Lung cancer

1. LUNG CANCER

2. Lung cancer
• The term lung cancer is used for tumors arising from the
respiratory epithelium (bronchi, bronchioles, and alveoli).

3. • Most common cause of cancer death in men in world
• Fourth most common cancer reported in india
• More deaths by lung cancer than the next four most common
cancers combined (Colorectal, Breast, Prostate, & Pancreas

4. ETIOLOGY
Risk Factors
• Gender
• Smoking history
• Older age
• Presence of airflow obstruction
• Genetic predisposition
• Occupational exposures

5. SMOKING
• It is estimated that cigarette smoking is responsible for
approximately 85 to 90% of all cases of lung cancer,
• More than 40 carcinogens have been identified in
cigarette smoke
• Lung cancer is 10 times more common in cigarette
smokers than nonsmokers.

7. • The risk for development of lung cancer correlates with:
• the number of cigarettes smoked per day
• lifetime duration of smoking,
• age at onset of smoking,
• tar and nicotine content of the cigarettes
• degree of inhalation,
• use of unfiltered cigarettes

8. LUNG CANCER
(2007 American Cancer Society Data)
active
passive
85-87
3-5
Relationship to Smoking
Etiology
Tobacco Percent

9. SECOND-HAND SMOKE
• Passive smoking has been identified as a
possible cause of lung cancer in nonsmokers
• Risk of lung cancer by about 35%

10. ENVIRONMENTAL AND OCCUPATIONAL
EXPOSURE
• Chronic exposure to industrial carcinogens, such as
• arsenic
• asbestos,
• mustard gas
• nickel,
• and radiation, has been associated with the
development of lung cancer

11. Preexisting Lung Disease
• Tobacco smoking causes chronic inflammation and
destruction of lung tissue, which results in chronic
obstructive pulmonary disease (COPD).
• patients in whom idiopathic pulmonary fibrosis or
pulmonary fibrosis from asbestosis or silica develops are
at increased risk for the development of lung cancer

12. Dietary Factors
• Increased consumption of fruits and green and yellow
vegetables is associated with a reduced risk for lung
cancer
• low serum concentrations of antioxidant vitamins such
as vitamins A and E are associated with the
development of lung cancer.

13. Inheritance
• First-degree relatives of patients with lung cancer have a
two- to six-fold increase in the risk for lung cancer after
adjusting for tobacco use.
• Second-degree relatives of lung cancer patients have a
relative risk

14. 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%)

15. Non-Small Cell Lung Cancer(NSCLC)
• 1. Squamous cell carcinoma
• 2. Adenocarcinoma
• 3. Large cell carcinomas

16. Squamous cell carcinoma
• Slow growing
• makes up 20-30% 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)

17. Adenocarcinoma
• Most common type of Lung cancer
• (30-40% of all lung cancers)
• Common In non smokers
• Clearly defined peripheral lesions (RLL lesion)
• Easily seen on a CXR
• Highly metastatic in nature
o Pts present with or develop brain, liver,
adrenal or bone metastasis

18. 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

19. Small Cell Lung Cancer
• most aggressive form of lung cancer
• Accounts 20% of lung cancer
• Because of aggressive nature, at the time of diagnosis
these tumors have often metastasize to other parts of
the body (brain, liver, and bone marrow

20. Pathophysiology

21. CLINICAL MANIFESTATIONS
• cough - 45% of cases
it is nonspecific and also common in patients who smoke and
have COPD
• Hemoptysis -30% of patients
Because of bleeding caused by malignancy
• Dyspnea -30 to 50% of patients
• Wheezing is uncommon as an initial symptom in lung cancer
and may signify major airway obstruction

22. • Chest pain- 25% of patients,
may be dull in nature, but chest pain that is severe and
persists may be due to chest wall involvement

