and DHN,
(RBC) F: 4.2 – 5.4 x 1012/ L polycythemia, acute poisoning, pulmonary
fibrosis

Decreased in all anemias, in leukemia and after

hemorrhage when blood volume has been
restored
Platelets 0.15 – 0.45 x 1012/L Increased in malignancy, myeloproliferative
disease, RA and post-operatively; about 50% of
patient with unexpected increase of platelet
count will be found to have a malignancy

Decreased in thrombocytopenic purpura, acute

leukemia, aplastic anemia and during cancer
chemotherapy
Hematocrit (Hct) Males: 42 – 52% Decreased in severe anemias, anemia of
Females: 35 – 47% pregnancy, acute massive blood loss

Increased in erythrocytosis of any cause, and in

DHN or hemoconcentration associated with
shock
Neutrophils 45 – 73% Increased with acute infections, trauma or
surgery, leukemia, malignant disease, necrosis

Decreased with viral infections, bone marrow

suppression, primary bone marrow disease
Lactate 48 to 115 IU/liter LDH is a protein that normally appears all
dehydrogenase  LDH1: 18.1% to over the body in small amounts. Many cancers
(LDH) 29% of the total can raise LDH levels. So it is not useful in
(heart, red blood identifying a specific kind of cancer. But
cells and kidneys) measuring LDH levels can be helpful in
 LDH2: 29.4% to monitoring treatment for cancer. Noncancer
37.5% of the total conditions that can raise LDH levels include
(heart, red blood heart failure, hypothyroidism, anemia, and lung
cells and kidneys) or liver disease.
 LDH3: 18.8% to
26% of the total
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(lungs)
 LDH4: 9.2% to
16.5% of the total
(liver and skeletal
muscles)
 LDH5: 5.3% to
13.4% of the total
(liver and skeletal
muscles)

Neuron-specific 1.5‐13.5 ng/mL NSE is linked to several cancers. But it is used

enolase (NSE) most often to monitor treatment in people with
neuroblastoma or small cell lung cancer.
Carcinoembryonic Normal range: < 2.5 CEA is normally found in small amounts in the
antigen (CEA) ng/ml. blood. Colorectal cancer is the most common
Levels > 10 ng/ml cancer that makes this tumor marker go up.
suggest extensive Other cancers that can also raise CEA levels
disease and levels > 20 include pancreas, lung, breast, ovary, and
ng/ml suggest thyroid cancers. Noncancer conditions that can
metastatic disease. raise blood CEA include arthritis, hepatitis, and
cigarette smoking.
ACTH Adults: 6-76 pg/ml Elevated level found in paraneoplastic
(Adrenocorticotropi (1.3-16.7 pmol/L) syndrome caused by small cell carcinoma. Non-
c Hormone) diagnostic of lung cancer, but an indicator of
metastases.
Calcitonin less than 10 pg/mL Elevated levels of this thyroid
hormone occasionally occur with small cell
lung cancer; increasing levels may indicate
progression of disease.

DIAGNOSTIC TESTS

 CHEST X-RAY
o Solitary nodule
o Indirect signs: atelectasis, postobstructive pneumonia, pleural effusion
(particularly unilateral), mediastinal widening, cavitary lesions
 CT SCAN
o Signs of malignancy: solid lesion ≥ 8mm, irregular margins, spicules, and no or
irregular calcifications
 PET (Positron Emission Tomography)
o More accurate than CT at differentiating between benign and malignant nodules;
Good negative predictive value: high sensitivity for detecting malignancies, but
moderate positive predictive value: does not distinguish malignant processes from
other metabolically active processes (e.g., infections, inflammatory conditions).
o Performed prior to biopsy if the CT imaging is inconclusive, particularly for
patients with a high probability of malignancy
 Bronchoscopy and Biopsy
o Confirmatory test
o Procedures
 Fiberoptic Bronchoscopy with transbronchial biopsy: central nodules
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 CT-guided transthoracic biopsy (fine needle aspiration): peripheral

nodules
 Thoracoscopy: if bronchoscopy or CT-guided biopsies are inconclusive, or
in small peripheral nodules; Simultaneous diagnostic and curative
approach; if the lesion is found to be malignant in cryosection, immediate
resection of the tumor may be considered.
 Mediastinoscopy: to biopsy mediastinal nodes or masses
 MRI
o Area of increased density, area of enhanced contrast, area of high radioactivity,
space occupying lesion, hilar adenopathy, hilar or mediastinal mass, hilar
enlargement, pleural effusion, multiple pulmonary nodules, pleural masses, rib
lesion with adjacent soft tissue mass, mediastinal mass, metastases.
 Sputum Cytology
o Can reveal presence of lung cancer cells

