This document consists of a case presentation on Small Cell Lung Cancer by Evlin Petescia

1. .
Case presentation on
Small Cell Lung Cancer
By:
J. Evlin Petescia
3rd year Bsc(N)
RINER

2. B A S E L I N E D ATA :
Name: Mr. X Age: 51 Gender: Male
Diagnosis :
Limited Stage
Small Cell Lung
Cancer

3. H I S T O R Y C O L L E C T I O N :
chief complaints
Chief complaints: Dyspnea on exertion since 6months
Dry cough
Loss of appetite
Fatigue

4. H I S T O R Y O F P R E S E N T I L L N E S S
• Mr. X was apparently normal 6months back when
he developed dyspnea on exertion,dry cough,loss
of appetite and fatigue. The patient underwent
tests at an outside hospital due to the symptoms
where he was diagnosed with pneumonia and was
treated with antibiotics. Despite the treatment the
prognosis was delayed. Thus the patient was
referred to our hospital,when he underwent few
diagnostic procedures and was diagnosed with
small cell lung cancer.

5. H I S T O R Y O F PA S T I L L N E S
Mr. X had previously
been diagnosed with
diabetes mellitus with
an uncontrolled glucose
level and is also
hypertensive.
No history of previous
surgeries

6. P E R S O N A L H I S T O R Y
Mr.x is a chain smoker and smokes
more than 40 packs of cigarettes per
year.

7. P H Y S I C A L
A S S E S S M E N T
• Abnormal Findings:
Fatigue
Non Productive Cough
Dyspnea on exertion

8. D I S E A S E
C O N D I T I O N
• Anatomy of the lungs
The lungs are the major
organs of the respiratory
system, and are divided
into sections, or lobes. The
right lung has three lobes
and is slightly larger than
the left lung, which has

10. • The lungs are separated by the mediastinum. This area
contains the heart, trachea, esophagus, and
many lymph nodes. The lungs are covered by a
protective membrane known as the pleura and are
separated from the abdominal cavity by the muscular
diaphragm.
• With each inhalation, air is pulled through
the windpipe (trachea) and the branching passageways of
the lungs (the bronchi), filling thousands of tiny air sacs
(alveoli) at the ends of the bronchi. These sacs, which
resemble bunches of grapes, are surrounded by
small blood vessels (capillaries). Oxygen passes through the
thin membranes of the alveoli and into the bloodstream.
The red blood cells pick up the oxygen and carry it to the
body's organs and tissues. As the blood cells release the

11. • PHYSIOLOGY:
The lungs are the foundational organs of the respiratory
system, whose most basic function is to facilitate gas exchange
from the environment into the bloodstream. Oxygen gets
transported through the alveoli into the capillary network, where it
can enter the arterial system, ultimately to perfuse tissue.

12. L U N G C A N C E R
• What is lung cancer?
Lung cancer is cancer that forms in tissues of the lung,
usually in the cells that line the air passages.
• Incidence:
Lung caner is one of the most commonest cancers and
cause of cancer-related deaths all over the world.
It accounts for 13% of all new cancer cases and 19% of
cancer related deaths worldwide.

13. • In India lung cancer constitutes 6.9% of all new
cancer cases and 9.3% of all cancer related
deaths in both sexes.
• CLASSIFICATION OF STAGING:
1. Small cell lung cancer(SCLC)
2. Non-small cell lung cancer(NSCLC)

14. S M A L L C E L L L U N G C A N C E R
• Definition:
An aggressive (fast-growing) cancer that forms in
tissues of the lung and can spread to other parts of the
body.

16. I N C I D E N C E
• The incidence of small cell lung cancer (SCLC) has declined
over the last few years, as smoking rates have fallen. SCLC
once accounted for 20-25% of all newly diagnosed lung
cancers; it now comprises only about 13% of all lung
cancers.

17. R I S K F A C T O R S
• Tobacco smoke
• Electronic cigarettes
• Secondhand smoke
• Environmental and occupational exposure
• Genetic mutations

18. E T I O L O G Y
• The predominant cause of small cell lung cancer (SCLC) is
tobacco smoking.
• Inhalation of carcinogenssuch as radon gasand occupational
and environmental agents.

19. BOOK PICTURE PATIENT
PICTURE
1.Smoking ✅
2. Inhalation of
radon gas and
other occupational
and environmental
agents.
❎

20. PATHOPHYSIOLOGY
• Factors like smoking cigarettes and bidi and
inhaling occupational and environmental agents
contains carcinogens. These carcinogens present
in them binds to the cells 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 the
daughter cells,the DNA undergoes further
changes and becomes unstable.

21. • With these genetic changes, the pulmonary
epithelium undergoes malignant transformation
from noraml epithelium to invasive carcinoma.

