Lung Cancer

OVERVIEW

 Lung cancer is one of the leading cause of cancer-related death

worldwide.
 Overall incidence of lung cancer is:
 Most common cause of cancer death in men and women
 Declining for men since 1980s
 Declining for women since mid-2000s (reversal of increasing
trend since 1980s)
 Second highest cancer incidence in both sexes after prostate
(males) and breast (females) cancers.
OVERVIEW

 Lung cancer has a poor prognosis

 Small-cell lung carcinoma (SCLC, 15% of all lung cancer)
 Non-small-cell lung carcinoma (NSCLC, 85%) are the two
major forms of lung cancer.
 squamous-cell carcinoma
 Adenocarcinoma
 large-cell carcinoma.
TYPES OF LUNG CANCER
TYPES OF LUNG CANCER
OVERVIEW

 Smoking is the single most important risk

factor for lung cancer, which can cause all
types of lung cancer but is more strongly
linked with SCLC and squamous-cell
carcinoma
Etiology and Risk Factors

 Cigarette smoking
 Cigarette smoking is the leading cause of lung cancer,
accounting for about 85% of lung cancers. Risk for lung
cancer increases with the duration, intensity and depth of
smoke inhalation.
 Second-hand (passive) smoking also causes lung cancer,
but is less strongly associated compared to active
smoking.
 Cigarettes contain multiple carcinogens (more than 60)
that have been shown to induce cancers in laboratory
settings.
Etiology and Risk Factors

 Never smokers
Defined as people who smoked fewer than
100 cigarettes in their lifetime.
Accounts for 25% of lung cancers
worldwide and is seen as a distinct lung
cancer type.
Associated with: female cases
Etiology and Risk Factors

 Environmental exposure
 A number of environmental risk factors have
been identified, most of which relates to
occupational exposures such as asbestos, tar,
soot, and a number of metals such as arsenic,
chromium, and nickel.
 Air pollution has also been linked to increased
risk of lung cancer.
Etiology and Risk Factors

 Genetics
 There is an increased risk of lung cancer among
first-degree relatives, indicating a genetic
susceptibility
Etiology and Risk Factors

 Precursor lesions
 Squamous dysplasia and carcinoma: precursor lesion
for squamous-cell carcinoma.
 Adenomatous hyperplasia: precursor lesion for
bronchioalveolar carcinoma, a form of adenocarcinoma.
 Idiopathicpulmonary neuroendocrine cell hyperplasia:
precursor for pulmonary carcinoids.
 Precursor lesion for SCLC is unknown.
Diagnostic Tests

 Chest X-ray
 CT scan
 PET-CT scan
 Bronchoscopy and biops
 remove a small sample of cells from inside the
lungs.
Diagnostic tests

 Othertypes of biopsy
Percutaneous needle biopsy
Thoracoscopy
Mediastinoscopy
https://www.webmd.com/lung-cancer/ss/slideshow-
 https://www.vectorstock.com/royalty-free-vector/man-with-lung-cancer-
symptoms-vector-16300366
SUPERIOR VENA CAVA SYNDROME
SUPERIOR VENA CAVA SYNDROME
STAGES OF LUNG CANCER
Stages of Lung Cancer
TNM staging
 Stage 1
(bet 2-5 cm) and no lymph nodes are involved, no metastasis
 Stage 2
(bet 2-7 cm) adjacent lymph nodes is involve and no metastasis
 Stage 3
small or larger, the adjacent lymph nodes and lymph nodes on the other
side of the chest, above collar bone, or in the neck are involved. No
metastasis.
 Stage 4
any size tumor and any amount of lymph node involvement. The main
determinant of stage 4 is the presence of metastases elsewhere in the body.
FIVE YEAR SURVIVAL RATE

NSCLC SCLC

 1A 49%  1 31%
 1B 45%  2 19%
 2A 30%  3 8%
 2B 31%  4 2%
 3A 14%
 3B 5%
 4 1%
Nursing Diagnoses

