Lung cancer.ppt

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Malignant lung tumor:

Malignant lung tumor Conducted by: Ms. Monika (Clinical instructor) Army college of nursing


INTRODUCTION OF CANCER Cancer is the term used for diseases in which abnormal cells divide ( mitosis ) without control. Cancer cells can invade nearby tissues and spread through the bloodstream and lymphatic system to other parts of the body (metastasis) . Lung cancer , the most common cause of cancer-related death in men and women, is responsible for 1.3 million deaths worldwide annually


DEFINITION OF LUNG CANCER Lung cancer or bronchogenic cancer is defined as a malignant tumor of the lung arising within the wall or epithelium of the bronchus. OR Lung cancer is a disease which consists of uncontrolled cell growth in tissues of the lung . This growth may lead to metastasis

Seven cardinal signs of cancer (Caution):

Seven cardinal signs of cancer (Caution) C---- Change in bowel or bladder habits could be a sign of colorectal cancer. A ---- sore that does not heal on the skin or in the mouth could be a malignancy and should be checked by a doctor . U---- Unusual bleeding or discharge from the rectum, bladder or vagina could mean colorectal, prostate, bladder or cervical cancer .


CONTD… T---- Thickening of breast tissue or a new lump in the breast is a warning sign of breast cancer. A lump in the testes could mean testicular cancer . I---- Indigestion or trouble swallowing could be cancer of the mouth, throat, esophagus or stomach.


CONTD… O---- Obvious changes to moles or warts could mean skin cancer . N---- Nagging cough or hoarseness that persists for four to six weeks could be a sign of lung or throat cancer.

Facts related to lung cancer:

Facts related to lung cancer Lung cancer is one of the top ten cancers that affect people in most parts of the world. The World Health Organization estimates that over 900,000 new cases of lung cancer were diagnosed worldwide in 2000. However, the incidence of lung cancer is not the same in all countries with some of the highest rates in New Zealand and the US and the lowest rates in India, Africa and South America.


CONTD… Lung cancer is most commonly diagnosed in people in the age range of 55-65 years old. Although the incidence of lung cancer is now falling in men, it continues to rise in women.

Types of lung cancer :

Types of lung cancer The main types of lung cancer are : SMALL CELL LUNG CARCINOMA (SCLC) NON-SMALL CELL LUNG CARCINOMA (NSCLC) This distinction is important, because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery , while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation


a) SMALL CELL LUNG CARCINOMA (SCLC) A type of lung cancer made up of small, round cells. Small cell lung cancer is less common than non-small cell lung cancer and often grows more quickly. The name is often shortened to SCLC. Another name for SCLC is oat cell cancer because the cancer cells may look like oats ( flat shape) when viewed under a microscope, grows rapidly and quickly spreads to other organs.


b) NON-SMALL CELL LUNG CARCINOMA (NSCLC) Non-small cell lung cancer (NSCLC) is the most common type of lung cancer . It usually grows and spreads more slowly than small cell lung cancer .

Type of NSCLC:

Type of NSCLC There are three forms of NSCLC : ADENOCARCINOMAS :are often found in an outer area of the lung. SQUAMOUS CELL CARCINOMAS : are usually found in the center of the lung by an air tube (bronchus). LARGE CELL CARCINOMAS : can occur in any part of the lung. They tend to grow and spread faster than the other two types.


SMALL CELL CARCINOMA Incidence:- 15% -20% SPECIFIC CHARACTERISTICS:- Malignant tumor Tends to spread soon Growth rate:- fast growth.


