Lung cancer

1. Lung cancer
Prepared by:
Shorouq alshahrani
RABAB ALSHAHRANI
HALA ALONAZI
FACULTY NAME :
DR.ESMAT

2. OUTLINES
 Anatomy and physiology of the lung.
 Definition of lung Cancer
 Epidemiology.
 Pathophysiology.
 Type of lung cancer.
 Stages of lung cancer
 Risk factors
 Sign and symptoms.
 Diagnostic studies
 Prevention of lung cancer
 Treatment plan
 Nursing assessment.
 Nursing care plan.

3. ANATOMY AND PHYSIOLOGY OF THE LUNG.

4. EPIDEMIOLOGY.
-Lung cancer is the number-one cancer killer among
men and women in the United States, accounting for
31% of cancer deaths in men and 25% in women
(American Cancer Society, 2002; Greenlee et al.,
2001)..
-Lung cancer affects primarily those in the sixth or
seventh decade of life; less than 5% of patients are
under the age of 40. In approximately 70% of lung
cancer patients, the disease has spread to regional
lymphatics and other sites by the time of diagnosis.

5. EPIDEMIOLOGY.
 According to the latest WHO data published in 2017
Lung Cancers Deaths in Saudi Arabia reached 906
or 0.93% of total deaths.
 The adjusted Death Rate is 5.53 per 100,000 of
population ranks Saudi Arabia #133 in the world.
 Only about 13% of patients with lung cancer survive
5 years after diagnosis.
-www.worldlifeexpectancy.com › saudi-arabia-lung-
cancers

6. DEFINITION OF LUNG CANCER
is the uncontrolled growth of abnormal cells in one or
both lungs. These abnormal cells do not carry out the
functions of normal lung cells and do not develop into
healthy lung tissue.

7. PATHOPHYSIOLOGY:
Lung cancers arise from a single transformed
epithelial cell in the tracheobronchial airways. A
carcinogen (cigarette smoke, other occupational and
environmental agents) binds to a cell’s DNA and
damages it. 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 to eventual
invasive carcinoma.

8. TYPES OF LUNG CANCER
Non-small cell carcinoma represents 70% to
75% of tumors;
small cell carcinoma represents 15% to 20%
of tumors

9. TYPES OF LUNG CANCER
1-Squamous cell carcinoma is more centrally
located and arises more commonly in the
segmental and subsegmental bronchi in
response to repetitive
carcinogenic exposure
the cell types includ
squamous cell carcinoma
(30%).
2- Adenocarcinoma is the most prevalent
carcinoma of the lung for both men and
women; it presents more peripherally as
peripheral masses or nodules and often
metastasizes.
(31% to 34%)

10. TYPES OF LUNG CANCER
3-Large cell carcinoma
also called undifferentiated
carcinoma is a fast-growing
tumor that tends to
arise peripherally
(10% to 16%)

11. TYPES OF LUNG CANCER
small cell carcinomas
arise primarily as a proximal lesion or lesions but may
arise in any part of the tracheobronchial tree.

12. RISK FACTOR:

13. STAGES OF LUNG CANCER
-Doctor will use results from tests and tissue
samples to determine the lung cancer stage and
helps determine the recommended treatment
plan.
The stage of the lung cancer is determined by a
combination of all of these factors:
T – Tumor size and location
N – Regional lymph node involvement. It is
important to know whether the lung cancer has
spread to the lymph nodes around the lung.
M – Metastasis status. Metastasis status refers to
which organs the cancer has spread.

14. CONT ..
Non-small cell lung cancer stages range from one to four, The
lower the lung cancer stage, the less the cancer has spread.
 Stage 1: Cancer is found in the lung, but it has not spread
outside the lung.
 Stage 2: Cancer is found in the lung and nearby lymph nodes.
 Stage 3: Cancer is in the lung and lymph nodes in the middle
of the chest.
 Stage 3A: Cancer is found in lymph nodes, but only on the
same side of the chest where cancer first started growing.
 Stage 3B: Cancer has spread to lymph nodes on the opposite
side of the chest or to lymph nodes above the collarbone.
 Stage 4: Cancer has spread to both lungs, into the area
around the lungs, or to distant organs.

