Lung Cancer

Objectives
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 cases with lung cancer
General Overview of Lung
Physiology: Breathing
Healthy lung tissue
Diseased Lung Tissue
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
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=3wzjqbh
besI.
Lung Cancer Re-cap
Small Cell Lung Cancer Non-Small-Cell Lung Cancer
Squamous cell Adenocarinoma
Causes and Risk factors of Lung
Cancer
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:

) Localized – involving the lung.

) Generalized – involves other areas

throughout the body if the cancer has
ocalized Signs and Symptoms
ugh
eathing Problems, SOB, stridor
ange in phlegm
ng infection, hemoptysis
oarseness, Hiccups
t loss
est Pain and tightness
ncoats Syndrome
orner’s Syndrome
eural Effusion
perior Vena Cava Syndrome
tigue
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
arly/late Signs and Symptoms Of
ung Cancer
Early Signs Late signs

Cough/chronic cough Bone pain, spinal cord

compression
Dyspnea Chest pain/tightness

Hemoptysis Dysphagia

Chest/shoulder pain Head and neck edema

Recurring temperature Blurred vision, headaches

Recurring respiratory Weakness, anorexia,

infections weight-loss, cachexia
Pleural effusion
Diagnostic Tests
• CXR
• CT Scans
• MRI
• Sputum cytology
• Fibreoptic bronchoscopy
• Transthoracic fine needle aspiration
aboratory 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
VATS (video assisted
horacoscopic surgery)
ursing Management for post
ndoscopic procedures
onchoscopy Mediastinoscopy VATS
onitor V/S; NPO status Monitor VS; potential for Monitor V/S; potential
aintained until return bleeding, infection and for bleeding, infection
gag reflex. dyspnea; NPO status and dyspnea; NPO status
until return of gag reflex until return of gag reflex
ver up to 101F can be
pected afterwards
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
Death
Nursing pulmonary post-op
onsiderations/interventions
Positioning in bed, Monitor V/S
Prevention of respiratory complications
– Early ambulation, DB&C, incentive spirometer, managing
dyspnea
Prevention of deep vein thrombosis
– Early ambulation
Pain management
Infection control
Educating the patient

Inform the patient what to expect, from administration of

anesthesia to thoracotomy and the likely use of chest tubes and a
drainage system postoperatively.
Tell the patient about the administration of oxygen postoperatively
and the possible use of a ventilator.
Explain the importance of frequent turning to promote drainage of
lung secretions.
Instruct the proper use of an incentive spirometry and how to
perform diaphragmatic and pursed-lip breathing techniques.
Teach the patient to splint the incision site with hands, a pillow or a
folded towel to avoid discomfort
 Cancer Staging
nical Staging Pathological

based on findings gathered by • Based on the examination of the

the doctor tissue samples obtained from the
used to plan the initial therapy primary tumor, nodes or metastasis
• Helpful in planning additional
may be modified by additional
treatment and follow-up
nformation found during
pathological examination
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
= Tumors : tumor size,
(local invasion)

= Node : node
involvement (size and
type)

= Metastasis : general
involvement in organs and
tissues
ung Cancer Staging Continued

T: Tx, T0, Tis, T1-T4 (T3-

tumors greater than 7cm,
T4 is a tumor of any size)
N: N0, N1, N2, N3
M: M0, M1a, M1b
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.
Side effects of treatments
rgery Radiation Chemotherapy
n fatigue Anemia,
thrombocytopenia
motomas Decreased nutritional Fatigue
intake
mmorhage Radiodermatitis Alopecia, SOB
ered respiratory Decreased hematopoietic Cold, pale
nction function
sk for atelectasis, Risk for Pneumonitis, Tingling
eumonia, hypoxia esophagitis, cough
sk for DVT N/V Irritable
Grief Dizzy, weak
 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
Prognostic Factors
The best estimate on how a patient will do based on:
*type of cancer cells
*grade of the cancer
*size or location of the tumor
*stage of the cancer at the time of diagnosis
*age of the person
*gender
*results of blood or other tests
*a persons specific response to treatment
*overall health and physical condition
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
Prevention: Tertiary

Targeted at people who survived a cancer

disease
Assists them to retain an optimal level of
functioning regardless of their potential
debilitating disease