Lung Cancer (Bronchogenic Carcinoma)

8/3/2019 Lung Cancer (Bronchogenic Carcinoma)

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JACQUELINE D. DE ASIS, RN, M


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Malignancy in the epithilium of therespiratory tract.The number-one cancer killer among menand women in the United States.


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Small cell carcinoma (oat cell carcinoma)Squamous cell carcinomaAdenocarcinomaLarge cell carcinoma


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Arises from bronchial epitheliumAs growth occurs, cavitation may develop inlung distal to the tumor; pancoasts tumorarises in apex and upper lung zones.Secondary infections distal to obstructivetumor in bronchioles commonly occur.


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Arises from bronchial mucous gland, oftensubpleuralRarely cavitatesOften arises in previously scarred lung tissue.Incidence strongly linked to cigarettesmoking.Increasing incidence in women.

Bronchioalveolar cell carcinoma is a subtype.


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More often peripheral mass.Cavitation is common.May be located centrally, midlung, orperipherally.Rare hilar movement.Often grows to large tumor mass beforediagnosis.


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65-75% manifest as hilar or central mass.May compress bronchi.Involvement of the diaphragm throughparalysis of phrenic nerve and hoarsenessthrough paralysis of recurrent laryngealnerve.Pleural and paricardial effusions andtamponade often seen.Does not form cavities.


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SCLCNSCLC


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Tobacco /cigarette smoke


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Second-hand smoke


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Environmental and Occupational exposure


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Genetics


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Dietary factors


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WARNING SIGNALS OF LUNG CANCERAny change in respiratory patternsPersistent coughSputum streaked with bloodFrank hemoptysisRust-colored or purulent sputumUnexplained weight loss

Fatigue


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Chest, shoulder, back or arm painRecurring episodes of pleural effusion,pneumonia, or bronchitisUnexplained dyspnea


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CENTRALLY LOCATED PULMONARY TUMORSObstructs air flowCoughing, wheezing, stridor, and dyspneaAs obstruction increases, bronchiopulmonaryinfection often occurs distal to theobstruction.Chest, shoulder, arm, and back pain maydevelop as the tumor invades theperivascular nerves.


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SQUAMOUS AND SMALL CELL TUMORSHemoptysisPericardial effusionTamponadeCardiac dysrythmias


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PERIPHERAL PULMONARY TUMORSPleural pain that increases on inspirationPleural effusion-lung expansion is limited


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APICES OF THE LUNGSUsually asymptomatic until it extends intosurrounding structures.Arm and shoulder painAtrophy of the arm and hand musclesBone painHorners syndrome (MIOSIS, PTOSIS,

ANHIDROSIS)


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Chest x-rayCT Scans/MRI/SPECTSputum cytologyFiberoptic bronchoscopyTransthoracic fine-needle aspiration


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FOR METASTASIS:abdominal scans, positron emissiontomography (PET) scans, or liverultrasound or scans.CT of the brain, magnetic resonanceimaging (MRI), and other neurologicdiagnostic procedures .

Mediastinoscopy or mediastinotomy


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Direct extensions to the laryngeal nerveproduces hoarseness.Compression of the esophagus may causedysphagia.

Invasion or compression of the superior venacava produces superior vena cava syndrome.Obstruction of the venous blood flow leads toSOB, facial, arm, trunk swelling, distendedneck veins, chest pain, and venous stasis.


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Regional lymph node involvement mayproduce manifestations caused by impairedlymph 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 pleuraleffusion.


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Stage IA-T1NOMOTumor is 3 cm or less in diameterNo metastases to regional lymph nodesNo distant metastases


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Stae IB-T2N0MOTumor is greater than 3cm in diameter or isany size that either invades the visceralpleura

Has associated atelectasis or obstructivepneumonitis extending to the hilar regionNo metastases to lymph nodes or distantmetastasis


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Stage IIA-TINIMOTumor is 3 cm or less in diameterWith metastasis to the lymph nodes in theperibronchial or ipsilateral hilar region, or

bothWithout distant metastasis


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Stage IIB-T2N1MOTumor is greater than 3 cm or is any size thateither invades the visceral pleura or hasassociated atelectasis or obstructive

pneumonitis extending to the hilar region.With metastasis to lymph nodes in theperibronchial or ipsilateral hilar region, orboth.

Without distant metastasis


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Stage IIIA-T2N2MOTumor is greater than 3 cm in diameter or isany size that either invades the visceralpleura or has associated atelectasis or

obstructive pneumonitis extending to thehilar regionWith metastasis to ipsilateral mediastinal orsubcarinal nodes.

Without distant metastasis


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RADIATION THERAPY/RADIOTHERAPYCHEMOTHERAPYSURGERYPALLIATIVE THERAPY


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Indicated for patients with locally advanceddisease: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 orchemotherapy.


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Used to reduce the size of a tumor, tomake an inoperable tumor operable, or torelieve the pressure of the tumor on vitalstructures.


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Is administered over a period of 5 to 6 weeks,either consecutively or in split courses.It can control symptoms of spinal cordmetastasis and superior vena cavalcompression.

Prophylactic brain irradiation is used incertain patients to treat microscopicmetastases to the brain.Radiation may help relieve cough, chestpain, dyspnea, hemoptysis, and bone and

liver pain.


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Used to alter tumor growth patterns, totreat patients with distant metastases orsmall cell cancer of the lung, and as anadjunct to surgery or radiation therapy.

Combinations of two or more medicationsmay be more beneficial than single-doseregimens.

May provide relief, especially of pain


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Response to chemotherapy depends on thetumors cell type. The effectiveness of chemotherapy in thetreatment of NSCLC remains controversial.


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Surgical resection is the preferred methodof treating patients with:1. Localized non-small cell tumors2. No evidence of metastatic spread3. Adequate cardiopulmonary function.


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Surgery is primarily used for non-smallcell carcinomas.The role of surgical resection in thetreatment of SCLC is limited.PRIMARY AIM: to remove the tumorcompletely while preserving as much of the normal surrounding lung tissue aspossible.


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LobectomyBilobecotmySleeve resectionPneumonectomySegmentectomyWedge resectionChest wall resection with removal of cancerous lung tissue


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May include:1. radiation therapy to shrink the tumor to

provide pain relief 2. variety of bronchoscopic interventions

to open a narrowed bronchus or airway3. pain management4. comfort measures.


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RADIATION THERAPYdiminished cardiopulmonary functionpulmonary fibrosispericarditismyelitiscor pulmonale


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CHEMOTHERAPYPneumonitisPulmonary toxicity


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SURGICAL RESECTIONRespiratory failureSurgical complicationsProlonged mechanical ventilation


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Managing Symptoms

The nurse instructs the patient and familyabout the potential side effects of thespecific treatment and strategies to manage

them.Strategies for managing such symptoms asdyspnea, fatigue, nausea and vomiting, andanorexia will assist the patient and family to

cope with the therapeutic measures.


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Relieving breathing problemsDeep-breathing exercisesChest physiotherapyDirected cough

SuctioningBronchoscopyBronchodilator medicationsSupplemental oxygen

Decrease dyspnea


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Lung Cancer (Bronchogenic Carcinoma)