16. CONT..
Small-cell lung cancer (SCLC) has two main stages: -
The limited stage, cancer is found in only one lung or
nearby lymph nodes on the same side of the chest.
- The extensive stage means cancer has spread:
throughout one lung
to the opposite lung
to lymph nodes on the opposite side
to fluid around the lung
to bone marrow
to distant organs

18. SIGNS & SYMPTOMS :
Many people with lung cancer don't have symptoms
until the disease is in its later stages. Because there
are very few nerve endings in the lungs, a tumor
could grow without causing pain or discomfort.
symptoms include:
- Persistent cough
- Hoarseness
-
Constant or progressive chest pain
-
Shortness of breath, wheezing or stridor.
-
-Frequent lung infections such as bronchitis or
pneumonia.
- Hemoptysis

19. CONT..
Some symptoms of lung cancer may not seem related to
the lungs or breathing. These symptoms can still be a sign
of lung cancer because lung cancer usually does not
cause symptoms in its earlier stages. This means some
symptoms do not appear until the cancer has spread to
other parts of the body.
symptoms may include:
- Weight loss
-
- Loss of appetite ( anorexia )
-
- fatigue
- Headaches
- Bone pain or fractures
- Blood clots

20. CONT ..
Lung cancer sometimes creates a substance similar
to hormones, causing a wide variety of symptoms
called paraneoplastic syndrome which include:
muscle weakness
nausea
vomiting
fluid retention
high blood pressure
high blood sugar
confusion
seizures
coma

21. DIAGNOSTIC TESTS:
- Imaging tests:
• X-ray : image of the lungs may reveal an abnormal mass or
nodule ,determine size of the tumor and location.
• CT scan :can reveal small lesions in the lungs that might not
be detected on an X-ray.
• Positron emission tomography ( PET ) scan : it is form of
radioactive sugar is injected into the blood. Cancer cells in
the body absorb large amounts of the sugar. A special
camera can then spot the radioactivity. This test can help
show whether the cancer has spread to the lymph nodes or
other parts of the body
• Bone scan : A small, safe amount of radioactive substance is
put into the vein. This substance builds up in areas of bone
that may not be normal because of cancer. These areas show
up as dense, gray to black areas, called "hot spots." These
areas may indicate cancer.

22. CONT..
- procedure test:
• Bronchoscopy : A lighted, flexible tube is passed
through the mouth or nose and into the large airways of
the lungs. This test can help the doctor see tumors, or it
can be used to take samples of tissue or fluids to see if
cancer cells are present
Endobronchial ultrasound (EBUS) : an ultrasound
device .It is passed down into the windpipe to look at
nearby lymph nodes and other structures in the chest. This
is done with numbing medicine (local anesthesia) and light
sedation. A hollow needle can be passed through the
bronchoscope and guided by ultrasound into an area of
concern to take biopsy samples
Mediastinoscopy and mediastinotomy : Both of these
tests let the surgeon look at and take samples of lymph
nodes in the area between the lungs (this area is called
the mediastinum)

23. CONT..
Thoracentesis : This test is done to check whether fluid
around the lungs is caused by cancer or by some other
medical problem. A needle is placed between the ribs to
drain the fluid. The fluid is checked for cancer cells.
Thoracoscopy or video-assisted thoracoscopic
surgery (VATS) biopsy
A small cut is made in the chest. The surgeon then uses a
thin, lighted tube connected to a video camera and screen
to look at the space between the lungs and the chest wall.
The surgeon can see small tumors on the lung or lining of
the chest wall and can take out pieces of tissue to be
looked at under the microscope. can also be used as part
of the treatment to remove part of a lung in some early-
stage lung cancers.

24. CONT..
Sputum cytology: A sample of mucus patient cough
up from the lungs is examined under a microscope to
see if cancer cells are present.
Fine needle aspiration (FNA) biopsy: A long, thin
(fine) needle is used to remove a sample of cells from
the area that may be cancer. The sample is examined
in the lab to see if it contains cancer cells.