STAGES

STAGING OF NSCLC
The staging of NSCLC is based on the UICC (Union for International Cancer Control) TNM
staging system. This classification defines four stages from I to IV, corresponding to cancer
spread.
UICC stages TNM Brief Description
Stage IA T1 Tumor size ≤ 7 cm
Stage IB T2a No lymph node involvement
Stage IIA T2b, N0 or T1, N1 beyond the ipsilateral hilar
Stage IIB T3, N0 or T2b, or N1 nodes
No mediastinal invasion
No metastases
Stage IIIA Up to T4, N1 or T3, N2 Tumor size > 7 cm
Mediastinal lymph
node involvement and/or
regional spread
No mediastinal invasion
or metastases
Stage IIIB T4, N2 or N3 Mediastinal invasion
Stage IV M1 Distant nodes and/or
distant metastases

V. Medical/Surgical/Nursing Management

Radiation Therapy

Radiation therapy is a nuclear medical treatment that employs ionizing radiation to kill

abnormal cells or control their growth. It is one of the three main approaches to the treatment
of malignant tumors alongside chemotherapy and surgery, but can also be used to treat
noncancerous diseases such as benign hyperthyroidism, Cushing disease, Dupuytren contracture,
and plantar fibromatosis. Radiation therapy is typically employed as a supplement to other
treatments and rarely represents the sole approach. There are three forms of radiation
therapy: external beam radiation therapy (teletherapy), which involves irradiation from an
external source; unsealed source radiotherapy (systemic radioisotope therapy), which involves
the administration of radiopharmaceuticals that accumulate in target tissues and irradiate these
 NCM 106 SY 2020-2021

internally; and sealed source radiotherapy (brachytherapy), which involves the implantation of

radioactive material beside or within the tissue to be irradiated. The type of radiation therapy
employed depends on the disease and the specific type of cancer being treated. Radiation therapy
can be employed curatively (i.e., to kill the diseased tissue completely) or palliatively (e.g., to
shrink a tumor, control its growth, or relieve symptoms caused by a tumor). Palliative indications
include bone pain, spinal cord and nerve compression, and hemostasis. As with all medical use
of ionizing radiation, the radiation dose should be maintained as low as reasonably achievable
(ALARA principle) and appropriate safety measures should be observed to minimize
carcinogenic effects.

Types

By Objective:

 Curative: applying radiotherapy with the intent of curing a patient (e.g., completely
removing a malignancy)
 Palliative: applying radiotherapy with the intent of prolonging life and/or alleviating
symptoms. Examples include:
o Preventive local radiation of osteolytic bone metastases
o Radiation therapy in painful bone metastases to alleviate symptoms
o Treatment of venous congestion associated with mediastinal tumors

By timing

Type Timing Goal

Neoadjuvant radiotherapy Applied before the main Reduce tumor size to help facilitate
treatment, typically resection, possibly increasing the
preoperatively chances of curative resection
Intraoperative radiotherapy Applied during surgery Deliver a high dose of radiation to
the targeted area more precisely
than external beam
radiatio therapy, which minimizes:
Radiation exposure to surrounding
tissue
Delays between surgery
and EBRT → reduces the chance
of tumor cell repopulation
Adjuvant radiotherapy Applied after surgery Destroy malignant cells still
present after surgery
Radiation boost Supplemental irradiation  Destruction of residual tumor cells
of the tumor bed applied and reducing the chance of
after initial radiotherapy local tumor recurrence
(typically neoadjuvant
therapy) 
Chemoradiotherapy Any radiotherapy in Chemotherapy may increase
combination a tumor's sensitivity to radiation
with chemotherapy and vice-versa
Support successful surgical
resection
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By technology

