The document provides a comprehensive overview of lung tumors, differentiating between benign and malignant types, along with their prevalence, causes, symptoms, diagnosis, and treatment options. It elaborates on various types of benign lung tumors, including hamartomas and bronchial adenomas, and discusses lung cancer's etiology, clinical features, staging, and treatment approaches, emphasizing the significant role of smoking. Diagnostic methods and tumor management strategies are also covered, highlighting the complexity involved in lung cancer prognosis and treatment.

1. Lung cancer
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2. Outlines of seminar
•Introduction of benign lung tumour
•Introduction of carcinoma of lungs
•Etiology
•Clinical features
•Diagnostic investigations
•Staging
•Management
•Nursing management
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3. Benign Lung Tumors
• Benign growths are not necessarily harmless, even though
this is implied by the name.
• Unlikely to spread, but they can become cancerous and
they can also impair lung function.
• Benign tumours of the lung are uncommon and account for
fewer than 15% of solitary lesions seen on chest
radiographs.
• A peripheral tumour usually causes no symptoms until it
is large; a central tumour may present with haemoptysis
and signs of bronchial obstruction while small.
• A tumour is likely to be benign if it has not increased in
size on chest radiographs for more than 2 years or it has
some degree of calcification
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4. common types of benign lung tumors:
Hamartomas (chondroadenomas)
• most common type of benign lung tumor and the third
most common cause of solitary pulmonary nodules.
•These firm marble like tumors are made up of tissue
from the epithelial tissue as well as tissue such as fat
and cartilage.
•They are usually located in the periphery of the lung.
•Usually appear in chest X-rays as a coin-like round
growth.
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5. Bronchial adenomas
•make up about half of all benign lung tumors.
•They are a diverse group of tumors that arise from
mucous glands and ducts of the windpipe or large
airways of the lung.
•A mucous gland adenoma is an example of a true
benign bronchial adenoma.
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6. Bronchopulmonary carcinoid tumours
•These carcinoid tumours are derived from the
neuroendocrine cells of bronchial glands.
•Most (80%) are found in the major bronchi and are
characteristically slow growing and highly vascular.
•They are currently classified within a spectrum of
neuroendocrine tumours.
•Most behave in a benign way; however,
approximately 15% metastasize.
•Surgical excision is preferred.
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7. •Rare neoplasms may include chondromas,
fibromas, lipoma, leiomyomas, hemangiomas.
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8. Causes of Benign Lung Tumors
•An infectious fungus (histoplasmosis, cryptococcosis,
or aspergillosis)
•Tuberculosis (TB)
•A lung abscess
•Smokers are at higher risk than non-smokers.
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9. •Wegener granulomatosis(multisystem autoimmune )
•Sarcoidosis
•Birth defects such as a lung cyst or other lung
malformation.
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10. Symptoms of benign lung tumors
Often there are no symptoms that a benign lung tumor is
present. More than 90% are found by accident, when a
patient receives a chest X-ray or CT scan for some other
reason.
If symptoms do appear, they may include:
•Persistent coughing or wheezing
•Shortness of breath or difficulty breathing
•Coughing up blood
•Rattling sounds in the lungs
•Higher likelihood of pneumonia
•Lung tissue collapse
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11. Diagnosis
•History and Physical exam
•Taking repeated X-rays, over a period of two years,
shorter if the nodule is smaller than 6 millimeters and
patient’s risk is low.
•If the nodule remains the same size for at least two
years, it is considered benign (benign lung nodules
grow slowly but cancerous nodules, on average double
in size every four months).
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12. •Positron emission tomography (PET) scan and CT
Scan:
•Magnetic resonance imaging (MRI)
•Biopsy
•Other tests: Blood tests, Tuberculin skin test to
check for TB
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13. Treatment of Benign Lung Tumors
•Benign lung tumors require no treatment. It is wise,
however, to monitor the tumor over at least a two-
year period in order to note any changes that might
indicate the presence of cancer.
•A biopsy or surgical removal of a tumor may be
needed when:
•The patient is a smoker.
•The patient has difficulty breathing, or other
troubling symptoms.
•Tests show that cancer could be present.
•The nodule continues to grow.
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14. Cancer of lungs
• Lung cancer is the leading cause of cancer incidence
and cancer death for both men and women.
• Malignant chest tumor can be primary, arising within
the lung, chest wall, or mediastinum, or it can be a
metastasis from a primary tumor site elsewhere in the
body.
• In approximately 70 percent of the patient with lung
cancer disease has spread to regional lymphatic and
other sites by the time of diagnosis.