25. PREVENTION:
• health education has had some success in reducing
tobacco consumption
• Stopping smoking reduces the risk of developing
lung cancer.
• Avoid secondhand smoke.
• Avoid carcinogens at work.
• Choose a healthy diet.Food sources of vitamins
and nutrients are best.
• Regular exercise , there's strong evidence to
suggest that regular exercise can lower the risk of
developing lung cancer and other types of cancer

26. TREATMENT PLAN
 The type of treatment receive for lung cancer
depends on several factors, including:
• the type of lung cancer that patient have (non-
small-cell or small-cell cancer)
• the size and position of the cancer
• how far advanced the cancer is (the stage)
• The overall health

27. NON-SMALL-CELL LUNG CANCER
• In good general health the patient have surgery to
remove the cancerous cells. This may be followed by a
course of chemotherapy to destroy any cancer cells that
may have remained in the body.
• If the cancer hasn't spread too far but surgery isn't
possible radiotherapy to destroy the cancerous cells will
usually be recommended. In some cases, this may be
combined with chemotherapy (known as
chemoradiotherapy).
• If the cancer has spread too far for surgery or
radiotherapy to be effective, chemotherapy is usually
recommended. If the cancer starts to grow again after
initial chemotherapy treatment, another course of
treatment may be recommended.

28. SMALL-CELL LUNG CANCER
• Small-cell lung cancer is usually treated with
chemotherapy, either on its own or in combination
with radiotherapy. This can help to prolong life and
relieve symptoms.
• Surgery isn't usually used to treat this type of lung
cancer. This is because the cancer has often
already spread to other areas of the body by the
time it's diagnosed.
• if the cancer is found very early, surgery may be
used. In these cases, chemotherapy or
radiotherapy may be given after surgery to help
reduce the risk of the cancer returning.

29. SURGERY:
 During surgery the surgeon works to remove the
lung cancer and a margin of healthy tissue.
Procedures to remove lung cancer include:
• 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
• Lobectomy to remove the entire lobe of one lung
• Pneumonectomy to remove an entire lung

30. AFTER THE OPERATION
 The patient will be able to go home 5 to 10 days
after the operation. it can take many weeks to
recover fully from a lung operation.
• The patient encouraged to start moving around as
soon as possible.
• regular leg movements to help the circulation and
prevent blood clots from forming.
• A breathing exercises to help prevent
complications.

31. RADIATION THERAPY
Radiation therapy uses high-powered energy beams from
sources such as X-rays and protons to kill cancer cells.
 Stereotactic radiotherapy – a more accurate type of
external beam radiotherapy where several high-energy
beams are used to deliver a higher dose of radiation to
the tumour, while sparing the surrounding healthy tissue
as much as possible.
 Internal radiotherapy – a catheter (thin tube) is
inserted into the lung. A small piece of radioactive
material is placed inside the catheter and positioned
against the site of the tumour before being removed
after a few minutes

32. SIDE EFFECTS OF RADIOTHERAPY
 Side effects of radiotherapy to the chest include:
• chest pain
• fatigue
• persistent cough that may bring up blood-stained
(this is normal)
• difficulties swallowing (dysphagia)
• redness and soreness of the skin, which looks and
feels like sunburn
• hair loss on the chest

33. CHEMOTHERAPY
• Before surgery to reduce the size of a tumor to make it
easier to remove
• After surgery to kill any remaining cancer cells in the
body
• In combination with radiation therapy for lung cancers
that cannot be removed with surgery
Side effects
• fatigue
• nausea
• vomiting
• mouth ulcers
• hair loss

34. IMMUNOTHERAPY
 Immunotherapy uses the immune system to fight
cancer.
 The body's disease-fighting immune system may
not attack the cancer because the cancer cells
produce proteins that blind the immune system
cells. Immunotherapy works by interfering with that
process.
 Immunotherapy treatments are generally reserved
for people with advanced lung cancer.

35. PALLIATIVE CARE
 People with lung cancer often experience signs and
symptoms of the cancer, as well as side effects of
treatment.
 Supportive care, also known as palliative care, is
involves in working to minimize the signs and symptoms
to ensure that the patient comfortable during and after
the cancer treatment.
 In one study, people with advanced non-small cell lung
cancer who began receiving supportive care soon after
their diagnosis lived longer than those who continued
with treatments, such as chemotherapy and radiation.
 Those receiving supportive care reported improved
mood and quality of life. They survived, on average,
almost three months longer than did those receiving
standard care.