23. Metastasis
• Intrathoracic Spread
Dysphagia
Hoarseness
dyspnea and hiccups
superior vena cava (SVC)
as a result of compression or direct invasion by
the tumor itself or by enlarged mediastinal lymph nodes

24. • Brain metastasis
headaache, seizures, papilledema, vomiting
• Endocrine
Paraneoplastic Syndrome
It is caused by excretion of hormones and cytokines by the
tumour cells or by immune response against the tumour it is
manifested by hypercalcemia, SIADH, Adrenal hypersecretion,

25. DIAGNOSIS
• History and physical examination
• CHEST X-RAY
initial diagnostic test
identify a lung mass or infiltrate
evidence of metastasis to adjesent structures
• CT SCAN
small lesion, lesion behind of cardiac or blood
vessel
Lymph node enlargement
location and extent of mass

26. Bronchoscopy
• Bronchoscope may verify the existence of tumor , of Central
type, and cytologic diagnosis of lung cancer should be obtained
though FBC
• bronchial washings
• bronchoalveolar lavage fluid

27. fine-needle aspiration cytology
(FNAC)
• Lesions not amenable to bronchoscopy this procedure
may be performed under CT or fluoroscopic guidance to
aspirate cells from a suspicious area

28. Sputum cytology
• Cytologic examination of sputum may reveal exfoliated
malignant cells recognizable to the pathologist who is specially
trained for such work.
• The sputum must to be fresh, send on time, repeat(4-6 times)..

29. Staging
T = tumor size
N = node involvement
M = metastasis status

31. Management
• The objective of management is to provide a cure if
possible
• Treatment depends on
the cell type
the stage of the disease
physiologic status of the patient

32. SURGICAL MANAGEMENT
Surgical resection is the preferred method of
treating patients
• With localized non-small cell tumors,
• No evidence of metastatic spread,
• adequate cardiopulmonary function

33. TYPES
• Lobectomy- a single lobe of lung Is removed
• Bilobectomy- two lobes of the lung are removed
• Sleeve resection- cancerous lobe(s) is removed
and a segment of the main bronchus is resected
• Segmentectomy: a segment of the lung is
removed

34. • Wedge resection: removal of a small, pie-shaped area
of the segment
• Pneumonectomy: removal of entire lung

37. RADIATION THERAPY
• Radiation therapy may cure a small percentage of
patients
• It is useful in controlling neoplasms that cannot be
surgically resected but are responsive to radiation

39. CHEMOTHERAPY
• Chemotherapy is used to alter tumor growth patterns to treat patients with
distant metastases
• small cell cancer of the lung as an adjunct to surgery or radiation therapy
• Eg- alkylating agents (cyclophosphamide)
• platinum analogues (cisplatin and carboplatin),
• taxanes (paclitaxel, docetaxel)
• vinca alkaloids (vinblastine and vindesine),
• doxorubicin,
• etoposide

40. PALLIATIVE THERAPY
• Palliative therapy may include radiation therapy to shrink
the
tumor to provide pain relief
• Potent analgesics
• Symptomatic management

41. Nursing Diagnoses
• Ineffective breathing pattern r/t loss of lung
parenchyma /adequate ventilation
• Impaired gas exchange r/t excessive or thick
secretions ,decreased passage of gases between
alveoli of lungs and vascular system
• Chronic pain related to Stage IV NSCLC diagnosis as
evidenced by client reporting “pain in right chest and
lower ribs”.
• Risk of infection related to altered immune system
secondary to effects of cytotoxic drugs.

42. • Risk for disturbed self concept related to changes in
lifestyle.
• Nausea related to effects of chemotherapy as evidenced
by client reporting feeling nauseated.
• Risk for deficient fluid volume related to gastrointestinal
fluid loss secondary to vomiting.
• 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”.

43. interventions
• MANAGING SYMPTOMS
• RELIEVING BREATHING PROBLEMS
• REDUCING FATIGUE
• PROVIDING PSYCHOLOGICAL SUPPORT