 External beam radiotherapy (EBRT; teletherapy): radiation therapy using a source of

radiation outside the body 
o Procedure: irradiation of target tissue from different angles in order to spare
surrounding tissue 
o Options
 Conventional high-energy EBRT: irradiation of internal organs and CNS
 Soft x-ray therapy: radiation of dermatological diseases (such as basal
cell carcinoma, keloids, psoriasis) 
 Brachytherapy (sealed source radiation therapy): radiation therapy involving the
implantation of radioactive seeds (approx. the size of a grain of rice) within or next to the
target tissue
o Low-dose radiation possible
 Unsealed source radiotherapy (systemic radioisotope therapy): radiation therapy
involving the administration of radiopharmaceuticals that accumulate in target tissues and
irradiate these internally

Complications

 Acute radiation injury 

o Nausea, malaise, dysphagia, vomiting immediately following irradiation
o Erythema
o Mucosal inflammation (stomatitis, esophagitis, enteritis, etc.)
o Bone marrow damage: anemia, thrombocytopenia,
and/or leukocytopenia (pancytopenia)
 Infection due to immunocompromise
o Early radiation-induced lung injury (radiation pneumonitis): Dyspnea,
dry cough, hemoptysis, and fever may occur several weeks following radiation. 
 Partial respiratory insufficiency is an early sign.
 Chronic radiation damage 
o Late radiation-induced lung injury (radiation fibrosis) 
o Bone: fractures
o Bone marrow damage: anemia, thrombocytopenia,
and/or leukocytopenia (pancytopenia)
 Infection due to immunocompromise
 Heart: increased risk of myocardial infarction
 Gastrointestinal: impaired function
 Thyroid: impaired function (hypothyroidism)
 Impaired fertility
o Fibrosis in ovaries involving amenorrhea
o Azoospermia
 Radiation of the head
o Leukoencephalopathy
o Hormone imbalances and their outcomes, such as stunted growth due to
low growth hormone levels
 Xerostomia
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 Malignancies: especially leukemias (AML, CML, ALL), MDS, lymphoma, thyroid
cancer

PALLIATIVE CARE

Palliative care is…

 The medical specialty focused on relieving pain, stress and other symptoms to improve
your quality of life.
 Care received at the same time as cancer treatment.
 Care to be discussed even before you have side effects.
 A specialty that uses a variety of medications to address symptoms and discomfort.

Palliative care is NOT…

 Only administered during hospice care or at the end of life.

 A signal that treatment is not working or a replacement for treatment.
 Morphine-only treatment.
 Something you should wait to ask for.

Lung cancer palliative care is appropriate at all stages of the illness, not just during end-of-life
care. It is perfectly okay for you to ask for supportive care for lung cancer. It does not signal that
you are weak or complaining about your symptoms. Palliative care provides relief from a variety
of physical and emotional symptoms.

Surgical Management

LOBECTOMY

A lobectomy is a surgery to remove one of the lobes of the lungs. The lungs have sections
called lobes. The right lung has 3 lobes. The left lung has 2 lobes. A lobectomy may be done
when a problem is found in just part of a lung. The affected lobe is removed, and the remaining
healthy lung tissue can work as normal.

There are two ways to perform a lobectomy:  

 Thoracotomy: An incision (cut) will be made between two ribs, from the front of the
chest around to the back. The lobe is removed through this incision. 
 Video-Assisted Thoracic Surgery (VATS):  Small incisions are made, in which your
surgeon will insert a thorascope (tube with a camera attached). This tube allows the
surgeon to see inside your chest, and is less invasive than undergoing a thoracotomy. 

