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8/3/2019 Chest Tumors_NCM 104 1st Sem, 2010
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CHEST TUMORS
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ANATOMY AND PHYSIOLOGY OF THE
RESPIRATORY SYSTEM
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LUNG CANCER (BRONCHOGENIC
CARCINOMA)
Leading cancer killer
Cancer that forms in tissues of lung,
usually in the cells lining air passages.
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LUNG CANCERCANCER FACTS HOW DOESLUNG CANCER DEVELOP
Pathophysiology
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CATEGORIES OF LUNG CANCER
Small cell lung cancer
a. small cell carcinoma (oat cell cancer)b. mixed small cell / large cell carcinoma
c. combined small cell carcinoma
Non-small cell lung cancera. Squamous cell cancer
b. Large cell carcinomac. Adenocarcinoma
d. Bronchoalveolar cell cancer
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CLASSIFICATIONS AND STAGING
Is decease in which malignant cancer cellsform in the tissues of the lung.
Most malignant form of lung cancer arises fromthe bronchi
Hypersecretes antidiuretic hormone leadinghyponatremia.
Metastesis is early hrough the bloodsteam andlynphatics to the mediastinum, liver, bone,bone marrow, CNS, adrenal glands, pancreas
and other endocrine organ.
Small Cell Lung Cancer
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Small cell Carcinoma
Combined small cell
carcinoma
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NON SMALL CELL LUNG CANCER
is a disease in which malignant cancercells form in the tissues of the lung tissue
grow uncontrollably and form tumors.
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a. Squamous cell cancer
centrally located andarises more commonlyin the segmental andsub segmental bronchi.
b. Large cell carcinoma(undifferentiatedcarcinoma) fast growing
tumor that tends to ariseperipherally.
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STAGES OF NON SMALL CELL LUNG
CANCER
Occult Stage cancer cells are found in asample of a patients coughed upsputum but no cancer cells have yet beendetected in the lungs.
Stage O are noninvasive cancers andonly a few layers of cancer cells aredetected within one local area.
Stage I the cancer cell has reachedhigher layers of the lung but has notspread into the lymph nodes or beyond thelung
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Stage II cancer cells have spread tonearby lymph nodes
Stage III - cancers cells have spreadbeyond the lung to the chest wall,diaphragm, or further lymph nodes.
Stage IV cancer has spread
(metastasized) to other parts of the body.
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RISK FACTORS
Tobacco Smoke
Second hand smoke
Environmental and occupationalexposure
Genetics
Dietary factors
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CLINICAL MANIFESTATIONS
Cough dry, persistent without sputum production Dysphea
Hemoptysis Chest or shoulder pain
Recurring fever Shortness of breath Chest pain and tightness Hoarseness
Dysphagia Head and neck edema Symptoms of Pleural or Pericardial Effusion
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! Nursing Alert
A cough that changes in charactershould arouse suspicion of lung
cancer.
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ASSESSMENT AND DIAGNOSTIC FINDINGS
Chest X-ray
A scan of the chest
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Sputum Cytology
Fiberopticbronchoscopy
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Endoscope with
esophagealultrasound
Positron Emission
Tomographs Scan(PET)
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Magnetic ResonanceImaging (MRI)
Mediatinoscopy /
Mediastinotomy
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MEDICAL MANAGEMENT
Surgical Resection preferred method oftreating patients with localized non-small celltumors.
Radiation Therapy useful in controlling
neoplasm that cannot be surgically resected. Chemotherapy used to alter tumor growth
patterns, to treat distant metastases or small cellcancer of the lung.
Palliative Therapy - to shrink the tumor toprovide pain relief, a variety of bronchoscopicinterventions and pain management and comfortmeasures.
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TYPES OF LUNG RESECTION
Lobectomy: a single lobe of lung is removed.
Bilobectomy: two lobes of the lung areremoved.
Sleeve Resection: Cancerous lobe(s) isremoved and a 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 ofCancerous Lung Tissue: for cancers that have
invaded the chest wall.
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TREATMENT AND RELATED COMPLICATIONS
RespiratoryfailureDiminished cardiopulmonary
function
Pulmonary fibrosisMyelitis
Cor pulmonale
Pneumonitis Pulmonary toxicity
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NURSING MANAGEMENT
Managing Symptoms
Relieving Breathing Problems
Reducing Fatigue Providing Psychological
support
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GERONTOLOGICAL CONSIDERATIONS
Issues that must be considered in care ofelderly patient with lung cancer includefunctional status, comorbid conditions,
nutritional status, cognition, concomitantmedications, psychological and socialsupport.
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TUMORS OF MEDIASTINUM
Result from pressure of mass againstimportant intrathoracic organs is a growth inthe central chest cavity, which separate the
lungs and contains the heart, aorta,esophagus, thymus and trachea
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CLINICAL MANIFESTATION
Cough
Wheezing Dyspnea
Anterior chest or neck pain Bulging of the chest wall
Heart palpitations
Angina
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CIRCULATORY DISTURBANCES
Central cyanosis
Superior vena cava syndrome
Marked distension of veins ofneck and chest wall
Dysphagia
Weight loss
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ASSESSMENT AND DIAGNOSIS FINDINGS
Chest X-rays
CT Scan
MRI PET
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MEDICAL AND SURGICAL
MANAGEMENT
Median Sternomy is atype of surgicalprocedure in which
vertical line incision ismade along the sternum
Thoracotomy is a
open surgical procedurewhere all or part of thelung is removed.
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Bilateral AnteriorThoracotomy
(Clamshell incision)Largest incisioncommonly used inthorasic surgery.
Video AssistedThorascopic SurgeryUses small cameras and
instruments to see andoperate inside the bodywithout making largeincisions.
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COMPLICATIONS
Hemorrhage
Injury to phrenic
Recurrent laryngealnerve
Infection
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GODBLESS!!!!!
Thank you=)
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