Lung cancer is the leading cause of cancer death worldwide. There are two main types: small cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer accounts for about 80% of cases and includes adenocarcinoma, squamous cell carcinoma, and large cell carcinomas. Risk factors include smoking, radon exposure, and air pollution. Symptoms often do not appear until later stages and include coughing, shortness of breath, and weight loss. Diagnosis involves imaging tests and biopsy. Treatment may include surgery, chemotherapy, and radiation. Nursing care focuses on airway management, pain management, education, and preventing complications.

1. LUNG CANCER
By: ROMMEL LUIS C. ISRAEL III

2. What is lung cancer?
Lung cancer occurs when
cells in the tissue of one or
both lungs grow abnormally.
The abnormal cells form
growths called cancers.
Australia government Report to the Nation - Lung Cancer 2011（P.2）
Most common cancer in the
world
Leading cause of cancer
death in men and women in
the US
Also called Bronchogenic
Carcinoma
National Institute Of Health (n.d.). Medline Plus. Retrieved March 16, 2014, from ttp://www.nlm.nih.gov/medlineplus/lungcancer.html

3. Classification/Types
• Based upon the microscopic appearance of the tumor
cells
1. Small Cell Lung Cancers (SCLC)
- About 20% of lung cancers
- Most aggressive and rapidly growing
- Strongly related to smoking (1% occuring in non-
smokers only)
- Metastasize rapidly to many sites of the body
(most often discovered after they have spread
extensively)
Reference: WebMD. Retrieved March 16, 2014, from http://www.webmd.com/lung-cancer/guide/lung-cancer-types

4. Classification/Types
2. Non-Small Cell Lung Cancers (NSCLC)
- Most common type of lung cancer (about 80% of all cases)
- 3 Main Types:
a. Adenocarcinoma
- most common;
- associated with smoking though can be seen in non-
smokers also
- most arise in the outer or peripheral areas of the
lungs;
- tendency to spread through the lymph nodes and
beyond;
- Bronchioalveolar Carcinoma, a subtype of
adenocarcinoma, develops at multiple sites in the
lungs and it may look like Pneumonia on a Chest x-
ray)
Reference: WebMD. Retrieved March 16, 2014, from http://www.webmd.com/lung-cancer/guide/lung-cancer-types

5. Classification/Types 1
b. Squamous Cell Carcinoma
- also known as epidermoid carcinoma;
- arises most frequently in the central chest
area in the bronchi
- most often stays within the lung, spreads
to lymph nodes, grows quite large forming a cavity
c. Large Cell Carcinomas
- sometimes referred to as undifferentiated carcinoma
- least common
- has high tendency to spread to the lymph nodes and
distant sites
* Mixtures of different types of NSCLC are also seen
Reference: WebMD. Retrieved March 16, 2014, from http://www.webmd.com/lung-cancer/guide/lung-cancer-types

6. Other Type:
1. Bronchial carcinoids
- 5%-10% of lung cancers
- These tumors are generally small (3-4 cm or less) when
diagnosed
- occur most commonly in persons under 40 years of age
- not related to cigarette smoking
- carcinoid tumors can metastasize, generally grow and spread
more slowly
- many are detected early enough to be surgically removed.
2. Cancers of supporting lung tissue such as smooth muscle, blood
vessels, or cells involved in the immune response can rarely
occur in the lung.
Reference: WebMD. Retrieved March 16, 2014, from http://www.webmd.com/lung-cancer/guide/understanding-lung-cancer-basics
Classification/Types

7. Signs and Symptoms
• Early stage – usually has no symptoms
• Coughing
• Respiratory infections
• Shortness of Breath (increasing, wheezing, persistent Chest Pain)
• Hoarseness
• Swelling of the neck and face
• Pain and weakness in the shoulder, arm or hand
• Fatigue/Weakness
• Loss of Appetite and weight
• Intermittent fever
• Severe headaches/ Body Pain
• Difficulty of swallowing
Reference: WebMD. Retrieved March 16, 2014, from http://www.webmd.com/lung-cancer/guide/understanding-lung-cancer-symptoms

8. Risk factorsLifestyle factors
• Tobacco smoking
90% of lung cancer in males
65% of lung cancer in females
• Passive smoking
• Radon exposure
• Occupational exposure(carcinogens, asbestos,
radiation, diesel exhaust fumes )
• Air pollution
Biomedical factors
• Family history of lung cancer
• Previous lung diseases
Lung fibrosis, chronic bronchitis, emphysema and
pulmonary tuberculosis Australia government Report to the Nation - Lung Cancer 2011（P.2-3）
Image:Australia government,http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/content/warnings-b-lung

9. Tests to diagnose
Imaging tests
Chest X-ray
CT scan
Sputum cytology
Tissue sample (biopsy)
Bronchoscopy
Mediastinoscopy
Needle biopsy
Mayo clinic,Diseases and Conditions,lung cancer, http://www.mayoclinic.org/diseases-conditions/lung-cancer/basics/tests-diagnosis/con-20025531
Images:Taiho pharmaceutical company HP,http://www.taiho.co.jp/kenko/sign/lung/index.html