• Impaired gas exchange related to altered

oxygen supply
• Ineffective airway clearance related to
restriction to chest movement
• Fear/Anxiety related to threat/ change in
health status
Nursing Management
• Advise the patient to eat a class of nutritious food such as
brocolli, cauliflower , cabbage and watercress
• SURGERY
Pain management is essential to facilitate early mobility
and recovery.
Provide emotional support for patient and family.
• RADIATION THERAPY
Promoting comfort and well –being by integrate an
anticipatory and ongoing approach to symptom assesment,
intervention and evaluation.
Nursing Management

FOR OLDER ADULTS

 Nurses act as advocates and educators
with elderly patients and families, giving
realistic view of what the treatment , side
effects, and ongoing care requirements
will entail.
Nursing Management

 Management of nausea and vomiting, weakness, fatigue,

weight loss and appetite loss
 Elevate HOB
 Splinting to aid in coughing
 Each breathing exercises to increase diaphragmatic
excursion.
 Teach the patient about the relaxation technique to
decrease anxiety.
 Encourage energy conservation.
Management
 Smoking cessation
 Three main interventions exist in addition to
counselling and support:
Nicotine replacement therapy (NRT): can be
purchased in many forms including gum and
transdermal patch; all forms increases rate of
quitting by 50-70%.
Antidepressants: bupropion and nortriptyline
are as effective as NRT; (SSRI) are not
effective.
Nicotine receptor partial agonist: varenicline
Management
 Surgery
 First
line of choice for NSCLC who are medically fit to
undergo surgery.
 Wedge resection (segmental resection) - A wedge
resection for lung cancer involves removing a portion of
the lung that includes the tumor and some surrounding
tissue. This surgery is used when a tumor is caught
very early.
 Lobectomy - A lobectomy is the most common surgery
used to treat lung cancer, and involves removing a lobe
of the lung.
 Pneumonectomy - A pneumonectomy involves removal
of an entire lung.
Management
 Radiation therapy
 Indicated for patients with stage I, II, III NSCLC.
 Also used in combination with surgery for NSCLC and
with chemotherapy for SCLC.
 Radiation Techniques for Lung Cancer
 External beam radiation (external beam)
 Intensity Modulated Radiation Therapy (IMRT)
 Brachytherapy (internal or implant radiation therapy)
 StereotacticBody Radiation Therapy (SBRT) /
Stereotactic Ablative Radiotherapy (SABR)
 Stereotactic Radiosurgery (SRS)
Radiation therapy
Radiation Therapy
Radiation Therapy
Management

 Chemotherapy
 Firstline of treatment for SCLC, which are often
disseminated upon clinical presentation.
 Also indicated for patients with more advanced
stage of NSCLC (to improve survival, disease
control or for palliative care).
 First
line therapy for NSCLC with EGFR
mutations involves targeted therapies.
Management
 Small cell lung cancer
 combination of chemotherapy drugs, including either
cisplatin or carboplatin. Combinations include:
 EP (cisplatin and etoposide)
 carboplatin and etoposide
 Gemcarbo (gemcitabine and carboplatin)
 Small cell lung cancer usually responds well to these
treatments. But researchers are continuing to test other
combinations to see if they can either improve the results,
lessen the side effects, or both.
Management

 Non small cell lung cancer

 Vinorelbine
 Gemcitabine
 Paclitaxel (Taxol)
 Docetaxel (Taxotere)
 Etoposide
 Pemetrexed
Management
 Biotherapy/Immunotherapy
 Targeted therapy drugs used for lung cancer
include:
 Gefitinib (Iressa®).
 Afatanib (Giotrif®).
 Erlotinib (Tarceva®)
 Osimertinib (Tagrisso®)
 Crizotinib (Xalkori®)
 Ceritinib (Zykadia®)
 Nintedanib (Vargatef®)
Management
 Palliative care
 Palliative care aims to improve the quality of life
and reduce suffering for patients rather than to
prolong life.
 Studies have shown that early palliative care
actually prolongs life in lung cancer patients (by
2.7 months in a study with metastatic NSCLC
patients). It also reduces patient suffering,
healthcare costs, unnecessary treatment, and
impart greater patient and family satisfaction