lung cancer for nursing students

1. ALL INDIA INSTITUTE OF MEDICAL
SCIENCES
Seminar
on
Lung Cancer
By: Muskan goel
BSc Nursing 3rd year

2. At the end of seminar, group will be able to
understand Lung Cancer and apply this knowledge in
clinical practice

3. At the end of seminar,
group will be able to:
• Introdue the topic
• Define the topic
• Enlist Etiological factors
• Describe Types
• Describe
Pathophysiology:
• Enlist Sign and
Symptoms
• Diagnose the disease
• Understand TNM
Classification
• Describe Staging
• Describe Management
of Disease
• Describe Nursing
Management
• Conclude the topic
• Summarize the topic

4. Lung cancer is the most common visceral
malignancy, accounting for roughly one-third of all
cancer deaths, and it is the most common cause of
cancer related death in both men and women.

5. Lung Cancer Survival Rate

7. Asbestos
Radiation Exposure
Other substances:
Previous history of
lung cancer and cancer
of other upper
arodigestive tract
other lung diseases

8. Two main types :
Small cell lung cancer (15% of all lung cancers)
Non Small cell lung cancer(most common 85%)

9.  It is most aggressive form of lung cancer.
 It usually starts in bronchi and then effects the
whole lung.
 These cancer cells are small and are considered to
be quite aggressive in nature and they have a large
growth factors.
 Because of these reasons, at the time of diagnosis,
(60% of the time), these tumors have often
metastasize to other parts of the body(brain, liver,
and bone marrow)

10. NSCLC is any type of epitheial lung cancer other
than small cell lung cancer.
Non- small cell lung Ca usually grows and
spreads more slowly than SCLC.
 Squamous cell carcinoma
 Adenocarcinoma
 large cell carcinoma

11. Other uncommon carcinomas
1. Bronchial carcinoids
2. Cystic adenoid carcinomas
3. Carcinosarcomas
4. Mesothiliomas

12. Carcinogens like smoking, occupational and
environmental agents, genetics.
Binds with cells DNA and damage the cells.
Cellular changes and abnormal cell growth occur.
Malignant transformation of pulmonary epithelial
cells.

13. • Abnormal proliferation of the lung cell.
• Non specific inflammatory changes with
hypersecretion of mucus, desquamation of the cells.
lesions formation in the lungs tissues involving the
bronchi, bronchioles or even alveoli
Carcinoma of lung

15. Symptoms related to primary disease
Cough
Hoarseness
Hemoptysis
Chest pain
Dyspnea
Pneumonia

16. Symptoms related to disease metastasis
Nodal mass
Bone pain
Pathological fracture
Headache
Seizure (neurological changes)
Jaundice
Bowel and Abdominal symptoms with rapidly
enlarging liver
Subcutaneous masses
Regional lymphadenopathy

17. Para neoplastic manifestations
Anorexia
weight loss
Nausea etc.
Others
Paresthesias and weakness of arm and hand (tumor
in lung apics/superior sulcus)
Horner syndrome (by involvment of cervical
sympathetic nerves

19. History taking
Physical examination
CBC
CT of chest and abdomen (for staging, involvement
of mediastinal lymphnodes, pleural effusion,
unsuspected adrenal masses in case of NSCLC.
CT guided needle biopsy

20. Chest x-ray

21. • PET

22. Needle biopsy
fine needle
core biopsy
Bronchoscopy
Thoracoscopy

23. • Mediastinoscopy

24. Tx-Tumor size is unknown, or cancer cells only
found in sputum.
T0 -Tumor is present only in the cells linig the airway
T1- Tumors less than or equal to 3 cm
T2 -Tumors size is 4-7 cm
T3 -Tumors greater than 7 cm
T4 -Tumor that invades structures in the chest such as
heart, major blood vessels near the heart, the trachea,
the esophagus.

25. N0 - No nodes are involved.
N1- The tumor has spread to nearby nodes on the
same side of the body.
N2- The tumor has spread to nodes farther away,
but on the same side of the chest.
N3- The tumor has spread to lymph nodes on the
other side of the chest from the original tumor, or
has spread to nodes near the collarbone or neck
muscles.

26. M0 - the tumor has not spread to distant regions.
M1:
M1a- The tumor has spread to the opposite lung, to
the lung lining
M1b- The tumor has spread to distant regions of the
body, such as the brain or bones.

27. Stage 1- Tumor is small and localised to lung, no
lymph node involvement
• A- Tumor <3cm
• B- Tumor >3cm and invading surrounding local
area.
Stage 2
• A- Tumor <3cm with invasion of lymph nodes.
• Tumor >3cm involving the bronchus and lymph
nodes on the same side of chest and tissue of local
organs.