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15. Primary lung cancer
•Lung cancer is a malignant lung tumor characterized
by uncontrolled cell growth in tissues of the lung.
•Most cancers that start in the lung, known as primary
lung cancers, are carcinomas i.e. malignancies that
arise from epithelial cells.
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16. Types
Based on the size and appearance of the cancer cells,
lung cancer is classifies as:
•Small Cell Lung cancer (SCLC)
•Non Small Cell Lung cancer (NSCLC)
•Secondary or Metastatic lung cancers
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17. Small Cell Lung cancer (SCLC)
•Also called oat-cell carcinoma because of the packed
nature of small dense cells, begins in the larger airways
and becomes sizeable.
•The oat cells contain dense neurosecretory granules
vesicles containing neuroendocrine hormones.
•These cancers grow quickly and spread early in the
course of the disease. Sixty to seventy percent have
metastatic disease at presentation.
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18. •Most small cell cancers arise in the major bronchi
and spread by infiltration along the bronchial wall
•This type of lung cancer is strongly associated with
smoking.
•These represent about 20% of all lung cancer.
•The tumours are very responsive to chemotherapy
but carries a worse prognosis as they tend to
metastasize early to lymph nodes and by blood-
borne spread.
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19. Non Small Cell Lung Cancer (NSCLC)
•Non–small cell lung carcinoma (NSCLC) represents
approximately 80% of tumors
•The three main subtypes of NSCLC are:
•Adenocarcinoma: Nearly 40% of lung cancers are
adenocarcinoma, which begin in the alveolus
•Squamous cell carcinoma: Accounts for about 20 -
30% of lung cancers which typically occur close to
bronchi.
•Large-cell carcinoma: About 15% of lung cancers are
large-cell carcinoma. These are so named because the
cancer cells are large, with excess cytoplasm,
large nuclei and noticeable nucleoli.
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21. Secondary or Metastatic lung cancers
•Secondary lung cancers (or lung
metastases) are tumors which have
spread to the lung from another cancer
somewhere else in the body.
•The lung is a common site for metastasis from other
cancers. This is because all blood flows through the
lungs and may contain tumour cells from any other part
of the body.
•Tumors of the breast, prostate, colon and bladder
commonly metastasize to the lung.
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22. Etiology
•Cigarette Smoking-People who smoke is 10 times
more likely to develop lung cancer than non smoker.
Smoking accounts for about 85% of lung cancer cases.
•Passive smoking-Research has shown that non-
smokers who reside with a smoker have a 20- 30 %
increase in risk for developing lung cancer when
compared with other non-smokers.
•Marijuana smoke contains many of the carcinogens as
those in tobacco smoke.
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23. •Occupational Exposure to asbestos, radon gas ,
radiation.
•Air pollution: chemicals released from the burning
of fossil fuels, motor vehicle emissions.
•Indoor air pollution related to the burning of wood,
dung or crop residue for cooking and heating.
Women who are exposed to indoor coal smoke have
about twice the risk and a number of the by-products
of burning biomass
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24. •Preexisting Lung Damage
•Genetic predisposition: Some familial predisposition
to lung cancer seems apparent, because the
incidence of lung cancer in close relatives of patients
with lung cancer appears to be two to three times
that in the general population regardless of smoking
status.
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25. Pathogenesis
•Lung cancer is initiated by activation of oncogenes or
inactivation of tumor suppressor genes.
•Carcinogens cause mutations in these genes which induce
the development of cancer
•Mutations in the K-ras proto-oncogene are responsible for
10–30% of lung adenocarcinomas
•The epidermal growth factor receptor (EGFR) regulates cell
proliferation, apoptosis, angiogenesis, and tumor invasion..
•Mutations and amplification of EGFR are common in non-
small-cell lung carcinoma.
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26. •Lung cancers arise from a single transformed
epithelial cell, in which the carcinogen binds to and
damages the cell’s DNA.
•This damage results in cellular changes, abnormal
cell growth, and eventually a malignant cell.
•As the damaged DNA is passed on to daughter cells,
the DNA undergoes further changes and becomes
unstable.
•With the accumulation of genetic changes, the
pulmonary epithelium undergoes malignant
transformation from normal epithelium eventually to
invasive carcinoma.
•Carcinoma tends to arise at sites of previous scarring
(TB, fibrosis) in the lung
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27. Clinical features
Often, lung cancer develops insidiously and is
asymptomatic until late in its course. Clinical features of
lung carcinoma depend on: the site of the lesion; the
invasion of neighbouring structures; the extent of
metastases.
•The most frequent symptom of lung cancer is chronic
cough. The cough may start as a dry, persistent cough,
without sputum production.