36. NURSING ASSESSMENT FOR PATIENT WITH
LUNG CANCER:
 During assessment it important for the nurse to ASSESS:
 assess symptoms, such as shortness of breath, cough,
bloody mucus or blood from the lungs (sputum),
and wheezing.
 How long the patient had the symptoms.
 Whether the symptoms are becoming worse.
 Any change in the appetite or a recent weight loss.
 Is the patient use of tobacco, and how long he use it.
 The exposure to smoke from other people's smoking
(secondhand smoke).
 The patient contact with certain chemicals, such
as radioactive dust, or radon.
 The work-related contact with fumes and dust
 Any respiratory problems patient had when he or she were a
child.
 The family history of respiratory problems and/or cancer.

37. NURSING ASSESSMENT FOR PATIENT WITH
LUNG CANCER:
 the nurse will examine head to toe during the physical exam:
 Take the temperature and weight to check for a fever or weight
loss.
 Examine the ears, eyes, nose, and throat for signs of infection.
 Listen to the heart and lungs with a stethoscope.
 listen for abnormal air movement through the lungs that may
indicate presence of pneumonia or other respiratory problems.
 Examine the chest for areas of pain in the ribs or muscles.
 (abdominal palpation) to check for pain, fluid buildup, or an
enlarged liver.
 Examine the neck, armpits, groin, and other areas of the body to
check for enlarged lymph nodes.
 Laboratory tests may also be part of the physical exam for lung
cancer. Laboratory tests may include a complete blood
count (CBC), and chemistry screen

38. NURSING CARE PLAN:
1. Impaired Gas Exchange
2. Ineffective Airway Clearance
3. Acute Pain
4. Imbalance nutrition less than body requirement
5. Fatigue

39. IMPAIRED GAS EXCHANGE RELATED TO
DISEASE PROCESS EVIDENCED BY COUGH ,
SHORTNESS OF BREATHE.
 Nursing Interventions
 Note respiratory rate, depth of respirations. Observe for use of accessory muscles,
pursed-lip breathing, changes in skin or mucous membrane color, pallor, cyanosis.
 Auscultate lungs for air movement and abnormal breath sounds.
 Investigate restlessness and changes in mentation or level of consciousness.
 Assess patient response to activity. Encourage rest periods and limit activities to
patient tolerance.
 Note development of fever.
 Maintain patent airway by positioning, suctioning, use of airway adjuncts.
 Reposition frequently, placing patient in sitting positions and supine to side
positions.
 Administer supplemental oxygen via nasal cannula, partial rebreathing mask, or
high-humidity face mask, as indicated.
 Encourage and assist with deep-breathing exercises
 Monitor and graph ABGs, pulse oximetry readings. Note hemoglobin(Hb) levels.
 Note changes in amount or type of chest tube drainage

40. ACUTE PAIN RELATED TO CANCER INVASION OF PLEURA SURGICAL
INCISION TISSUE TRAUMA EVIDENCED BY VERBAL REPORTS OF
DISCOMFORT AND CHANGES IN BP, HEART/RESPIRATORY RATE

Nursing Interventions
 Assess the pain. Determine pain characteristics: continuous, aching,
stabbing, burning. Have patient rate intensity on a 0–10 scale.
 Assess patient’s verbal and nonverbal pain signs.
 Note possible pathophysiological and psychological causes of pain.
 Evaluate effectiveness of pain control. Encourage sufficient medication
to manage pain; change medication or time span as appropriate.
 Encourage verbalization of feelings about the pain.
 Provide comfort measures: frequent changes of position, back rubs,
support with pillows.
 Encourage use of relaxation techniques, and appropriate diversional
activities.
 Schedule rest periods, provide quiet environment.
 Assist with self-care activities, breathing and/or arm exercises, and
ambulation.

41. REFERENCES
Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing 10th edition
Oxford handbook of oncology by Jim Cassidy, Donald
Bissett, Roy A. J. Spence OBE, Miranda Payne &
Gareth Morris-Stiff 4th edition
https://www.lung.org/american lung association
https://www.nhs.uk/conditions/lung-cancer/