Lungs Cancer


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  • Lungs Cancer

    1. 1. LUNG CANCER
    2. 2. WHAT IS IT? <ul><li>LUNG CANCER </li></ul><ul><li>IS THE MALIGNANCY </li></ul><ul><li>IN THE EPITHELIUM OF </li></ul><ul><li>THE RESPIRATORY TRACT </li></ul><ul><li>(Luckmann & Sorennsen 1993) </li></ul>06/07/09
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    4. 4. HOW TO CLASSIFY? <ul><li>Clinically, grouped into 2 divisions </li></ul><ul><li>SMALL CELL LUNG CANCER (Oat Cell) </li></ul><ul><li>NON SMALL CELL LUNG CANCER </li></ul><ul><ul><li>Squamous Cell Epidermoid </li></ul></ul><ul><ul><li>Adenocarcinoma </li></ul></ul><ul><ul><li>Large Cell </li></ul></ul>06/07/09
    5. 5. SMALL CELL LUNG CARCINOMA <ul><li>20-25% of lung cancer </li></ul><ul><li>Rapid growth </li></ul><ul><li>Metastasis to mediastinum,thoracic and extra thoracic structures </li></ul><ul><li>May narrow bronchi (compression) </li></ul><ul><li>Causes hoarseness (paralysis of laryngeal nerve) </li></ul>06/07/09
    6. 6. NON SMALL CELL LUNG CARCINOMA <ul><li>SQUAMOUS CELL/ EPIDERMOID </li></ul><ul><li>30-35% of lung cancer </li></ul><ul><li>Arise from bronchial epithelium </li></ul><ul><li>Cavitation may also occur </li></ul><ul><li>Slow growth, metastasis not common </li></ul><ul><li>Secondary infections distal to obstructive tumor in bronchioles frequently occur </li></ul>06/07/09
    7. 7. NON SMALL CELL LUNG CARCINOMA <ul><li>ADENOCARCINOMA </li></ul><ul><li>25-30% of lung cancer </li></ul><ul><li>Arise from bronchiole mucus gland </li></ul><ul><li>Slow growth, may metastasize </li></ul><ul><li>Rarely cavity </li></ul><ul><li>Strongly linked to cigarette smoking </li></ul><ul><li>Bronchiolo alveolar cell carcinoma is a subtype </li></ul>06/07/09
    8. 8. NON SMALL CELL LUNG CARCINOMA <ul><li>LARGE CELL CARCINOMA </li></ul><ul><li>10-20% of lung cancer </li></ul><ul><li>Cavitation common </li></ul><ul><li>Slow, metastasis may occur to kidney, liver and adrenals </li></ul><ul><li>May be located centrally, mid lung or peripherally </li></ul>06/07/09
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    12. 12. CAUSES AND RISK FACTOR <ul><li>Smoking (heavy smoking?) </li></ul><ul><li>Exposure to secondhand smoke </li></ul><ul><li>Family history of lung cancer </li></ul><ul><li>Exposure to asbestos and other chemicals </li></ul><ul><li>Air pollution (urban vs rural) </li></ul>06/07/09
    13. 13. SIGN AND SYMPTOMS <ul><li>Chronic persistent cough( obstructs airflow) </li></ul><ul><li>Coughing up blood, sputum streaked with blood </li></ul><ul><li>Any change in respiratory pattern </li></ul><ul><li>Weight loss and loss of appetite. </li></ul><ul><li>Difficulty swallowing. </li></ul><ul><li>Swelling in the neck and face. </li></ul><ul><li>Pericardial effusion and temponade </li></ul>06/07/09
    14. 14. SIGN AND SYMPTOMS <ul><li>Chest pain ,shoulder, or back pain that does not go away and often gets worse with deep breathing </li></ul><ul><li>SOB, dyspnea and wheezing </li></ul><ul><li>Repeated bouts of pneumonia or bronchitis </li></ul><ul><li>Hoarseness that lasts more than two weeks </li></ul><ul><li>Increasing fatigue and weakness. </li></ul><ul><li>Clubbing of the fingers and toes </li></ul>06/07/09
    15. 15. SIGN AND SYMPTOMS <ul><li>Horner’s Syndrome (miosis pupil contraction, partial eyelid ptosis, anhidrosis absence of sweating) </li></ul><ul><li>Tumor rib involvement bone pain sympathetic nerve ganglia </li></ul>06/07/09
    16. 16. Diagnosis <ul><li>  </li></ul><ul><li>Chest X-Ray </li></ul><ul><li>Sputum cytology </li></ul><ul><li>CT scan </li></ul><ul><li>MRI scan </li></ul><ul><li>Bronchoscopy </li></ul><ul><li>Lung biopsy /percutaneous needle biopsy/ mediastinoscopy </li></ul>06/07/09