•Haemoptysis occurs in fewer than 50% of patients
presenting for the first time.
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28. •Dyspnea due to occlusion of the airway or
lung parenchyma by tumour, pleural effusion,
pneumonia, or complications of treatment
•wheezing or shortness of breath
•Chest or shoulder pain may indicate chest
wall or pleural involvement by a tumor. Pain
also is a late manifestation
•Systemic symptoms: weight loss, anorexia,
fever, clubbing of the fingernails or fatigue
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29. •Repeated unresolved upper respiratory tract
infections.
•Pleural fluid is an ominous feature and the
presence of blood in a pleural effusion
suggests that the pleura has been directly
invaded.
•Invasion of the mediastinum may result in
hoarseness (because of recurrent laryngeal
nerve involvement), dysphagia (because of
the involvement of, or extrinsic pressure on,
the oesophagus) and superior venecaval
obstruction.
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30. TNM staging
Primary tumour (T)
•TX: Tumour proven by the presence of malignant
cells and bronchial secretions, but not visualised by
radiography or bronchoscopy
•T0: No evidence of primary tumour
•TIS: Carcinoma in situ
•T1: A tumour that is 3 cm or less in greatest
dimension, surrounded by lung or visceral pleura and
without evidence of invasion proximal to a lobar
bronchus
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31. T2 : any of
•a tumour of more than 3 cm but less than or
equal to 7 cm across
or
•a tumour of any size that either invades the
visceral pleura
or
•has associated atelectasis or obstructive
pneumonitis, which extends to the hilar region,
but does not involve an entire lung;
•at bronchoscopy, the proximal extent of
demonstrable tumour must be within bronchus
or at least 2 cm distal to the carina
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33. T3 :Any of:
•Tumor size more than 7 cm across
or
•Direct extension into the chest wall, diaphragm,
mediastinal pleura or pericardium, without involving
the heart, great vessels, trachea, oesophagus or
vertebral body,
or
•a tumour in the main bronchus within 2 cm of the
carina without involving the carina
or
•Separate tumor nodule in the same lobe
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34. T4:
•A tumour of any size, with invasion of the
mediastinum or involving the heart, great vessels,
trachea, oesophagus, vertebral body or carina, or
•Separate tumor nodule in a different lobe of the
same lung
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35. Nodal involvement (N)
•N0: No demonstrable metastasis or regional lymph
node
•N1: Metastasis to lymph nodes in the peribronchial or
the ipsilateral hilar region, or both, including direct
extension
•N2 : Metastasis to the ipsilateral, mediastinal and
subcarinal lymph nodes
•N3: Metastasis to the contralateral mediastinal lymph
nodes, contralateral hilar lymph nodes or ipsilateral or
contralateral supraclavicular lymph nodes
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36. Distant metastasis (M)
•M0: No known distant metastasis
•M1: Distant metastasis present
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37. Stages of lung cancer
Stage IA (T1N0M0)
•Cancer is limited to the lung and hasn't spread to the
lymph nodes. The tumor is generally 3 centimeters or
less in diameter with no metastasis.
Stage IB: T2N0M0.
•A tumour of more than 3 cm but less than or equal to
7 cm or a tumour of any size that either invades the
visceral pleura or has associated atelectasis or
obstructive pneumonitis, which extends to the hilar
region,; however there is no metastasis to lymph nodes
or distant sites.
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38. Stage IIA: T1N1M0
•A tumour that is 3 cm or less in greatest dimension
with metastasis to the nearby lymph nodes without
distant metastasis.
Stage IIB: T2N1M0
•A tumour of more than 3 cm but less than or equal to
7 cm or a tumour of any size that either invades the
visceral pleura or has associated atelectasis or
obstructive pneumonitis, which extends to the hilar
region with metastasis to the nearby lymph nodes
without distant metastasis.
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39. Stage IIIA: T3N0M0 , T3N1M0,
T1-3N2M0
•The tumor at this stage may have grown
very large and invaded other organs near
the lungs or this stage may indicate a
smaller tumor accompanied by cancer
cells in lymph nodes farther away from
the lungs.
Stage IIIB:
•Any T N3 M0
•T4 Any N M0
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Stage IV:
Any T Any N M1.
• Cancer has spread beyond the affected lung to the
other lung or to distant areas of the body.

41. Diagnostic Findings
Medical History and Physical Examination for Lung
Cancer
Chest radiography- An X-ray image of lungs may reveal
an abnormal pulmonary nodule (coin lesion), atelectasis,
and infection.
