LUNG CANCER

By: Xyndee Claire A. Sarmiento

OBJECTIVES

 To provide a general overview of lung physiology and penile cancer

 To explore the types and classifications of both lung cancer and penile cancer
 To provide causes and risk factors of both
 To present the signs and symptoms of lung cancer and penile cancer in
throughout its progression
To explore assessment and diagnostic information of both
To discuss treatments and side effects
To explain preventive health strategies regarding lung cancer
To explore the nurses role and nursing interventions for a client with lung cancer
and penile cancer
General Overview of Lung Physiology:
Breathing
Healthy Lung Tissue
 LUNG
CAN CER

According to the latest

WHO data published in 2017
Lung Cancers deaths in
Philippines reached 11,365 or
1.84% of total deaths. The age
adjusted death rate is 16.99 per
100,000 of populations ranks
Philippines #72 in the world.
Lung cancer affects primarily those in the sixth or seventh decade of life;

less than 5% of patients are under the age of 40.

In approximately 70% of lung cancer patients, the disease has spread to

regional lymphatics and other sites by the time of diagnosis.

As a result, the long-term survival rate for lung cancer patients is low.
 Evidence indicates that carcinoma tends to arise at sites of previous
scarring (TB, fibrosis) in the lung.

More than 85% of lung cancers are caused by the inhalation of

carcinogenic chemicals, most commonly cigarette smoke.

PATHOPHYSIOLOGY
Types of Lung Cancer:

Small Cell Lung Cancer (20-25% of all lung cancers)

Non Small Cell Lung Cancer (most common ~80%)

Small Cell Lung Cancer
• Small Cell Lung Cancer is the most aggressive form of lung
cancer.

• It usually starts in the bronchi which is problematic because

post-pneumonia and atelectasis often occur.

• These cancer cells are small and are considered to be quite

aggressive in nature and they have a large growth factor.
• Because of these reasons, at the time of diagnosis, (60% of
the time), these tumors have often metastasize to other parts
of the body (brain, liver, and bone marrow).

• SCLC accounts for 20-25% of all lung cancers.

Non-small Cell Lung Cancer
There are three sub-types of non small cell lung
cancer include:
• 1.Squamous cell carcinomas usually arise centrally in larger
bronchi.

• 2. Adenocarcinoma are often found in the periphery of the lungs.

• 3.Large cell carcinomas can occur in any part of the lung and tend
to grow and spread faster than the other two types.
 Squamous Cell Carcinoma
• Moderate to poor differentiation
• makes up 30-40% of all lung cancers
• more common in males
• most occur centrally in the large bronchi
• Uncommon metastasis that is slow effects the liver, adrenal glands
and lymph nodes.
•Associated with smoking
• Not easily visualized on x-ray (may delay diagnose)
• Most likely presents as a Pancoasts tumor
 Adenocarcinoma
• Increasing in frequency. Most common type of Lung cancer (40-50%
of all lung cancers).
• Clearly defined peripheral lesions (RLL lesion)
• Glandular appearance under a microscope
• Easily seen on a CXR
• Can occur in non-smokers
• Highly metastatic in nature
• Pts present with or develop brain, liver,
adrenal or bone metastasis
 Large Cell Carcinomas

• makes up 15-20% of all lung cancers

• Poorly differentiated cells
• Tends to occur in the outer part (periphery) of lung, invading sub-
segmental bronchi or larger airways
• Metastasis is slow BUT
• Early metastasis occurs to the kidney, liver organs as well as the
adrenal glands
Causes and Risk Factors of Lung Cancer
TOBACCO SMOKE
Lung cancer is 10 times more common in cigarette smokers
than nonsmokers. Risk is determined by the pack-year history (number of
packs of cigarettes used each day, multiplied by the number of years
smoked), the age of initiation of smoking, the depth of inhalation, and the tar
and nicotine levels in the cigarettes smoked.
SECOND-HAND SMOKE
Passive smoking has been identified as a possible cause of lung cancer in
nonsmokers. In other words, people who are involuntarily exposed to tobacco
smoke in a closed environment (home, car, building) are at increased risk for
developing lung cancer as compared to unexposed nonsmokers.
ENVIRONMENTAL AND OCCUPATIONAL EXPOSURE
Various carcinogens have been identified in the atmosphere, including motor vehicle
emissions and pollutants from refineries and manufacturing plants. Evidence suggests that the
incidence of lung cancer is greater in urban areas as a result of the buildup of pollutants and
motor vehicle emissions.

Radon
Radon is gas that is undetectable, fragrance-free, and tasteless radioactive gas that
occurs naturally in soil and rocks. It naturally occurs in can cause damage to the lungs that
may lead to lung cancer. People who work in mines may be exposed to radon and, in some
parts of the country, radon is found in houses. Smoking increases the risk of lung cancer even
more for those already at risk because of exposure to radon. A kit available at most hardware
stores allows homeowners to measure radon levels in their homes.
GENETICS
Some familial predisposition to lung cancer seems apparent, because the incidence
of lung cancer in close relatives of patients with lung cancer appears to be two to three times
that of the general population regardless of smoking status.