    17. 17. Treatment <ul><li>General health </li></ul><ul><li>Type of lung cancer (small cell or non-small cell) </li></ul><ul><li>Size and position of the tumour </li></ul><ul><li>Stage </li></ul>06/07/09
    18. 18. SURGICAL MANAGEMENT <ul><li>Wedge Resection: Involves the removal of a small localized area of diseased tissue near the surface of the lung. Pulmonary functions & structures remain unchanged. </li></ul><ul><li>Segmental Resection : involves the removal of one or more lung segments (a bronchiole and its alveoli) the remaining lung tissue over expands to fill the space. </li></ul><ul><li>Lobectomy: lobectomy involves removing an entire lobe of one lung. </li></ul>06/07/09
    19. 19. SURGICAL MANAGEMENT <ul><li>Pneumonectomy: an entire lung is removed. </li></ul><ul><li>HOW WOULD THE </li></ul><ul><li>PATIENT BREATHE </li></ul><ul><li>THEN?? </li></ul>06/07/09
    20. 20. <ul><li>Once the lung is removed, the involved side of the thoracic cavity is an empty space. </li></ul><ul><li>In order to reduce the size of this cavity, the phrenic nerve is severed on the affected side to paralyze the diaphragm in an elevated position </li></ul><ul><li>Thoracoplasty may also be performed to further reduce the thoracic space </li></ul>06/07/09
    21. 21. MEDICAL MANAGEMENT <ul><li>Radiation therapy </li></ul><ul><li>Chemotherapy </li></ul>06/07/09
    22. 22. NURSING MANAGEMENT: <ul><li>Assessment: </li></ul><ul><li>Respiratory assessment </li></ul><ul><li>Lab investigations and other diagnostic tests </li></ul><ul><li>Patient’s knowledge and understanding of diagnosis and treatment, </li></ul><ul><li>Patient’s anxiety level and support system, </li></ul><ul><li>Exposure to carcinogen </li></ul>06/07/09
    23. 23. NURSING DIAGNOSIS: <ul><li>Ineffective airway clearance related to increased tracheobroncheal secretion </li></ul><ul><li>Anxiety related to lack of knowledge </li></ul><ul><li>Pain related to the pressure of the tumor </li></ul><ul><li>Altered nutrition less then body requirement related increased metabolic demand and decreased food intake </li></ul><ul><li>Ineffective breathing pattern related to decreased lung capacity </li></ul>06/07/09
    24. 24. NURSING INTERVENTION <ul><li>Monitor S/S of respiratory failure </li></ul><ul><li>Monitor results of chest X-ray examinations, lab values and other investigations </li></ul><ul><li>Administer chemotherapy and other desired medications </li></ul><ul><li>Educate patient with their disease and its progression </li></ul><ul><li>Provide opportunity to the client to ventilate his feelings </li></ul><ul><li>Identify their support system </li></ul><ul><li>Post surgery care </li></ul><ul><li>Care of patients with chest drainage </li></ul>06/07/09
    25. 25. Health promotions/teaching: <ul><li>Abstinence from smoking : </li></ul><ul><li>Determine the cause /factors of smoking and help client abstinence from smoking </li></ul><ul><li>Nicotine therapy or Non nicotine therapy </li></ul><ul><li>Use of nicotine patch, gum, nasal spray, inhaler </li></ul><ul><li>Dealing with urge to smoking </li></ul><ul><li>Counseling/ support group </li></ul><ul><li>Discussion with any Ex smoker </li></ul><ul><li>Avoid Relapse </li></ul><ul><li>Change environment </li></ul>06/07/09
    26. 26. Prevention <ul><li>Stop smoking. </li></ul><ul><li>Avoid secondhand smoke </li></ul><ul><li>Avoid carcinogens at work. Take precautions to protect yourself from exposure to toxic chemicals at work. </li></ul><ul><li>Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. </li></ul><ul><li>Exercise </li></ul>06/07/09
    27. 27. CONCLUSION <ul><li>WHAT U R IS </li></ul><ul><li>HOW DO U </li></ul><ul><li>PERCIEVE </li></ul><ul><li>URSELF </li></ul>06/07/09