CT scan
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42. • Positron emission tomography
• Sputum cytology
• Bronchoscopy: to diagnose and determine the extent of
lung cancer.
• Biopsy
• Percutaneous needle aspiration of peripheral tumors may
be done under the guidance of fluoroscopy or CT Scan.
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43. •Mediastinotomy and Mediastinoscopy- for direct
visualisation and to obtain biopsy samples from lymph
nodes in the mediastinum.
•If surgery is a potential treatment, Pulmonary function
tests, arterial blood gas analysis, V/Q scans, and
exercise testing may all be used as part of the
preoperative assessment.
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44. •The more commonly used tumor markers in lung
cancer are CEA, and sometimes CA-125.
•There is no any real role for tumor markers in lung
cancer.
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45. Treatment of Lung Cancer
Medical management
•Treatment depends on the cell type, the stage of the
disease, and the patient’s physiologic status
(particularly cardiac and pulmonary status). In
general, treatment may involve surgery, radiation
therapy, or chemotherapy—or a combination of
these.
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46. Chemotherapy
• Chemotherapy is used to alter tumor growth patterns, to
treat distant metastases or small cell cancer of the lung,
and as an adjunct to surgery or radiation therapy.
• Chemotherapy may provide relief, especially of pain, but
it does not usually cure the disease.
• Chemotherapy may be administered before surgery
(neoadjuvant therapy) or after surgery (adjuvant therapy).
• Combinations of two or more medications may be more
beneficial than single-dose regimens.
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47. •Small-cell lung carcinoma (SCLC), even relatively
early stage disease, is treated primarily with
chemotherapy and radiation.
•In SCLC, cisplatin and etoposide are most
commonly used.
•Combinations with carboplatin, gemcitabine,
paclitaxel, vinorelbine, topotecan, and irinotecan are
also used
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48. •In advanced non-small cell lung carcinoma
(NSCLC), chemotherapy improves survival and is
used as first-line treatment, provided the person is
well enough for the treatment.
•Typically, two drugs are used, of which one is often
platinum-based (either cisplatin or carboplatin).
Other commonly used drugs are gemcitabine,
paclitaxel, docetaxel, etoposide or vinorelbine
•Chemotherapy before surgery in NSCLC that can be
removed surgically also appears to improve
outcome.
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49. Radiotherapy
•Radiotherapy is often given together with
chemotherapy, and may be used with curative intent
in people with NSCLC who are not eligible for
surgery.
•Irradiation also may be used to reduce the size of a
tumor, to make an inoperable tumor operable, or to
relieve the pressure of the tumor on vital structures.
•For potentially curable SCLC cases, chest
radiotherapy is often recommended in addition to
chemotherapy.
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50. •For both NSCLC and SCLC patients, smaller doses
of radiation to the chest may be used for symptom
control (palliative radiotherapy)
•Prophylactic cranial irradiation (PCI) is a type of
radiotherapy to the brain, used to reduce the risk of
metastasis.
•PCI is most useful in SCLC.
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51. Surgical Management
•Surgical resection is the preferred method of treating
patients with localized non–small cell tumors, no
evidence of metastatic spread, and adequate
cardiopulmonary function.
•If the patient’s cardiovascular status, pulmonary
function, and functional status are satisfactory, surgery
is generally well tolerated.
•Surgery is primarily used for NSCLCs, because small
cell cancer of the lung grows rapidly and metastasizes
early and extensively.
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52. The most common surgical procedure for a small,
apparently curable tumor of the lung is:
•lobectomy (removal of a lobe of the lung).
•In some cases, an entire lung may be removed
(pneumonectomy)
•Wedge resection to remove a small section of lung
that contains the tumor along with a margin of
healthy tissue.
•Segmental resection to remove a larger portion of
lung, but not an entire lobe (bronchioles and its
alveoli).
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53. •Thoracoscopic lung resection
•Laser surgery is used. This involves the
delivery of laser light inside the
airway via a bronchoscope to remove the obstructing
tumor
•Chest tube insertion
•Lung Transplantation
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54. •Targeted therapy
Several drugs especially for the treatment of
advanced disease in lung cancer are used.
Erlotinib, gefitinib and afatinib inhibit tyrosine kinase
at the epidermal growth factor receptor.
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55. Complications of Lung Cancer
•Pleural effusion
•Superior vena cava syndrome
•Atelectasis and pneumonia
•Metastasis
•Surgical complications and prolonged mechanical
ventilation
•Pulmonary toxicity
•Complication of treatment
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56. Nursing Management
Assessment
• Assess and document respiratory rate and depth, skin and
mucous membrane color, lung sounds, cough and sputum
amount and character.
