Lung Cancer

LUNG CANCER
• Lung cancer tops the list for cancer
• Attributable mortality in the nation Of the world's 1.3 billion people

who smoke, eighty percent come from LMICs such as the Philippines
• Almost a quarter of Filipinos aged 15 years and older smoke tobacco,

placing millions of people at significant risk for developing lung
cancer
WHAT IS LUNG CANCER?
Lung carcinoma, is caused by UNCHECKED GROWTH and

SPREAD of some CELLS form the LUNGS
TWO MAIN TYPES
1. SMALL CELL LUNG CANCER
2. NON-SMALL CELL LUNG CANCER

SMALL CELL LUNG CANCER
• Grows fairly rapidly

• Spreads more quickly and aggressively
• Accounts for 15% of cases
• Found mostly in heavy smokers
NON-SMALL CELL LUNG CANCER
• Most common type
• About 80-85% are NSCLC
• Grows more slowly

TYPES OF NSCL
• Squamous cell carcinomas usually arise centrally in

larger bronchi
• Adenocarcinoma : formed from grandular structure in
epithelial tissues (mucus secreting glands) are often found
in the periphery of the lungs
• Large cell carcinomas can occur in any part of the lung
and tend to grow and spread faster than the other two
types
CAUSES AND RISK FACTORS
• Gender
• Smoking history
• Active smoking = 85-87%
• Passive smoking = 3-5%
• Older age
• Presence of airflow obstruction
• Genetic predisposition.
CAUSES AND RISK FACTORS
• Pollution and Occupational Exposure
• Industry work due to asbestos(heat resistant fibrous)
• Lung Disease like T.B
• family History
• Diet (low in fruits and vegetables)

PATHOPHYSIOLOGY & CLINICAL
MANIFESTATION
Carcinogens like smoking, occupational and
environmental agents, genetics
Binds with cell’s DNA and damage the cells
Cellular changes and abnormal cell growth occur

Malignant transformation of pulmonary epithelial cells
Abnormal proliferation of the lung cell. These cells grow slowly

and covers the segmental bronchi and lobes of the lung.
Non specific inflammatory changes with hypersecretion of

mucus, desquamation of the cells.
Lesions formation in the lung’s tissues involving the bronchi,
bronchioles or even alveoli
Bronchogenic carcinoma
FLOW CHART
SIGNS AND SYMPTOMS
1) LOCALIZED
– involving the lung
2) GENERALIZED
– involves other areas throughout the body if the
cancer has spread.
Localized Signs and Symptom
• Cough and fatigue
• Breathing Problems, stridor
• blood in phlegm
• Lung infection, hemoptysis
• Hoarseness, Hiccups
• Weight loss
• Chest Pain and tightness
• Pleural Effusion
Generalized Signs and Symptom
• Bone pain
• Headaches, mental status changes or neurologic findings
• Abdominal pain, elevated liver function tests, enlarged liver,
gastrointestinal disturbances (anorexia, cachexia), jaundice,
hepatomegaly
• Weight loss
Diagnostic Tests
• Chest x-ray
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Positron emission tomography (PET) scan
• Sputum cytology
• Fibreoptic bronchoscopy
• Transthoracic fine needle aspiration
LABORATORY TEST
• 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)
Mediastinoscopy
Video Assisted Thoracoscopic Needle Biopsy

Surgery
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.
Surgical treatment
✓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
Radiation Therapy
• Useful in controlling the neoplasm
that can not be surgically
removed.
• Used to reduce the size of the

tumor
• May help to remove the symptoms

like cough, chest pain, dyspnea
and hemoptysis etc.
Chemotherapy
is used to alter tumor growth and to
treat the patient with metastasis
• Non small cell:

✓Two drug regimen.
✓Cis/Carbo platin + 1 other
(Taxol/Taxotere/Gemcitabine)
• Small cell:
✓Cisplatin / Etoposide
Side Effects od Treatment
Complimentary Therapies
• ACUPUNCTURE and MASSAGE and pharmacological
approaches such as vitamins and herbal medicine
• These herbal therapies combined with chemotherapy

increases survival in non-small-cell lung cancer by up to
42%, compared with chemotherapy alone
• Foods: Green tea, Garlic, Fish Oil, Lactobacillus