22. CLINICAL MANIFESTATIONS
• Dry cough
• Dyspnea
• Hemoptysis
• Chest or shoulder pain
• Weight loss
• Fever

23. BOOM PICTURE PATIENT PICTURE
Dry cough ✅
Dyspnea ✅
Hemoptysis ❎
Chest or shoulder pain ❎
Fever ❎

24. TYPES OF SCLC
1. Limited stage SCLC : Limited-stage small cell lung
carcinoma is a type of small cell lung cancer that is confined to an
area
2. Extensive stage SCLC : This describes cancers
that have spread widely throughout the lung, to the
other lung, to lymph nodes on the other side of the
chest, or to other parts of the body (including the
bone marrow).

25. ASSESMENT AND DIAGNOSTIC
FINDINGS
• Chest x-ray : A chest x-ray is performed to search for
a pulmonary nodule, atelectasis, and infection.
• CT Scan : It is done to identify small nodules that are
not easily visulaized on the chest x-ray.
• Fiberoptic Bronchoscopy : It provides detailed study
of tracheobronchial tree and allows for washings and
biopsies of suspicious areas.
• Transthoracic fine-needle aspiration : It may be
performed under CT guidance to aspirate cells from a
suspicious area.

26. MEDICATIONS
• Cisplatin: ( anti-cancer, anti-neoplastic,cytotoxic
chemotherapy drug)
Trade name: Platinol
Mechanism of Action:
Cisplatin interferes with DNA replication and kills the
fastest proliferating cells.
DOSAGE:
1mg/ml injection

27. • Indications:
Bladder, head and neck, lung, ovarian, and testicular cancers. It is effective
against various types of cancers, including carcinomas, germ cell tumors, lymphomas,
and sarcomas.
• Contraindication:
-pregnancy
-breastfeeding
• Side Effects: Seizures, Renal tubular damage, thrombocytopenia, leukopenia,
pancytopenia ,fibrosis and anaphylaxis

28. • Nurses responsibility:
ASSESS:
• Anaphylaxis: wheezing, tachycardia, facial swelling, fainting;
discontinue product, report to prescriber; resuscitation equipment
should be nearby, may occur within minutes;
• Monitor temp q4hr; may indicate beginning infection
• Bleeding: hematuria, bruising, petechiae.
Evaluate:
• Therapeutic response: decreased tumor size, spread of malignancy
Teach patient/family:
• To report signs of infection: increased temp, sore throat, flulike
symptoms
• To report signs of anemia: fatigue, headache, faintness.
• To report bleeding, bruising, petechiae; to avoid use of razors,
commercial

29. IRINOTECAN
• ACTION:
Cytotoxic by producing damage to single-strand DNA during DNA
synthesis;
binds to topoisomerase I
• USES:
Metastatic carcinoma of the colon or rectum or 1st-line treatment in
combination with 5-FU and leucovorin for metastatic colon or rectal
carcinomas
Unlabeled uses: Cervical, gastric, lung, ovarian, pancreatic cancer,
malignant
glioma, rhabdomyosarcoma
• CONTRAINDICATIONS:
Pregnancy (D), hypersensitivity

30. • Dosage: 20mg/ml injection
• Side Effects : Thromboembolism, severe diarrhoea,
hepatotoxicity,leukopenia,neutropenia, anemia
• Nurses Responsibility:
Evaluate:
• Therapeutic response: decrease in tumor size, spread of cancer
Teach patient/family:
• To avoid foods with citric acid or hot or rough texture if stomatitis is
present; to
drink adequate fluids
• To report stomatitis; any bleeding, white spots, ulcerations in mouth; to
examine mouth daily, report symptoms
• To report signs of anemia: fatigue, headache, faintness, SOB, irritability,
infection, rash

31. • To report if pregnancy is planned or suspected pregnancy (D)
•To avoid salicylates, NSAIDs, alcohol because bleeding may
occur; to avoid all products unless approved by prescriber
• About alopecia; that, when hair grows back, it will be different
texture,thickness
• To avoid vaccinations while taking this product
• To report diarrhea that occurs 24 hr after administration;
severe dehydration can occur rapidly.

32. ETOPOSIDE ( ANTI -
NEOPLASTIC)
• ACTION:
Inhibits cells from entering mitosis, depresses
DNA/RNA
• INDICATION:
small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC),
high-risk gestational trophoblastic disease,acute lymphocytic leukemia
(ALL).

33. • CONTRAINDICATIONS:
Pregnancy (D), breastfeeding, hypersensitivity.
• DOSAGE:
50 mg capsules; 20 mg/mL injection
• SIDE EFFECTS:
MI, dysrhythmias, constipation,Nephrotoxicity, Thrombocytopenia, leukopenia,,
anemia, Stevens-Johnson syndrome,Bronchospasm.
• NURSES RESPONSIBILITY:
Evaluate:
• Therapeutic response: decreased tumor size, spread of malignancy
Teach patient/family:
• To report any changes in breathing or coughing
• That hair may be lost during treatment; that a wig or hairpiece may make
patient feel better; that new hair may be different in color, texture • That metallic
taste may occur.