29. Stage 3
• A. Tumor spread to the nearby structure and reginal
lymph nodes
• B. Tumor involving heart, trachea, esophagus,
mediastinum and lymph nodes.
Stage 4
Distant metastasis

31. Management
Radiation therapy
Chemotherapy
Surgery

32. 1stline chemotherapy regimes for advances NSCLC
Regime Dose (mg/m2) Days Cycle length
Cisplatin
Vinorelbine
Carboplatin
Paclitaxel
Carboplatin
Gemcitabine
Cisplatine
Gemcitabine
Necitumumab
Cisplatin
Docetaxel
Carboplatin
Paclitaxel
Bevacizumab
Cisplatin
Pemetrexed
Carboplatin
Pemetrexed
100
25
AUC= 6
22
5
AUC 5.5
1,000
75
1,250
800mg 75
75
AUC=6
200
15mg/kg
75
500
AUC=6
500
1
1,8,15
1
1
1
1,8
1
1,8
1
1
1
1
1
1
1
1
1
1
28
21
21
21
21
21
21
21
21

33. Regimen Dose Days Cycle length
Docetaxel 75 1 21
Docetaxel 75 1
Ramucirumab 10mg/kg 1 21
Pemetrexed 500 1 21

34. • Lobectomy

35. • Segmentectomy or
wedge resection:
• Pneumonectomy

36. • VATS (Vedio assisted thoracoscopic surgery)

37. • Radiofrequency ablation (RFA)- Use of high
energy radio waves to heat the tumor.A thin needle
like probe is put through the skin and moved in until
the tip is in the tumour.
• placement is guided by CT scans. once the tip is in place
an electric current is passed through the probe, which
heats the tumor and destroyes the cancer cells.

39. Anti-PD-1 Dose schedule comments
Nivolumab 240mg q14d
For PD-L1- positive
patients
Pembrolizumab 200mg q21d
Atezolizumab 1200mg q21d

40. Molecular targeted agents
Molecular
abnormality
Agents Dose (mg)/ orally Schedule
EFGR Gefitinib
Erlitinib
afatinib
250
150
40
Daily
Daily
daily
EGFR T790M Osimertinib 80 Daily
ALK translocation Crizotinib
(2ndline)Alectinib
Ceritinib
250
600
750
Bid
Bid
Daily
ROS translocation
Raf (V600E)
Ret mutations
Crizotinib
Velmurafenib
Dabrafenib
Vandetanib
250
960
150
300
Daily
Bid
Bid
Daily

41. • Palliative, or supportive care is aiimed at relieving
symptoms and improving a persons quality of life.
• Issues are addressed in palliative care
• physical
• emotional and coping
• spiritual

42. Grade Explanation of activity
0 Fully active, able to carry on all pre-disease performance
without restriction
1 Restricted in physically strenuous activity but ambulatory and
able to carry out work of a light or sedentary nature, e.g., light
house work, office work
2 Ambulatory and capable of all selfcare but unable to carry out
any work activities. Up and about more than 50% of waking
hours
3 Capable of only limited selfcare, confined to bed or chair
more than 50% of waking hours
4 Completely disabled. Cannot carry on any selfcare. Totally
confined to bed or chair
5 Dead

46. Includes ACUPUNCTURE and MASSAGE and
pharmacological approaches such as vitamins and
herbal medicine.
These herbal therapies combined with
chemotherapy increases survival in non- small cell
lung cancer by up to 42%, compared with
chemotherapy alone.

47. Foods: Green tea, Garlic, Fish oil, Lactobacillus.

48. Mind- body: help to reduce anxiety, mood
disturbance, or chronic pain in cancer patients
(audiotapes, vediotapes, books, music, relaxation,
yoga, meditation)
Accupuncture
Hypnosis
Massage therapy

49. 1) Preoperative pulmonary rehabilitation versus chest
physical therapy in patients undergoing lung cancer
resection: a pilot randomized controlled trial
Interventions: Patients were randomly assigned to
receive PR (strength and endurance training) versus CPT
(breathing exercises for lung expansion). Both groups
received educational classes.
Conclusion: These findings suggest that 4 weeks of PR
before lung cancer resection improves preoperative
functional capacity and decreases the postoperative
respiratory morbidity.

50. 2) Safety and Efficacy of Mild Moxibustion on
Cancer-Related Fatigue in Non-Small-Cell Lung
Cancer Patients Undergoing Chemotherapy
Conclusion- Chemotherapy is accompanied by
elevated fatigue scores and decreased life quality in
NSCLC patients. Although mild moxibustion
intervention could alleviate CRF in the patients and
was not associated with any adverse events and liver
and kidney toxicity when combined with
chemotherapy

51. • Nursing diagnosis
1.Impaired Gas Exchange r/t altered oxygen supply
(hypo-ventilation)
2.Ineffective airway clearance rlt increased amount of
secretions and restricted movement.
3.Acute pain rlt cancer invasion of the pleura
4.Fear /anxiety rlt perceived threat of death
5.Deficient knowledge rlt lack of exposer