• DIETARY FACTORS
Prior research has demonstrated that smokers who eat a diet low in fruits and
vegetables have an increased risk of developing lung cancer (Bast, Kufe, Pollock et al.,
2000). The actual active agents in a diet rich in fruits and vegetables have yet to be
determined. It has been hypothesized that carotenoids, particularly carotene or vitamin A,
may be important. Several ongoing trials may help to determine if carotene supplementation
has anticancer properties. Other nutrients, including vitamin E, selenium, vitamin C, fat, and
retinoids, are also being evaluated regarding their protective role against lung cancer (Bast,
Kufe, Pollock et al., 2000).
Clinical Manifestations
Often, lung cancer develops insidiously and is asymptomatic until late in its course.
 The signs and symptoms depend on the location and size of the tumor, the degree of
obstruction, and the existence of metastases to regional or distant sites.

The most frequent symptom of lung cancer is cough or change in a chronic cough.
The cough starts as a dry, persistent cough, without sputum production.
When obstruction of airways occurs, the cough may become productive due to infection.
Wheezing is noted (occurs when a bronchus becomes partially obstructed by the tumor)
in about 20% of patients with lung cancer.

Patients also may report dyspnea.

 Hemoptysis or blood tinged sputum may be expectorated.
In some patients, a recurring fever occurs as an early symptom in response to a
persistent infection in an area of pneumonitis distal to the tumor.

In fact, cancer of the lung should be suspected in people with repeated unresolved
upper respiratory tract infections.

Chest or shoulder pain may indicate chest wall or pleural involvement by a tumor.
Pain also is a late manifestation and may be related to metastasis to the bone.
If the tumor spreads to adjacent structures and regional lymph nodes,
the patient may present with chest pain and tightness, hoarseness
(involving the recurrent laryngeal nerve), dysphagia, head and neck
edema, and symptoms of pleural or pericardial effusion.

The most common sites of metastases are lymph nodes, bone, brain,
contralateral lung, adrenal glands, and liver.

Nonspecific symptoms of weakness, anorexia, and weight loss also

may be diagnostic.
Early/Late Signs and Symptoms of Lung
Cancer:
DIAGNOSTIC TESTS
• Chest X-ray (CXR)
• CT Scans
• Magnetic imaging resonance
• Sputum cytology
• Transthoracic fine needle aspiration
• Biopsy
• Endoscopy
Bronchoscopy
Mediastinoscopy
VATS (video assisted thoracoscopic surgery)
BRONCHOSCOPY
MEDIASTINOSCOPY
VATS (VIDEO ASSISTED THORACOSCOPIC
SURGERY)
MEDICAL MANAGEMENT
The objective of management is to provide a cure, if possible. Treatment
depends on the cell type, the stage of the disease, and the physiologic
status (particularly cardiac and pulmonary status) of the patient. In general,
treatment may involve surgery, radiationtherapy, or chemotherapy—or a
combination of these.
SURGICAL MANAGEMENT
Surgical resection is the preferred method of treating patients with localized non-
small cell tumors, no evidence of metastatic spread, and adequate cardiopulmonary
function. The cure rate of surgical resection depends on the type and stage of the
cancer. Surgery is primarily used for non-small cell carcinomas because small cell
cancer of the lung grows rapidly and metastasizes early and extensively.
RADIATION THERAPY
It is useful in controlling neoplasms that cannot be surgically resected but
are responsive to radiation. Radiation also may be 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. It can control symptoms of spinal cord
metastasis and superior vena caval compression.
CHEMOTHERAPY
Is 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.
PALLIATIVE THERAPY
Palliative therapy may include radiation therapy to shrink the
tumor to provide pain relief, a variety of bronchoscopic interventions
to open a narrowed bronchus or airway, and pain management and
other comfort measures. Evaluation and referral for hospice care are
important in planning for comfortable and dignified end-of-life care
for the patient and family.
PREVENTION

• Avoid the use of tobacco smoke

• Personal and family health are important risk factors
• Know environmental carcinogens that increase risk
• Aim is to early diagnose high risk populations via screening
• Assists them to retain an optimal level of functioning regardless of their
potential debilitating disease
NURSING MANAGEMENT:

oManaging Symptoms
The nurse instructs the patient and family about the potential side effects of
the specific treatment and strategies to manage them.