10. Treatment
1. Surgery
2. Chemotherapy
- A systemic treatment, enters the blood stream, kills
cancer cells both inside and outside the lung area
- Some side effects: Nausea and vomiting, Hair loss for
some, may be combined with surgery
3. Radiation
- Some side effects: skin changes, fatigue and trouble
swallowing
4. Pain Medication
WebMD. Retrieved March 16, 2014, from http://www.webmd.com/lung-cancer/guide/consumer-guide-chapter-outline
Image:http://www.redorbit.com/news/health/1112507697/more-fake-cancer-drugs-make-their-way-to-america/

11. Nursing Care
• Maintain/improve respiratory function.
• Control/alleviate pain.
• Support efforts to cope with diagnosis/situation.
• Provide information about disease process/prognosis and therapeutic
regimen.
Discharge Goals:
• Oxygenation/ventilation adequate to meet individual activity needs.
• Pain controlled.
• Anxiety/fear decreased to manageable level.
• Free of preventable complications.
• Disease process/prognosis and planned therapies understood.
• Plan in place to meet needs after discharge.
Nursing Care Plan. Retrieved March 16, 2014, from http://nursingcareplan-s.blogspot.com.au/2012/09/nursing-care-plan-for-lung-cancer.html
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12. 1. Note respiratory rate, depth, and ease of respirations. Observe for
use of accessory muscles, pursed-lip breathing, changes in
skin/mucous membrane color, e.g., pallor, cyanosis.
Rationale: Respirations may be increased as a result of pain or as an initial
compensatory mechanism to accommodate for loss of lung tissue; however,
increased work of breathing and cyanosis may indicate increasing oxygen
consumption and energy expenditures and/or reduced respiratory reserve,
e.g., elderly patient
2.Auscultate lungs for air movement and abnormal breath sounds.
Rationale: Consolidation and lack of air movement on operative side are
normal in the pneumonectomy patient; however, the lobectomy patient
should demonstrate normal airflow in remaining lobes.
Post-Operative Nursing Care
Nursing Care Plan. Retrieved March 16, 2014, from http://nursingcareplan-s.blogspot.com.au/2012/09/nursing-care-plan-for-lung-cancer.html
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13. 3. Investigate restlessness and changes in mentation/level of consciousness.
Rationale: May indicate increased hypoxia
4. Assess patient response to activity. Encourage rest periods/limit activities to patient
tolerance.
Rationale: Increased oxygen consumption/demand and stress of surgery can result in
increased dyspnea and changes in vital signs with activity; however, early mobilization is
desired to help prevent pulmonary complications and to obtain and maintain respiratory
and circulatory efficiency. Adequate rest balanced with activity can prevent respiratory
compromise.
5.Note development of fever.
Rationale: Fever within the first 24 hr after surgery is frequently due to atelectasis.
Fever within the 5th to 10th postoperative day usually indicates an infection, e.g., wound
or systemic.
Nursing Care Plan. Retrieved March 16, 2014, from http://nursingcareplan-s.blogspot.com.au/2012/09/nursing-care-plan-for-lung-cancer.html
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14. 1. Maintain patent airway by positioning, suctioning, use
of airway adjuncts.
Rationale: Airway obstruction impedes ventilation,
impairing gas exchange.
2. Reposition frequently, placing patient in sitting positions
and supine to side positions.
Rationale: Maximizes lung expansion and drainage of
secretions.
Nursing Care: AIRWAY MANAGEMENT
Nursing Care Plan. Retrieved March 16, 2014, from http://nursingcareplan-s.blogspot.com.au/2012/09/nursing-care-plan-for-lung-cancer.html
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15. 3. Avoid positioning patient with a pneumonectomy on the operative
side; instead, favor the “good lung down” position.
Rationale: Research shows that positioning patients following lung
surgery with their “good lung down” maximizes oxygenation
by using gravity to enhance blood flow to the healthy lung,
thus creating the best possible match between ventilation
and perfusion.
4. Encourage/assist with deep-breathing exercises and pursed-lip
breathing as appropriate.
Rationale: Promotes maximal ventilation and oxygenation and
reduces/prevents atelectasis
Nursing Care: AIRWAY MANAGEMENT
Nursing Care Plan. Retrieved March 16, 2014, from http://nursingcareplan-s.blogspot.com.au/2012/09/nursing-care-plan-for-lung-cancer.html
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16. 1. Maintain patency of chest drainage system for lobectomy,
segmental/wedge resection patient.
Rationale: Drains fluid from pleural cavity to promote re-expansion of
remaining lung segments.
2. Note changes in amount/type of chest tube drainage.
Rationale: Bloody drainage should decrease in amount and change to
a more serous composition as recovery progresses. A sudden
increase in amount of bloody drainage or return to frank
bleeding suggests thoracic bleeding/hemothorax; sudden
cessation suggests blockage of tube, requiring further
evaluation and intervention.
Nursing Care: TUBE CARE
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17. 3. Observe presence/degree of bubbling in water-seal chamber.
Rationale: Air leaks immediately postoperative are not uncommon,
especially following lobectomy or segmental resection;
however, this should diminish as healing progresses.
Prolonged or new leaks require evaluation to identify
problems in patient versus the drainage system.
Nursing Care: TUBE CARE
Nursing Care Plan. Retrieved March 16, 2014, from http://nursingcareplan-s.blogspot.com.au/2012/09/nursing-care-plan-for-lung-cancer.html
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