LUNG CANCER

LUNG CANCER

1. LUNG CANCER

2. Lung cancer The term lung cancer is used for tumors arising from the respiratory epithelium (bronchi, bronchioles, and alveoli).

3. Most common cause of cancer death in men in world Fourth most common cancer reported in india More deaths by lung cancer than the next four most common cancers combined (Colorectal, Breast, Prostate, & Pancreas

4. ETIOLOGY Risk Factors Gender Smoking history Older age Presence of airflow obstruction Genetic predisposition Occupational exposures

5. SMOKING It is estimated that cigarette smoking is responsible for approximately 85 to 90% of all cases of lung cancer , More than 40 carcinogens have been identified in cigarette smoke Lung cancer is 10 times more common in cigarette smokers than nonsmokers.

6. The risk for development of lung cancer correlates with: the number of cigarettes smoked per day lifetime duration of smoking, age at onset of smoking, tar and nicotine content of the cigarettes degree of inhalation, use of unfiltered cigarettes

7. LUNG CANCER (2007 American Cancer Society Data) Tobacco Percent active 85-87 passive 3-5 Etiology Relationship to Smoking

8. SECOND-HAND SMOKE Passive smoking has been identified as a possible cause of lung cancer in nonsmokers R isk of lung cancer by about 35%

9. ENVIRONMENTAL AND OCCUPATIONAL EXPOSURE Chronic exposure to industrial carcinogens, such as arsenic asbestos, mustard gas nickel , and radiation, has been associated with the development of lung cancer

10. Preexisting Lung Disease Tobacco smoking causes chronic inflammation and destruction of lung tissue, which results in chronic obstructive pulmonary disease (COPD). patients in whom idiopathic pulmonary fibrosis or pulmonary fibrosis from asbestosis or silica develops are at increased risk for the development of lung cancer

11. Dietary Factors Increased consumption of fruits and green and yellow vegetables is associated with a reduced risk for lung cancer low serum concentrations of antioxidant vitamins such as vitamins A and E are associated with the development of lung cancer.

12. Inheritance First-degree relatives of patients with lung cancer have a two- to six-fold increase in the risk for lung cancer after adjusting for tobacco use. Second-degree relatives of lung cancer patients have a relative risk

13. Types of Lung Cancer Two main Types of Lung Cancer : Small Cell Lung Cancer ( 20-25% of all lung cancers) Non Small Cell Lung Cance r (most common ~80%)

14. Non-Small Cell Lung Cancer(NSCLC) 1. Squamous cell carcinoma 2. Adenocarcinoma 3. Large cell carcinomas

15. Squamous cell carcinoma Slow growing makes up 20-30% 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 xray (may delay dx)

16. Adenocarcinoma Most common type of Lung cancer (30-40% of all lung cancers) Common In non smokers Clearly defined peripheral lesions (RLL lesion) Easily seen on a CXR Highly metastatic in nature Pts present with or develop brain, liver, adrenal or bone metastasis

17. Large cell carcinomas makes up 15-20% of all lung cancers Poorly differentiated cells T ends 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

18. Small Cell Lung Cancer most aggressive form of lung cancer Accounts 20% of lung cancer Because of aggressive nature, at the time of diagnosis these tumors have often metastasize to other parts of the body (brain, liver, and bone marrow

19. Pathophysiology

20. CLINICAL MANIFESTATIONS cough - 45 % of cases it is nonspecific and also common in patients who smoke and have COPD Hemoptysis -30 % of patients Because of bleeding caused by malignancy Dyspnea -30 to 50% of patients Wheezing is uncommon as an initial symptom in lung cancer and may signify major airway obstruction

21. Chest pain- 25 % of patients, may be dull in nature, but chest pain that is severe and persists may be due to chest wall involvement

22. M etastasis Intrathoracic Spread Dysphagia Hoarseness dyspnea and hiccups superior vena cava ( SVC) as a result of compression or direct invasion by the tumor itself or by enlarged mediastinal lymph nodes

23. Brain metastasis headaache , seizures, papilledema, vomiting Endocrine Paraneoplastic Syndrome It is caused by excretion of hormones and cytokines by the tumour cells or by immune response against the tumour it is manifested by hypercalcemia , SIADH, Adrenal hypersecretion ,

24. DIAGNOSIS History and physical examination CHEST X-RAY initial diagnostic test identify a lung mass or infiltrate evidence of metastasis to adjesent structures CT SCAN small lesion, lesion behind of cardiac or blood vessel Lymph node enlargement location and extent of mass

25. Bronchoscopy Bronchoscope may verify the existence of tumor , of Central type, and cytologic diagnosis of lung cancer should be obtained though FBC bronchial washings bronchoalveolar lavage fluid

26. fine-needle aspiration cytology (FNAC) L esions not amenable to bronchoscopy this procedure may be performed under CT or fluoroscopic guidance to aspirate cells from a suspicious area

27. S putum cytology Cytologic examination of sputum may reveal exfoliated malignant cells recognizable to the pathologist who is specially trained for such work . The sputum must to be fresh, send on time, repeat(4-6 times)..

28. Staging T = tumor size N = node involvement M = metastasis status

29. Management The objective of management is to provide a cure if possible Treatment depends on the cell type the stage of the disease physiologic status of the patient

30. SURGICAL MANAGEMENT Surgical resection is the preferred method of treating patients W ith localized non-small cell tumors, N o evidence of metastatic spread, adequate cardiopulmonary function

31. TYPES 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 Segmentectomy : a segment of the lung is removed

32. Wedge resection : removal of a small, pie-shaped area of the segment Pneumonectomy : removal of entire lung

33. RADIATION THERAPY Radiation therapy may cure a small percentage of patients It is useful in controlling neoplasms that cannot be surgically resected but are responsive to radiation

34. CHEMOTHERAPY Chemotherapy is used to alter tumor growth patterns to treat patients with distant metastases small cell cancer of the lung as an adjunct to surgery or radiation therapy Eg - alkylating agents (cyclophosphamide) platinum analogues ( cisplatin and carboplatin ), taxanes (paclitaxel, docetaxel ) vinca alkaloids (vinblastine and vindesine ), doxorubicin, etoposide

35. PALLIATIVE THERAPY Palliative therapy may include radiation therapy to shrink the tumor to provide pain relief Potent analgesics Symptomatic management

36. Nursing Diagnoses Ineffective breathing pattern r/t loss of lung parenchyma /adequate ventilation Impaired gas exchange r/t excessive or thick secretions ,decreased passage of gases between alveoli of lungs and vascular system Chronic pain related to Stage IV NSCLC diagnosis as evidenced by client reporting “pain in right chest and lower ribs”. Risk of infection related to altered immune system secondary to effects of cytotoxic drugs.

37. Risk for disturbed self concept related to changes in lifestyle. Nausea related to effects of chemotherapy as evidenced by client reporting feeling nauseated. Risk for deficient fluid volume related to gastrointestinal fluid loss secondary to vomiting. Fatigue related to chemotherapy secondary to stage IV NSCLC as evidenced by client reporting he “ no longer has the energy to play with his grandchildren or visit his friends”.

38. interventions MANAGING SYMPTOMS RELIEVING BREATHING PROBLEMS REDUCING FATIGUE PROVIDING PSYCHOLOGICAL SUPPORT