Procedure

The procedure almost always needs an inpatient stay. This means that it may be done as
part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your
condition and your healthcare provider's methods. In most cases, the procedure will follow this
process:

You will be asked to remove your clothes. You will be given a hospital gown to wear.
You may be asked to remove jewelry or other objects. You will lie down on an operating table.
 NCM 106 SY 2020-2021

An IV (intravenous) line will be put into your arm or hand. You may be given antibiotics before
and after the procedure. You will be given general anesthesia. This is medicine that prevents pain
and lets you sleep through the procedure. A breathing tube will be put into your throat and
hooked up to a breathing machine (ventilator). Your heart rate, blood pressure, and breathing
will be watched during the procedure. A soft, flexible tube (catheter) may be put into your
bladder. This is to drain urine during the procedure. Hair in the area of surgery may be trimmed.
The skin in the area will be cleaned with an antiseptic solution. A cut (incision) will be made on
the front of your chest at the level of the lobe to be removed. The cut will go under your arm
around to your back. When the ribs can be seen, a special tool will be used to spread them apart.
The lung lobe will be removed. One or more tubes may be put into your chest. These are to help
remove air and fluid after surgery. The cut will be closed with stitches (sutures) or staples. A
bandage or dressing will be put on the area. A thin tube (epidural catheter) may be put in the area
of the lower spine. This is done to send pain medicine into your back. It may be done in the
operating room or in the recovery room.

Indications

 Tuberculosis (TB). This is an ongoing (chronic) bacterial infection that often infects the
lungs.
 Lung abscess. This is an area of pus that may form in the lung. If the abscess does not go
away with antibiotic medicine, it may need to be removed.
 Emphysema. This is a chronic illness caused by the breakdown of the elastic fibers in the
lungs. This makes it harder for the lungs to move when you breathe.
 Benign tumor. This is a growth that is not cancer. It can press on large blood vessels and
affect the function of other organs.
 Lung cancer. This is a type of cancer that may affect the main airways to the lungs (the
bronchi), one or more lobes of the lungs, the pleural lining, or other lung tissue. If not
treated, it can spread to other parts of the body.
 Fungal infection. Fungi can grow in the body and cause infections.

Contraindications of thoracotomy

 Bleeding disorder or anticoagulation that cannot be corrected

 Acute cardiac ischemia
 Instability or insufficiency of major organ systems

Contraindications of VATS

 Absolute contraindications include the following:

o Markedly unstable or shocked patient
o Extensive adhesions obliterating the pleural space
o Prior talc pleurodesis
 Relative contraindications include the following:
o Inability to tolerate single-lung ventilation
o Previous  thoracotomies
o Extensive pleural diseases
o Coagulopathy
o Prior radiation treatment for thoracic malignancy; plan to resect
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Complications

 Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep
through the surgery, not remember it and to manage pain. Reactions can include
wheezing, rash, swelling, and low blood pressure.)
 Bleeding.
 Infection.
 Damage to nearby organs including the heart, lungs, blood vessels, and nerves.
 An air leak in the lung leading to a pneumothorax (Lung collapse.)
 Empyema (Collection of pus).
 Long term, chronic pain. 
 Bronchopleural fistula (abnormal connection of the bronchus and pleural space), which
can lead to fluid in the chest.
 Air or gas in the chest.

PNEUMONECTOMY

Lung removal, also called a pneumonectomy, is surgery to remove an entire lung. The
most common reason for removing a lung is lung cancer when less extensive surgery isn’t an
option. You can survive with one lung, but most people have to modify their activity level and
may notice frequent shortness of breath after lung removal surgery.

There are two types of lung removal:

 Simple pneumonectomy is the removal of a lung.

 Extrapleural pneumonectomy is the removal of a lung, as well as part of the diaphragm,
part of the membrane covering the heart, and part of the lining of the chest wall.

A pneumonectomy is done during a surgery called a thoracotomy. During a thoracotomy, an

incision (cut) will be made between two ribs, from the front of the chest around to the back. This
allows the surgeon to remove the lung and anything else that need to be removed.  

Indications

In general, pneumonectomy is indicated for both malignant and benign diseases.