34. M A N A G E M E N T:
• MEDICAL MANAGEMENT:
Management may involve chemotherapy, radiation therapy or
a combination of these.
Chemotherapy:
Chemotherapy is the primary treatment for SCLC. For limited
stage SCLC, chemotherapy is often combined with radiation therapy to
the chest. For extensive stage SCLC, chemotherapy is often combined
with immunotherapy.
Radiation therapy: Radiation therapy can also be an option for
people with extensive stage SCLC that could spread to the brain or has
already spread to the brain. Surgery is not usually an option for people
with SCLC, except for in a small number of people with very limited stage
SCLC.

35. • Usually SCLC is treated with these combination of chemotherapy drugs:
• Etoposide (available as a generic drug) and cisplatin (available a a generic
drug)
• Etoposide and carboplatin (available as a generic drug)
• Irinotecan (Camptosar) and cisplatin
• Irinotecan (Camptosar) and carboplatin
PHOTODYNAMIC THERAPY
• Photodynamic therapy (PDT) is a treatment that uses a drug, called a
photosensitizer or photosensitizing agent, and a particular type of light.
When photosensitizers are exposed to a specific wavelength of light, they
produce a form of oxygen that kills nearby cells.
• Each photosensitizer is activated by light of a specific wavelength. This
wavelength determines how far the light can travel into the body.

37. NURSING MANAGEMENT
• NURSING DIAGNOSIS BASED ON PRIORITY:
1. Impaired gas exchange related to altered oxygen
supply as evidenced by dyspnea.
2. Ineffective airway clearance related to SCLC as
evidenced by dyspnea and cough.
3. Imbalance electrolytes related to chemotherapy as
evidenced by diarrhoea.
4. Fatigue related to decreased metabolic energy
levels as evidenced by lethargy.
5. Deficit knowledge related to small cell lung cancer.

38. 1. Impaired Gas Exchange related to altered oxygen supply as evidenced by dyspnea.
• Desired Outcomes
• Demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within patient’s normal
range.
• Be free of symptoms of respiratory distress.
INTERVENTION:
• Note respiratory rate, depth, and ease of respiration. 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.
• Maintain patent airway by positioning, suctioning.
• Reposition frequently, placing patient in sitting positions and supine to side positions.

39. • Encourage and assist with deep-breathing exercises and pursed-lip breathing as
appropriate.
• Monitor and graph ABG, pulse oximetry readings. Note hemoglobin (Hb) levels.

40. 2. Ineffective airway clearance related to SCLC as evidenced by
dyspnea and cough.
• Desired Outcomes:
• Patient will identify/demonstrate behaviors to achieve airway clearance.
• Patient will display/maintain patent airway with breath sounds clearing; absence of
dyspnea, cyanosis, as evidenced by keeping a patent airway and effectively clearing
secretions.
Nursing Interventions:
• Assess the rate, rhythm, and depth of respiration, chest movement, and use of
accessory muscles.
• Assess cough effectiveness and productivity.

41. • Elevate head of bed, change position frequently.
• Teach and assist patient with proper deep-breathing exercises.
• Use humidified oxygen or humidifier at bedside.
• Monitor serial chest x-rays, ABGs, pulse oximetry readings.

42. 3. Fatigue related to decrease in metabolic energy
production as evidenced by lethargy.
Desired Outcomes
• Report improved sense of energy.
• Perform ADLs and participate in desired activities
Nursing Intervention:
• Encourage patient to do whatever possible (self-
in chair, walking). Increase activity level as

43. • Refer to physical or occupational therapy.
• Establish realistic activity goals with patient.
• Have patient rate fatigue, using a numeric scale, if possible, and the time of
day when it is most severe.

44. Complications:
1. Pulmonary fibrosis
2. Pericarditis
3. Myelitis
4. Cor pulmonale
5. Pneumonitis
6. Pulmonary toxicity

45. HEALTH EDUCATION
• Advice patient to eat protein rich diet.
• Advice patient to perform deep breathing exercise,
pursed lip breathing, diaphragmatic breathing.
• Advice patient to complete the full course of
therapy and to not skip follow up
• Advice patient to quit smoking
• Insist the patient to immediately contact physician
if any complications occur.
• Advice patient to avoid exposure to infections.

46. S U M M A R Y
• Mr. X was a 51 year old who was admitted with
the chief complaints of dyspnea,fatigue,loss of
appetite,dry cough. He was diagnosed with small
cell lung cancer which is an aggressive fast
growing cancer. Patient was on chemotherapy,
Radiotherapy and Photodyanamic therapy. The
complete disappearance of the tumour was
confirmed after 4 weeks.

48. BIBLIOGRAPHY
• Brunner and suddarth’s textbook of medical
surgical nursing, south asian Edition,wolters
kluwer(India)pvt.Ltd, pg no : 419-422
• BT Basavanthappa,Textbook of essentials of
medical surgical nursing, 1st edition,page no: 70-
73
• Nurseslab.com