SQAMOUS CELL CARCINOMA Incidence :- 30% -35% Specific characteristics:- Arises from bronchial epithelium. As growth occurs, cavitation may develop in lung distal to tumor. Tumor may occur in apex &upper respiratory zone. Most common type in men. Growth rate:- slow growth


ADENOCARCINOMA Incidence:- 35% - 40% Specific characteristics:- Majority arises from bronchial mucus gland. Rarely cavities. Common in women. No clinical manifestations. Growth rate:- slow growth,


LARGE CELL LUNG CANCER Incidence:- 15% - 20% Specific characteristics:- More often peripheral mass ; either single or multiple masses; may be central. Often grows to large tumor mass. Growth rate:- rapid growth


ETIOLOGY Lung cancer may be because of :- Cigarette smoking , passive smoking Tobacco smoking Occupational carcinogens Nutrional deficiencies Non - neoplastic diseases such as tuberculosis, chronic bronchitis & emphysema Exposure to asbestos ,randon gases ,viruses Air pollution

a) Tobacco smoking :

a) Tobacco smoking Smoking , particularly of cigarettes , main contributor to lung cancer. Cigarette smoke contains over 60 known carcinogens , including radioisotopes , nitrosamine , and benzopyrene . Across the developed world, almost 90% of lung cancer deaths are caused by smoking.

Passive smoking:

Passive smoking the inhalation of smoke from another's smoking—is a cause of lung cancer in nonsmokers. A passive smoker can be classified as someone living or working with a smoker. 10–15% of lung cancer patients have never smoked.

Radon gas :

Radon gas Radon is an invisible, odorless, and tasteless radioactive gas that occurs naturally in soil and rocks. Exposure to radon (in mines or even houses) can cause damage to the lungs that may lead to lung cancer. Radon exposure is the second major cause of lung cancer in the general population, after smoking with the risk increasing by 8% to 16% .

Asbestos :

Asbestos Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air and stick to clothes. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk for lung cancer.


Viruses Viruses are known to cause lung cancer Implicated viruses include human papillomavirus , simian virus 40 (SV40), cytomegalovirus . These viruses may affect the cell cycle allowing uncontrolled cell division

Air pollution :

Air pollution High levels of air pollution and drinking water containing high levels of arsenic can increase your risk for lung cancer.


PATHOPHYSIOLOGY More than 90% of lung cancer originate from the epithelium of bronchus. They slowly & it takes 8 to 10 years, for a tumor to reach 1cm in size. Cancerous lung tissue cannot exchange oxygen & carbon dioxide It impairs the functioning of the lung

Slide 25:

Tumor cells grow & invade surrounding lung tissue It obstructs the flow of the air Significant growth of the tumor


SPREAD OF CANCEROUS CELLS Carcinoma of lung can be spread by : Direct extension Lymphatic metastasis Hematogenous metastasis


STAGING OF CANCER Staging is a system of classifying information about cancer, including where and to what extent the cancer has spread.


A) NON SMALL CELL LUNG CANCER It is staged according to the size of the tumor, and the extent to which the cancer has spread. The stages include: STAGE 0 :Cancer is limited to the lining of the air passage and hasn’t invaded lung tissue. STAGE1 :Invaded to lung tissue Hasn’t invaded to lymph nodes


CONTD… STAGE II : Spread to neighboring lymph nodes. STAGE IIIA : Spread from the lung to lymph nodes. STAGE III B : Spread locally to areas . STAGE IV :spread to other parts of the body.


B) SMALL CELL LUNG CANCER Stages include : Limited : confined to one lung & to its neighboring lymph nodes Extensive : spread beyond one lung or both lungs, lymph nodes , to other organs.


WARNING SIGNALS OF LUNG CANCER Any change in respiratory system Persistent cough & sputum with blood Hemoptysis Weight loss & fatigue Shoulder , chest , back , or arm pain Recurring episodes of pleural effusion , pneumonia or bronchitis Unexplained dyspnea


CLINICAL MANIFESTATIONS Manifestations depend on the type of tumor , its location & metastasis spread. The common manifestations are : Cough Dyspnea Chest pain – localized Excessive sputum production Hemoptysis


CONTI…. Fever , nausea & headache Vomiting Weight loss Fatigue & anorexia pneumonitis

Other symptoms that may be due to NSCLC:

Other symptoms that may be due to NSCLC Weakness Swallowing difficulty Joint pain Hoarseness or changing voice Swelling of the face Bone pain or tenderness Shoulder pain or weakness


DIAGNOSTIC TESTS To help find the cause of symptoms, the doctor assesses the medical history, including smoking history and family history of cancer. The doctor also performs a physical exam and may order a chest x-ray and other tests. Sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer.

a) Biopsy :

a) Biopsy A biopsy (the removal of a small sample of tissue for examination under a microscope by a pathologist) can show whether a person has cancer.

