Definition. Epidemiology. Lung Cancer is a disease which cancer (malignant tumors) cells grow in the lungs. LUNG CANCER Debra Mercer BSN, RN, RRT

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1 LUNG CANCER Debra Mercer BSN, RN, RRT Definition Lung Cancer is a disease which cancer (malignant tumors) cells grow in the lungs. Epidemiology Leading cancer killer in both men and women in the US - 169, 400 estimated new cases in , 900 recorded deaths in 2002 Cases drops among white and africanamerican MEN Cases continuously increasing among white and african-american WOMEN 1

2 ETIOLOGIC FACTORS 1. Cigarette Smoking risk of lung cancer development in heavy smokers is estimated to be times the risk of nonsmokers. 2. Passive Smoke called the environmental tobacco smoke (also known as the sidestream smoke) 2

3 3. Asbestos - a group of minerals that occur naturally as fibers and are used in certain industries 4. Radon - an invisible, odorless, and tasteless radioactive gas in soil and rocks 5. Occupational Agents - increased incidence of lung cancer documented in individuals working with arsenic, copper, silica, lead, zinc, gold, chloromethyl ether, diesel exhaust and etc. 3

4 6. Indoor Air Pollution - cigarette smoke, building materials-paints, household aerosol products, combustion devices 7. Dietary Factors although the relationship of diet to lung cancer requires further investigation, early evidence suggested an inverse relationship between lung cancer risk and consumption of vitamin A or betacarotene, vitamin C, Vitamin E, and selenium. PATHOPHYSIOLOGY 4

5 Carcinogenic Mucosal Stimulation Cellular Proliferation Cellular Hyperplasia Cellular Metaplasia Atypical Cell Formation Carcinoma in Situ Invasive Carcinoma Two Major Types of Lung Cancer Non-small cell lung cancer * Three Main Types: - Squamous cell carcinoma - Adenocarcinoma - Large cell carcinoma Small Cell lung cancer Common Signs and Symptoms A cough that doesn t go away and gets worse over time Constant chest pain Coughing up blood Shortness of breath, wheezing, or hoarseness Repeated problems with pneumonia or bronchitis Swelling of the neck and face Loss of appetite or weight loss Fatigue 5

6 Complications of Lung Cancer Paraneoplastic syndrome Superior vena cava syndrome - Edema of face/neck, dilated veins of upper chest - Headache, dizziness, syncope Diagnostic Procedures Chest X-ray, CT scans, MRI Sputum cytology Bronchoscopy with washings/biopsy Needle aspiration Thoracentesis Thoracotomy Mediastinoscopy Treatment of Lung Cancer Depends on grading and staging Surgery done for non-small cell cancer in Stage I and II (not generally used for small cell lung cancer) - Lobectomy - Segmental resection - Wedge resection - Pneumonectomy 6

7 Other treatments Radiation - Can be curative in small % of patients - Useful for tumors that cannot be resected surgically, but are radiosensitive * May shrink size of tumor to decrease symptoms (cough, dyspnea, chest pain, hemoptysis) and prolong life * Control spread of metastasis to spinal cord or brain Other Treatments (cont.) Chemotherapy Used to treat small cell tumors, distant metastasis May provide symptom relief (especially pain) but usually not curative Combinations of two or more chemotherapeutic agents Choice of agent depends on type of tumor Pre-op Nursing Care Baseline physical assessments, emotional assessments Teach Respiratory therapy important post-op deep breathing, coughing, splinting, use of incentive spirometry Chest tubes may be present (except for pneumonectomy) Leg exercises, use of VCB post-op No smoking after surgery 7

8 Post-op Nursing Care Ineffective airway clearance re: partial or total removal of lung Maintain patent airway, use of O 2, degrees Assess respiratory rate, depth, chest expansion, lung sounds, O 2 sat., ABG s Maintain patency of chest tubes as well as all areas of safe care for chest tubes Note: with pneumonectomy no chest drainage may have wound drain, fluid will loculate or solidify in area where lung removed Post-op Nursing Care (cont.) Risk for injury re: hemorrhage post-op Risk for infection re: lung surgery and presence of post-op chest drainage Pain re: surgical procedure 8