oRelieving Breathing Problems

Airway clearance techniques are key to maintaining airway patency through
the removal of excess secretions. This may be accomplished through deep-breathing
exercises, chest physiotherapy, directed cough, suctioning, and in some instances
bronchoscopy. Bronchodilator medications may be prescribed to promote bronchial
dilation.
 Nursing measures focus on decreasing dyspnea by encouraging the patient to
assume positions that promote lung expansion, breathing exercises for lung expansion
and relaxation, and educating the patient on energy conservation and airway clearance
techniques (Connolly & O’Neill, 1999).

oReducing Fatigue
Fatigue is a devastating symptom that affects quality of life in the cancer patient.
It is commonly experienced by the lung cancer patient and may be related to the disease
itself, the cancer treatment and complications (eg, anemia), sleep disturbances, pain and
discomfort, hypoxemia, poor nutrition, or the psychological ramifications of the disease
(eg, anxiety, depression).
 Educating the patient in energy conservation techniques or referring the patient
to a physical therapy, occupational therapy, or pulmonary rehabilitation program may be
helpful.

oProviding Psychological Support

Another important part of the nursing care of the patient with lung cancer
is psychological support and identification of potential resources for the patient
and family. The nurse must help the patient and family with informed decision
making regarding the possible treatment options, methods to maintain the
patient’s quality of life during the course of this disease, and end-of-life
treatment options.
PENILE CANCER
PENILE CANCER
Starts on the skin cells of the penis and can work its way inside.
 a rare type of cancer that most likely to occurs on the glans of penis, or
foreskin.
Penile squamous cell carcinoma most common penile malignancy,
behaves similarly to squamous cell carcinoma in other parts of the skin.
This is a slow-growing cancer in its early stages, and because it seldom
interferes with voiding and erectile function, patients do not complain until
pain or discharge from the cancer occurs.
 RISK FACTOR
• Not being circumcised. • Sexually transmitted
• Human papillomavirus (HPV) diseases.
• More common in men over • Leukoplakia of glans.
age 60 • HIV infection
• Smoking cigarette and • Poor genital hygiene
chewing tobacco
 Staging Of Penile Cancer
Jackson’s staging of carcinoma penis-The commonest method.
Stage I
Tumor involving only glans/prepuce/both. 90% five year survival
Stage II
Tumor extending into body of penis. 70% five year survival.
Stage III
Tumor having mobile inguinal nodes. 50%
Stage IV
Tumor spreading to adjacent structures/fixed nodes. 5%
 Signs and Symptoms
• Changes in thickness or color of skin on the penis.
• A lump on it
• A rash or small “crusty” bumps on it; it can look like an unhealed scab.
• Growths on the penis that look bluish-brown
• Smell discharge underneath the foreskin
• A sore on the penis, which may be bleeding
• Swelling at the end of the penis
• Lumps under the skin in the groin area
DIAGNOSIS
• Physical exam
• Biopsy
• Imaging test (X-rays, CT scans, ultrasounds and magnetic
resonance imaging (MRI)
TREATMENT :

• The aim is complete removal of • Circumcision

the tumor with organ preservation • Surgery (Penectomy)
as much as possible.
• Radiation
• Depends on the stage.
• Chemotherapy
• Cryotherapy
• Moh’s surgery
PREVENTION

Circumcision- neonatal.
HPV vaccination.
Hygiene.
Early management of premalignant conditions.
Early referral
NURSING INTERVENTION

• Psychosocial impact: for men undergo total penectomy, Sexual rehabilitation

Is possible when man is in a strong, supportive and reassuring relationship.
• Patient education:
 SELF EXAM of the penis. Teach patients to recognize characteristic signs
and symptoms of cancer that should be evaluated .
Genital hygiene
• Patient undergoing treatment:
Encourage the patient to get plenty of rest, eat well-balanced diet and
remain active to maintain an optimal level of health.
Teach the patient and his partner, if appropriate, about any prescribed
medications.
Tell the patient to report any illness, including cold, sore throat, or
fever.
Encourage the patient to share concerns and feelings. Open
discussion can help less isolated.
REFERENCES
• Carpenito-Moyet, L.J. (2009). Nursing Diagnosis; Application to clinical practice (13th ed.). Philadelphia, P.A.:
Lippincott Williams & Wilkins
• Cassileth, B., Deng, G., Gomez, J., Johnstone, P., Kumar, N., Vickers, A.
• Day, R.A., Paul, P., Williams, B. Smeltzer, S.C., Bare, B. (2010). Brunner & Suddarth’s Textbook of Canadian
Medical-Surgical Nursing (2nd ed.). Philadelphia, P.A.: Lippincott Williams & Wilkins.
• Otto, S. (2001). Oncology Nursing (4th ed.). St. Louis, Missouri: Mosby Inc.

• http://nursingcrib.com/nursing-notes-reviewer/lung-cancer/
• http://news.bbc.co.uk/2/hi/health/7130216.stm
• http://news.bbc.co.uk/2/hi/health/7130216.stm
• www.cancer.ca
• https://www.webmd.com