2) Bronchoscopy :

2) Bronchoscopy Bronchoscopy is where a bronchoscope (a thin, lighted tube) is put into the mouth or nose and down through the windpipe to look into the breathing passages. Cells or small samples of tissue can be taken through this tube.

3) Needle aspiration :

3) Needle aspiration Needle aspiration involves inserting a needle through the chest into the tumor to remove a sample of tissue.

4) Thoracentasis :

4) Thoracentasis Thoracentesis is a procedure where a needle is used to take a sample of the fluid that surrounds the lungs to check for cancer cells.

5) Thoracotomy :

5) Thoracotomy Thoracotomy is a major operation where the chest is opened.


MANAGEMENT Medical management : Early identification Radiation therapy Chemotherapy Surgical management : Surgical resection

a) Early identification :

a) Early identification Early detection is the key to improve survival rate for clients with lung cancer. Early detection should be done when pre malignant changes occur.


Cont……………d At this stage ,lesions are curable. A tumor must be at least 1 cm in diameter & it is detectable on a chest radiography. Management of client with lung cancer depends on tumor type ,stage as well as client health status. Following the diagnosis ,primary treatment modalities are radiation & chemotherapy.

2) Radiation therapy:

2) Radiation therapy Radiation therapy is the delivery of high-energy radiation to kill cancer cells and shrink tumor. High-energy rays damage DNA in cells, causing them to die or stop dividing. Healthy cells can be affected as well but are better able to repair the damage . Both small-cell and non-small cell lung cancers are frequently treated with radiation therapy, which is often combined with chemotherapy , surgery or both


Cont……………d It is administered over a period of 5 to 6 weeks. Ct scanning is often performed before treatment begins.

When radiation therapy is used :

When radiation therapy is used After surgery – To treat any cancer cells that might remain in the area after surgery Before surgery – To decrease the size of a tumor and make surgery more effective To cure cancer – With small tumors, and in patients that are unable to have surgery due to age, location of a tumor or other medical conditions


Cont…………..d To treat symptoms – When a tumor is causing symptoms such as shortness of breath and pain, sometimes radiation therapy is used to reduce tumor size to decrease symptoms. For prevention – In small-cell lung cancer, radiation therapy to the brain is sometimes given to kill any cells that have spread to the brain but are not detected by scans. This is called Prophylactic Cranial Irradiation (PCI)

Types of Radiation therapy :

Types of Radiation therapy Radiation therapy can be given externally or internally to treat lung cancer. Common procedures used include: a) External beam radiation therapy - This is used most commonly and involves the use of an external machine, which delivers high-dose radiation.

Internal radiation (brachytherapy):

Internal radiation ( brachytherapy ) Internal radiation therapy is a form of treatment where a source of radiation is put inside the body. One form of internal radiation therapy is called brachytherapy . In brachytherapy, the radiation source is a solid in the form of seeds, ribbons, or capsules, which are placed in your body in or near the cancer cells. This allows treatment with a high dose of radiation to a smaller part of your body. Internal radiation can also be in a liquid form.


Cont…d Internal radiation can also be in a liquid form. The pt receive liquid radiation by drinking it, by swallowing a pill, or through an IV. Liquid radiation travels throughout body, seeking out and killing cancer cells. Brachytherapy may be used with people who have cancers of the head, neck, breast, uterus, cervix, prostate, gall bladder, esophagus, eye, and lung.

Chemotherapy :

Chemotherapy Chemotherapy is the use of drugs to kill bacteria, viruses, fungi, and cancer cells. Most commonly, the term is used to refer to cancer-killing drugs. Chemotherapy drugs can be given by mouth or injection.