 Malignant indications for pneumonectomy include the following:

o Pulmonary metastasis (uncommon)
o Non-small cell lung carcinoma
 Benign indications for pneumonectomy include the following: 
o Chronic lung infection (multiple abscesses, bronchiectasis, fungal
infection, tuberculosis)
o Traumatic lung injury
o Bronchial obstruction with destroyed lung
o Congenital lung disease

Complications
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Potential complications of pneumonectomy and extrapleural pneumonectomy include the

following:

 Atrial fibrillation
 Cardiac herniation
 Tamponade
 Diaphragmatic/pericardial patch dehiscence
 Bronchopleural fistula
 Deep venous thrombosis
 Pulmonary embolism
 Pneumonia
 Pulmonary edema
 Respiratory insufficiency
 Myocardial infarction
 Bleeding
 Wound infection
 Urinary tract infection
 Sepsis
 Postpneumonectomy syndrome
 Empyema

LUNG SEGMENTECTOMY

A lung segmentectomy is a procedure that aims to remove diseased lung tissue

while leaving as much healthy lung tissue undamaged. During a lung
segmentectomy, only the diseased part of a lobe of a lung is removed.

A lung segmentectomy is performed under general anesthesia (you will be asleep during the
procedure) and can be performed in two ways:

Open surgery

During an open surgery lung segmentectomy, your surgeon will make an incision on the side of
the affected lung, between the ribs and below the armpit area. Once in position, your surgeon
will remove the diseased part of the lung.

Advanced minimally invasive surgical technique

Lung segmentectomy can now be performed minimally invasively in a surgery called a video-
assisted thoracoscopic surgery (VATS). During a VATS procedure, your surgeon will make
three small incisions into the chest. He or she will insert an instrument called a thoracoscopy
with a camera on the end into the chest. Using surgical instruments inserted in the other
incisions, your surgeon will expose the diseased lung and collapse it. The diseased portion of the
lung is then removed, the excess fluid and air is drained, and the lung is re-inflated. After the
lung is inflated, your surgeon will close the incision.

When appropriate, a VATS procedure is the preferred treatment due to the decreased risk for
infection, shorter hospital stay and lower risk of pain.
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Indications

 Bronchiectasis
 Early stage I cancer (usually in a patient who has significantly limiting cardiopulmonary
disease)
 Lung nodules
 Tuberculosis
 Suppurative lesions

Contraindications

Segmentectomy and lesser lung resections should not be performed in people who have no
pulmonary reserve or have numerous comorbidities for a thoracotomy.

Relative contraindications include the following:

 Coagulopathy
 Skin infection over the site
 Diffuse lung disease
 Extensive metastases

Complications

 Pneumonia
 Infection
 Reactions to medications for anesthesia
 Breathing problems or respiratory failure
 Persistent air leakage due to injuries in the pleura
 Bleeding
 Heart attack and heart arrhythmias (irregular heart beat)

WEDGE RESECTION

A wedge resection is a procedure that involves the surgical removal of a small, wedge-
shaped piece of lung tissue to remove a small tumor or to diagnose lung cancer.

Procedure

Depending on the location of the tumor and other factors, wedge resection can be performed
either by video-assisted thoracoscopic surgery (VATS) or by a thoracotomy (open chest
surgery).

While thoracotomy involves a long (six to 10 inch) incision in the chest, VATS is less invasive
with a few small incisions made during surgery.

The minimally invasive VATS procedure begins with an examination of the windpipe using a

bronchoscope, which is a flexible tube fitted with a camera. A small cut is then made between
the ribs, through which a small camera is inserted into the chest for inspection. To locate the
lesion or nodule, additional small cuts are made.
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The surgeon removes a small piece of the lung tissue that contains the nodule using special
staplers, which are designed to tightly seal the remaining lung tissue. Next, the cuts are closed
and a small flexible plastic tube is inserted into the chest to drain any fluid or air. The chest tube
is usually removed after the lung has expanded.

Finally, the lung is inspected to make sure it expands properly, the stitches are dissolved, and a
liquid plastic dressing is used over the incisions.