• Ask the patient to rate the degree of pain and dyspnea on
appropriate scales.
• Ask about appetite and weight loss, as well as symptoms of
other complications.
• Note activity tolerance and fatigue.
• In addition, the patient may be grieving about his or her
illness and impending death.
• Assessment of the patient’s coping strategies and support
systems
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57. Nursing Diagnosis
• Impaired gas exchange related to advanced disease
condition.
• Ineffective airway clearance related to pain, fatigue and
shortness of breath.
• Pain related to cancer mass compressing on adjacent
structures
• Imbalanced nutrition less than body requirements related
to low appetite
• Altered bowel habit(constipation) related to opioid use,
side effects of chemotherapy.
• Anxiety/grief related to disease condition.
• Activity intolerance related to surgery, shortness of
breaths.
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58. Relieving Breathing Problems
•Oxygen therapy may be necessary to relieve dyspnea.
•Positioning, relaxation and breathing exercises can
help reduce dyspnea and feelings of panic.
•Anti anxiety drugs or morphine may also be helpful to
reduce pain and discomfort.
•Resting between activities reduces the demand for
oxygen.
•Encourage the patient to avoid smoking and exposure
to secondary smoke.
•Bronchodilator medications may be prescribed to
promote bronchial dilation.
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59. Maintaining effective airway
•A clear airway can be promoted with a room humidifier
and oral fluids to reduce viscosity of secretions
•Nonproductive cough can be treated with an antitussive
as ordered by the physician.
•Instruct the patient to notify the physician if hemoptysis
is persistent.
•Exposure to powders, tobacco smoke, and aerosols
increases airway irritation and should be eliminated.
•Help to perform deep-breathing exercises, chest
physiotherapy, directed cough
•Suctioning may be necessary if the patient becomes too
weak to cough effectively.
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60. Maintaining nutritional balance
•Nutrition can be maintained by eating frequent small
meals. Nutritional supplements that are high in calories
but easy to eat or drink may be used.
•A dietician consultation is helpful.
•Antiemetics before meals may help control nausea.
•Mints may help reduce the metallic taste left in the
mouth by some chemotherapeutic medications.
•Good mouth care is essential and should be encouraged
to patient.
•Total parenteral nutrition may be necessary late in the
disease.
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61. Relieving pain and constipation
•Pain is controlled by opioids and supportive
noninvasive therapies.
•Prevent constipation with the use of high fiber foods
and extra fluids if tolerated. If these conservative
measures are ineffective, request an order for a bulk
forming agent, stool softener or laxative.
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62. Promoting activities tolerance
•Fatigue is prevented with frequent rest periods and
assistance with activities of daily living.
•Encourage the patient to identify and engage in
those activities that are most important to him or her
and to avoid unnecessary or undesirable activities.
•Assume comfortable position.
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63. Providing Psychological Support
•The patient who is grieving should be allowed the
opportunity to talk about his or her life and
impending death and to express anger or sadness.
•Do not force verbalization unless the patient wishes
to talk.
•Encourage the family to stay with the patient as
much as the patient wishes. Contact a spiritual
counselor if the patient desires a referral.
•Hospice care is available for the patient who has a
terminal condition. This allows the family to have
the support needed to care for the patient in his or
her home or a homelike environment.
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64. Pre operative care
•Reduce the clients anxiety level.
•Assess clients and family understanding about the
disease condition and surgery, prognosis and provide
further information.
•Explain that chest tubes, drain, oxygen therapy,
intubation and ventilation may be required.
•Teach post operative exercises including use of
spirometry, deep breathing and coughing exercises,
leg exercise.
•General care as in other surgery.
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65. Post operative Care
•Maintain closed chest drainage
•Assess chest drainage.
•Measure and document the amount of drainage
coming from pleural space in the collection
chamber. 500 -1000 ml of drainage may occur in the
first 24 hours .100- 300 ml may accumulate during
first 2 hours, after this the drainage lessens.
•Monitor vital signs.
•Check fluid patency in collection chamber.
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66. References
•Black, J M. (2010). Medical Surgical Nursing.8th
ED. Philadelphia: Saunders An imprint of Elsevier
•Smeltzer, SC. Bare, B. (2010) . Textbook of medical
surgical nursing. 12th edition. Philadelphia:
Lippincott Williams and Wilkins.
•Mosby. comprehensive review of nursing . 60th
edition. India: An imprint of Elsevier
•Davidson’s (2014). clinical practice of medicine.
21st edition. India: Elsevier
•http://my.clevelandclinic.org/health/articles/benign-
lung-tumors
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