CHEST TUMORS

ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM

LUNG CANCER (BRONCHOGENIC CARCINOMA)

Leading cancer killer Cancer that forms in tissues of lung, usually in the cells lining air passages.

Pathophysiology
LUNG CANCER CANCER FACTS HOW DOES LUNG CANCER DEVELOP

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 cancer

a. Squamous cell cancer b. Large cell carcinoma c. Adenocarcinoma d. Bronchoalveolar cell cancer

CLASSIFICATIONS AND STAGING

Small Cell Lung Cancer

Is decease in which malignant cancer cells form in the tissues of the lung. Most malignant form of lung cancer arises from the bronchi Hypersecretes antidiuretic hormone leading hyponatremia. Metastesis is early hrough the bloodsteam and lynphatics to the mediastinum, liver, bone, bone marrow, CNS, adrenal glands, pancreas and other endocrine organ.

Combined small cell carcinoma

Small cell Carcinoma

NON SMALL CELL LUNG CANCER

is a disease in which malignant cancer cells form in the tissues of the lung tissue grow uncontrollably and form tumors.

a. Squamous cell cancer centrally located and arises more commonly in the segmental and sub segmental bronchi. b. Large cell carcinoma (undifferentiated carcinoma) fast growing tumor that tends to arise peripherally.

c.

Adenocarcinoma cancer that begins in the cell that line the alveoli and make substance such as muchs

d. Bronchoalveolar cell cancer is found in the terminal bronchi and alveoli and usually slow growing.

STAGES OF NON SMALL CELL LUNG CANCER

Occult Stage cancer cells are found in a sample of a patients coughed up sputum but no cancer cells have yet been detected in the lungs. Stage O are noninvasive cancers and only a few layers of cancer cells are detected within one local area. Stage I the cancer cell has reached higher layers of the lung but has not spread into the lymph nodes or beyond the lung

Stage II cancer cells have spread to nearby lymph nodes Stage III - cancers cells have spread beyond the lung to the chest wall, diaphragm, or further lymph nodes. Stage IV cancer has spread (metastasized) to other parts of the body.

RISK FACTORS
Tobacco Smoke Second hand smoke Environmental and occupational exposure Genetics Dietary factors

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

! Nursing Alert
A cough that changes in character should arouse suspicion of lung cancer.

ASSESSMENT AND DIAGNOSTIC FINDINGS

Chest

X-ray

scan of the chest

 Sputum

Cytology

Fiberoptic

bronchoscopy

Endoscope with esophageal ultrasound

Positron Emission Tomographs Scan (PET)

Magnetic Resonance Imaging (MRI)

Mediatinoscopy / Mediastinotomy

MEDICAL MANAGEMENT

Surgical Resection preferred method of treating patients with localized non-small cell tumors. Radiation Therapy useful in controlling neoplasm that cannot be surgically resected. Chemotherapy used to alter tumor growth patterns, to treat distant metastases or small cell cancer of the lung. Palliative Therapy - to shrink the tumor to provide pain relief, a variety of bronchoscopic interventions and pain management and comfort measures.

TYPES OF LUNG RESECTION

Lobectomy: a single lobe of lung is removed. Bilobectomy: two lobes of the lung are removed. Sleeve Resection: Cancerous lobe(s) is removed 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, pieshaped area of the segment. Chest Wall Resection with Removal of Cancerous Lung Tissue: for cancers that have invaded the chest wall.

TREATMENT AND RELATED COMPLICATIONS

Respiratory failure Diminished cardiopulmonary function Pulmonary fibrosis Myelitis Cor pulmonale Pneumonitis Pulmonary toxicity

NURSING MANAGEMENT
Managing Symptoms Relieving Breathing Problems Reducing Fatigue Providing Psychological support

GERONTOLOGICAL CONSIDERATIONS

Issues that must be considered in care of elderly patient with lung cancer include functional status, comorbid conditions, nutritional status, cognition, concomitant medications, psychological and social support.

TUMORS OF MEDIASTINUM

Result from pressure of mass against important intrathoracic organs is a growth in the central chest cavity, which separate the lungs and contains the heart, aorta, esophagus, thymus and trachea

CLINICAL MANIFESTATION
Cough Wheezing Dyspnea Anterior chest or neck pain Bulging of the chest wall Heart palpitations Angina

CIRCULATORY DISTURBANCES
Central cyanosis Superior vena cava syndrome Marked distension of veins of neck and chest wall Dysphagia Weight loss

ASSESSMENT AND DIAGNOSIS FINDINGS

Chest X-rays CT Scan MRI PET

MEDICAL AND SURGICAL MANAGEMENT

Median Sternomy is a type of surgical procedure in which vertical line incision is made along the sternum Thoracotomy is a open surgical procedure where all or part of the lung is removed.

Bilateral Anterior Thoracotomy (Clamshell incision) Largest incision commonly used in thorasic surgery. Video Assisted Thorascopic Surgery Uses small cameras and instruments to see and operate inside the body without making large incisions.

COMPLICATIONS
Hemorrhage Injury to phrenic Recurrent laryngeal nerve Infection

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GODBLESS!!!!!