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JACQUELINE D.

DE ASIS, RN, MSN

Malignancy

in the epithilium of the respiratory tract. The number-one cancer killer among men and women in the United States.

Small

cell carcinoma (oat cell carcinoma) Squamous cell carcinoma Adenocarcinoma Large cell carcinoma

Arises

from bronchial epithelium As growth occurs, cavitation may develop in lung distal to the tumor; pancoasts tumor arises in apex and upper lung zones. Secondary infections distal to obstructive tumor in bronchioles commonly occur.

Arises

from bronchial mucous gland, often subpleural Rarely cavitates Often arises in previously scarred lung tissue. Incidence strongly linked to cigarette smoking. Increasing incidence in women. Bronchioalveolar cell carcinoma is a subtype.

More

often peripheral mass. Cavitation is common. May be located centrally, midlung, or peripherally. Rare hilar movement. Often grows to large tumor mass before diagnosis.

65-75%

manifest as hilar or central mass. May compress bronchi. Involvement of the diaphragm through paralysis of phrenic nerve and hoarseness through paralysis of recurrent laryngeal nerve. Pleural and paricardial effusions and tamponade often seen. Does not form cavities.

SCLC
NSCLC

Tobacco

/cigarette smoke

Second-hand

smoke

Environmental

and Occupational exposure

Genetics

Dietary

factors

WARNING

SIGNALS OF LUNG CANCER Any change in respiratory patterns Persistent cough Sputum streaked with blood Frank hemoptysis Rust-colored or purulent sputum Unexplained weight loss Fatigue

Chest, shoulder, back or arm pain Recurring episodes of pleural effusion, pneumonia, or bronchitis Unexplained dyspnea

CENTRALLY

LOCATED PULMONARY TUMORS Obstructs air flow Coughing, wheezing, stridor, and dyspnea As obstruction increases, bronchiopulmonary infection often occurs distal to the obstruction. Chest, shoulder, arm, and back pain may develop as the tumor invades the perivascular nerves.

SQUAMOUS

AND SMALL CELL TUMORS

Hemoptysis Pericardial effusion Tamponade Cardiac dysrythmias

PERIPHERAL

PULMONARY TUMORS Pleural pain that increases on inspiration Pleural effusion-lung expansion is limited

APICES

OF THE LUNGS Usually asymptomatic until it extends into surrounding structures. Arm and shoulder pain Atrophy of the arm and hand muscles Bone pain Horners syndrome (MIOSIS, PTOSIS, ANHIDROSIS)

Chest

x-ray CT Scans/MRI/SPECT Sputum cytology


Fiberoptic

bronchoscopy Transthoracic fine-needle aspiration

FOR

METASTASIS:

abdominal

scans, positron emission tomography (PET) scans, or liver ultrasound or scans. CT of the brain, magnetic resonance imaging (MRI), and other neurologic diagnostic procedures . Mediastinoscopy or mediastinotomy

Direct

extensions to the laryngeal nerve produces hoarseness. Compression of the esophagus may cause dysphagia. Invasion or compression of the superior vena cava produces superior vena cava syndrome. Obstruction of the venous blood flow leads to SOB, facial, arm, trunk swelling, distended neck veins, chest pain, and venous stasis.

Regional

lymph node involvement may produce manifestations caused by impaired lymph drainage. Involvement of the mediastinal lymph nodes may result in vocal cord paralysis, dysphagia, diaphragmatic paralysis on the affected side, vena cava compression and malignant pleural effusion.

Stage

IA-T1NOMO Tumor is 3 cm or less in diameter No metastases to regional lymph nodes No distant metastases

Stae

IB-T2N0MO Tumor is greater than 3cm in diameter or is any size that either invades the visceral pleura Has associated atelectasis or obstructive pneumonitis extending to the hilar region No metastases to lymph nodes or distant metastasis

Stage

IIA-TINIMO Tumor is 3 cm or less in diameter With metastasis to the lymph nodes in the peribronchial or ipsilateral hilar region, or both Without distant metastasis

Stage

IIB-T2N1MO Tumor is greater than 3 cm or is any size that either invades the visceral pleura or has associated atelectasis or obstructive pneumonitis extending to the hilar region. With metastasis to lymph nodes in the peribronchial or ipsilateral hilar region, or both. Without distant metastasis

Stage

IIIA-T2N2MO Tumor is greater than 3 cm in diameter or is any size that either invades the visceral pleura or has associated atelectasis or obstructive pneumonitis extending to the hilar region With metastasis to ipsilateral mediastinal or subcarinal nodes. Without distant metastasis

RADIATION

THERAPY/RADIOTHERAPY CHEMOTHERAPY SURGERY PALLIATIVE THERAPY

Indicated

for patients with locally advanced

disease: 1. For whom surgery poses an unacceptable high risk. 2. Who have technically inoperable tumors. 3. Who refuse thoracotomy May be used in combination with surgery or chemotherapy.

Used

to reduce the size of a tumor, to make an inoperable tumor operable, or to relieve the pressure of the tumor on vital structures.

Is administered over a period of 5 to 6 weeks, either consecutively or in split courses.

It

can control symptoms of spinal cord metastasis and superior vena caval compression. Prophylactic brain irradiation is used in certain patients to treat microscopic metastases to the brain. Radiation may help relieve cough, chest pain, dyspnea, hemoptysis, and bone and liver pain.

Used

to alter tumor growth patterns, to treat patients with distant metastases or small cell cancer of the lung, and as an adjunct to surgery or radiation therapy. Combinations of two or more medications may be more beneficial than single-dose regimens. May provide relief, especially of pain

Response

to chemotherapy depends on the tumors cell type. The effectiveness of chemotherapy in the treatment of NSCLC remains controversial.

Surgical

resection is the preferred method of treating patients with: 1. Localized non-small cell tumors 2. No evidence of metastatic spread 3. Adequate cardiopulmonary function.

Surgery

is primarily used for non-small cell carcinomas. The role of surgical resection in the treatment of SCLC is limited. PRIMARY AIM: to remove the tumor completely while preserving as much of the normal surrounding lung tissue as possible.

Lobectomy
Bilobecotmy Sleeve

resection Pneumonectomy Segmentectomy Wedge resection Chest wall resection with removal of cancerous lung tissue

May
1.

2.
3. 4.

include: radiation therapy to shrink the tumor to provide pain relief variety of bronchoscopic interventions to open a narrowed bronchus or airway pain management comfort measures.

RADIATION

THERAPY

diminished

cardiopulmonary function pulmonary fibrosis pericarditis myelitis cor pulmonale

CHEMOTHERAPY

Pneumonitis Pulmonary toxicity

SURGICAL

RESECTION Respiratory failure Surgical complications Prolonged mechanical ventilation

Managing Symptoms

The nurse instructs the patient and family about the potential side effects of the specific treatment and strategies to manage them. Strategies for managing such symptoms as dyspnea, fatigue, nausea and vomiting, and anorexia will assist the patient and family to cope with the therapeutic measures.

Relieving

breathing problems Deep-breathing exercises Chest physiotherapy Directed cough Suctioning Bronchoscopy Bronchodilator medications Supplemental oxygen Decrease dyspnea