Complimentary Therapies
• Mind-body: help to reduce anxiety, mood disturbance, or
chronic pain in cancer patients (audiotapes, videotapes,
books, music, relaxation, yoga, meditation)
• Acupuncture
• Hypnosis
• Massage therapy
Nursing Diagnosis
1. Ineffective breathing pattern r/t loss of adequate
ventilation as evidenced by overexertion of pt. during
respiration.
2. Impaired gas exchange r/t excessive or thick secretions or
r/t decreased passage of gases between alveoli of lungs and
vascular system as evidenced by decreased SPo2 level of pt.
3. Chronic pain related to Stage IV NSCLC diagnosis as
evidenced by client reporting “pain in right chest and lower
ribs”.
Nursing Diagnosis
4. Risk of infection related to altered immune system
secondary to effects of cytotoxic drugs as evidenced by side
effects of the drug/chemotherapy.
5. Risk for disturbed self concept related to changes in

lifestyle.
Nursing Diagnosis
6. Nausea related to effects of chemotherapy as evidenced

by client reporting feeling nauseated.
7. Risk for deficient fluid volume related to gastrointestinal
fluid loss secondary to vomiting.
8. Fatigue related to chemotherapy secondary to stage IV
NSCLC as evidenced by client reporting he “ no longer has
the energy to play with his grandchildren or visit his friends”.
Ineffective breathing pattern
• Teach patient about deep breathing exercises
• Encourage alternating activity with rest periods
• Chest physiotherapy
• Suctioning
• Bronchodilator medication
• O2 administration, if required
Impaired gas exchange
• Instruct the patient to stop smoking
• Semi-fowler position
• Administered antibiotics as prescribed
• Adequate hydration
• Deep breathing exercises
• Nebulization
• Suctioning, as required
Chronic pain
• Relaxation techniques
• Diversional therapy
• Frequent massage
• Encourage energy conservation
• Comfortable position
• Education to avoid concern about pharmacological and non-
pharmacological therapies
• Medication , as prescribed
Risk of infection
• Monitor the client body temp. routinely
• Encourage the patient to do regular ADL like brushing,
bathing, eating, toileting
• Provide a high calorie, high protein diet
• Hand washing before and after taking food
• Antibiotics, as prescribed
Risk of disturbed self concept
• Provide psychological support
• Encourage the family members in caring of the patient
• Encourage the communication with the patient
• Ask the client to identify personal strength and talent
Risk of disturbed self concept
• Provide psychological support
• Encourage the family members in caring of the patient
• Encourage the communication with the patient
• Ask the client to identify personal strength and talent
Risk of deficit fluid volume
• Encourage the patient to take fluids (2-3 l/day)
• Small and frequent diet
• I/V fluid administration, if prescribed
• Intake- output charting
• Administer skin care, apply hydrating lotion
• Weight recording

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LUNG CANCER

• Lung cancer tops the list for cancer

• Attributable mortality in the nation Of the world's 1.3 billion people

• Almost a quarter of Filipinos aged 15 years and older smoke tobacco,

Lung carcinoma, is caused by UNCHECKED GROWTH and

1. SMALL CELL LUNG CANCER

2. NON-SMALL CELL LUNG CANCER

• Grows fairly rapidly

• Most common type

• About 80-85% are NSCLC

• Grows more slowly

• Squamous cell carcinomas usually arise centrally in

• Pollution and Occupational Exposure

• Industry work due to asbestos(heat resistant fibrous)

• Lung Disease like T.B

• Diet (low in fruits and vegetables)

Binds with cell’s DNA and damage the cells

Cellular changes and abnormal cell growth occur

Abnormal proliferation of the lung cell. These cells grow slowly

Non specific inflammatory changes with hypersecretion of

*Blood Chemistry Test - to assess how organs are functioning such

• Biopsy-to determine if the tumor is cancer or not

Video Assisted Thoracoscopic Needle Biopsy

Other types of treatment that are used to treat certain

• Used to reduce the size of the

• May help to remove the symptoms

• Non small cell:

• These herbal therapies combined with chemotherapy

• Foods: Green tea, Garlic, Fish Oil, Lactobacillus

5. Risk for disturbed self concept related to changes in

6. Nausea related to effects of chemotherapy as evidenced

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