Uses of chemotherapy:

Uses of chemotherapy Chemotherapy may be used to: Cure the cancer Keep the cancer from spreading The response of lung cancer to chemotherapy depends on the tumor’s cell type. SCLC responds well to chemotherapeutic agent because of its rapid growth rate.

Routes of Chemotherapy:

Routes of Chemotherapy Depending on the type of cancer and where it is found, chemotherapy may be given in a number of different ways, including: Injections in the muscles Into the veins (intravenous, or IV) Pills Shots into the fluid that surrounds the spinal cord or brain

Drugs used in chemotherapy :

Drugs used in chemotherapy Carboplatin Topotecan Erlotinib Docetaxel Irinotecan Cisplatin

Side effects of chemotherapy :

Side effects of chemotherapy Are more likely to have infections Become tired more easily Bleed too much, even during everyday activities Feel pain from damage to the nerves Have a dry mouth, mouth sores, or swelling in the mouth Have a poor appetite and lose weight Have an upset stomach, vomiting, and diarrhea

Surgical management :

Surgical management Surgical intervention is the treatment of choice in early stage of NSCLC. Cure is possible if the disease is still localized to the thoracic cavity & no distant metatasis are present. The primary aim of surgical resection is to remove the tumor completely.

Pulmonary resection :

Pulmonary resection WEDGE RESECTION is a type of lung cancer surgery in which the tumor and a small amount of surrounding tissue is removed. A wedge resection is usually performed for very small lung cancers. With larger lung cancers, a lobectomy or pneumonectomy are usually the preferred surgical procedures.

2) Segmental resection :

2) Segmental resection Removal of one or more lung segments .

3) Lobectomy :

3) Lobectomy Removal of entire lobe of the lung

Pneumonectomy :

Pneumonectomy Removal of an entire lung

Alternative Names :

Alternative Names Cancer - lung - non-small cell Non-small cell lung cancer; NSCLC; Adenocarcinoma - lung Squamous cell carcinoma - lung




NSG ASSESSMENT Determine the understanding of patient & the family concerning the diagnostic tests. Assess the level of anxiety. Determine onset & duration of coughing, sputum production, & degree of dyspnea.


CONTD… Auscultate for breath sounds. Observe symmetry of chest during respiration. Ask about pain, its location, intensity & factors influencing pain.


NSG DIAGNOSES Ineffective breathing pattern related to obstructive respiratory processes associated with lung cancer Imbalanced nutrition: less than body requirements related to hyper metabolic state, anorexia


CONTD… Acute or chronic pain related to tumor effects, toxicities associated with radiotherapy/ chemotherapy Anxiety related to uncertain outcomes & fear recurrence


NSG INTERVENTIONS Improving breathing patterns Elevate head of bed to promote gravity drainage. Teach breathing retraining exercises. Give prescribed treatment such as antimicrobial agents.


CONTD… Administer oxygen if prescribed. Allow patient to sleep in reclining chair or with head of bed elevated if severely dyspneic. Improving nutritional status : Encourage small amounts of high calorie & high protein foods. Ensure adequate protein intake : milk, eggs, chicken, fish, cheese etc.


CONTD… Administer or encourage prescribed vitamin supplement . Change consistency of diet to soft or liquid. total parenteral nutrition for malnourished patients who is unable to eat. Controlling pain : Assess condition of the patient. Give analgesics to the patient.


CONTD… Evaluate problems of insomnia, depression, anxiety etc. Initiate bowel training program. Minimizing anxiety : Try to have the patient express concerns ; share these concerns. Expect some feelings of anxiety. Encourage the patient to communicate feelings.


HEALTH EDUCATION Help the patient Teach the patient to realize that every pain & ache is caused by lung cancer. Take NSAIDS or other prescribed medication. Tell the patient about treatment. Advise the patient to report new or persistent pain.


SUMMARIZATION Introduction Definition Anatomy Seven cardinal signs of cancer Facts related to lung cancer Types Etiology Pathophysiology


CONTD… Pathophysiology Spread Warning signals Clinical menifestations Diagnostic tests Complications Management Nsg assessment


CONTD… Nsg assessment Nsg diagnoses Nsg interventions Health education

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