Indications

Malignant indications are as follows:

 Early-stage non–small cell lung cancer (NSCLC; T1N0M0) and early-stage small-cell

lung cancer in patients with limited cardiopulmonary reserve (although lobectomy is
preferred)
 Metastasectomy of pulmonary metastases due to other cancers (renal, breast, colon,
melanoma, sarcoma)
 Ground-glass opacification lesions on chest CT scan in patients with past or present
cancer 
 Localization and excisional biopsy of ill-defined or small pulmonary lesions 

Infectious indications for TWR include tubercular granulomas, aspergilloma, and focal
organizing pneumonia. Other indications include the following:

 Excision of solitary pulmonary nodules

 Diagnosis of interstitial lung disease (ILD)
 Resection of hamartomas
 Resection of blebs
 Resection of pulmonary sclerosing hemangioma
 Resection of intralobar sequestrated lung
 Resection of localized bronchiectasis
 Lung volume reduction surgery in end-stage emphysema
 Resection of pulmonary arteriovenous malformations (PAVMs) 

Contraindications

 Hemodynamic instabilit
 Inability to tolerate single-lung ventilation
 Coagulopathy
 Severe cardiopulmonary failure
 Prior talc pleurodesis
 Pleural adhesions
 Refractory or uncontrollable cough
 Lung lesion larger than 4 cm
 N2 lung cancer

Complications

 Air leakage - Most leaks seal within a few days, but large leaks may persist for weeks
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 Bleeding can occur at the suture line or if the ligature from the blood vessel has slipped
off; thus, it is vital to ensure good hemostasis before leaving the OR
 Residual airspace is uncommon but can occur when a large amount of lung is resected
 Infection of the pleural space can occur when a residual airspace persists; in some cases,
the patient may need a muscle flap or an apical tent to close off the residual space and
eliminate the infection
 Respiratory failure is not a direct complication of surgery; patients who have borderline
lung function are more likely than healthy people to develop respiratory distress in the
postoperative period; if the preoperative workup was not adequate or if a high-risk patient
underwent surgery, he or she may require prolonged ventilation and even a tracheostomy
 Cardiac complications may include acute myocardial infarction and arrhythmias

VI. Evaluation

Screening for individuals at high risk has the potential to dramatically improve lung
cancer survival rates by finding the disease at an earlier stage when it is more likely to be
curable. Early detection, by low-dose CT screening, can decrease lung cancer mortality by 14 to
20 percent among high-risk populations.

VII. Implication

a. Nursing Practice

This case study provides information about Lung Cancer and its treatment which includes
surgery. In this case, the surgeries that can be performed are Pneumonectomy, Lobectomy, Lung
Segmentectomy, and Wedge Resection. Chemotherapy and Radiation therapy is also included in
their treatments. Nurses have a huge set of responsibilities for handling a patient with cancer.
This case study would serve as a help to the nursing practice since it provides an appropriate plan
of care that revolves around comprehensive supportive care and patient teaching that
can minimize complications and speed recovery from surgery, radiation
and/or chemotherapy.

b. Nursing Education

To the nursing education, this case study would help in sharing data or information about
the disease condition, which is Lung Cancer, and its management as well as the preoperative and
postoperative nursing interventions needed for the promotion of patient’s recovery. With these,
the students as well as the teachers would gain additional information about the disease and
patient’s condition so that it would equip them for an efficient nursing care in the future.

c. Nursing Research

This case study would help in the nursing research as a source of data for example, in
tracking the population of persons with this condition. With this information, it would make
people aware of its growing incidence rate and the need to treatment and share the importance of
early detection or early prevention of this disease condition.
 NCM 106 SY 2020-2021

VIII. Recommendations

 Learn enough about lung cancer to make decisions about your care. Ask your doctor
about your lung cancer, including your treatment options and, if you like, your prognosis.
As you learn more about lung cancer, you may become more confident in making
treatment decisions.
 Keep friends and family close. Keeping your close relationships strong will help you deal
with your lung cancer. Friends and family can provide the practical support you'll need,
such as helping take care of your home if you're in the hospital. And they can serve as
emotional support when you feel overwhelmed by cancer.
 Find someone to talk with. Find a good listener who is willing to listen to you talk about
your hopes and fears. This may be a friend or family member. The concern and
understanding of a counselor, medical social worker, clergy member or cancer support
group also may be helpful.