1. LUNG CANCER
PRESENTED BY,
ANU JAMES. MSc (N)
10/27/2013

2. LUNG CANCER.
• DEFINITION:
Chest tumor or lung cancer is the
malignancy in the epithelium of the
respiratory tract.
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3. ANATOMY AND PHYSIOLOGY.
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4. LUNGS
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5. LOBES OF LUNG
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6. BLOOD SUPPLY
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7. FUNCTIONS
BRONCHI AND BRONCHIOLES:• Control of air entry.
• Warming and humidity
• Support and patency.
• Cough reflex
RESPIRATORY BRONCHIOLES:• External respiration.
• Defense against microbes.
• Warming and humidifying.
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8. ETIOLOGY AND RISK FACTORS.
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Cigarette smoking.
Genetic predisposition.
Over 50 years of age.
Inhaled toxins such ad asbestosis,pollutants.
Occupational exposure to toxins.
Air pollution.
Tuberculosis and lower of radiation.
Idiopathic.
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9. TYPES OF LUNG CANCER.
• Small cell carcinoma.(oat cell carcinoma)
(20-25 %)
• Squamous cell carcinoma. (30-35 %)
• Adeno carcinoma. (33-35 %)
• Large cell carcinoma. (15 -20 %)
• Non small cell carcinoma. (75 %)
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10. PATHOPHYSIOLOGY
Etiological factors
partial obstruction of lung wall
Obstructive emphysema of the lob
Infection of the lobe
Secondary abscess formation
Involvement of pleura
Extension of chest wall
Inversion of intercostals nerves or bronchi
Spreading into the mechanism and compress the underlying structure
metastasis
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11. CLINICAL MANIFESTATIONS
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Persistent cough
Sputum streaked with blood
Frank haemoptysis
Unexplained weight loss.
Rust coloured purulent sputum.
Fatigue.
Chest,shoulder,arm, back pain
Reccuring episodes of pleural effusion
Unexplained dyspnoea
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12. DIAGNOSTIC EVALUATIONS
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History collection
Physical examination.
Blood examination
Sputum cytology.
Chest x-ray
Bronchoscopy
CT thorax and abdomen.
MRI
Positron emission tomography.
Thoracentesis.
ABG analysis.
Pulmonary angiography
Lung scan
Fine needle aspiration
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13. MANAGEMENT
MEDICAL MANAGEMENT:1. Radiation therapy
2. Chemo therapy
3. Supportive management
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14. RADIATION THERAPY
DEFINITION:Radiation therapy, sometimes called
radiotherapy,
x-ray
therapy
radiation
treatment, cobalt therapy, electron beam
therapy,
or
irradiation
uses
high
energy, penetrating waves or particles such as
x rays, gamma rays, proton rays, or neutron
rays to destroy cancer cells or keep them from
reproducing.
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15. PURPOSE:• The purpose of radiation therapy is to kill or damage
cancer cells. Radiation therapy is a common form of
cancer therapy. It is used in more than half of all cancer
cases. Radiation therapy can be used:
• alone to kill cancer
• before surgery to shrink a tumour and make it easier to
remove
• during surgery to kill cancer cells that may remain in
surrounding tissue after the surgery (called intra
operative radiation)
• after surgery to kill cancer cells remaining in the body
• to shrink an inoperable tumour in order to and
reduce pain and improve quality of life.
• in combination with chemotherapy.
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TYPES OF RADIATION
External beam radiation:it is a delivery of radiation from a source placed at
some distance from the target site.
Internal radiation:placement of specially prepared radio isotopes
directly to tumor itself.
Sealed source radiation:usually cesium 137 or radium 226 is used. This is
used for both intracavity and interstitial therapy.
Unsealed source of radiation:its used for internal radio therapy or colloid
suspensions that come in to direct contact with body
tissue.
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17. CHEMOTHERAPY
Definition :it’s a treatment of cancer with anticancer
drugs.
TYPES:• Adjuvant chemotherapy:Used after initial treatment with either surgery or
radiation therapy.
• Neoadjuvant chemotherapy:It refers to the pre operative treatment of
chemotherapy to reduce the bulk and the lower the
stage of tumor, making it amenable to surgery.
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18. SURGICAL MANAGEMENT
1. Laser surgery:
Its used as a palliative for relief of endotracheal
obstruction that are not reactable . The tumor
measurement is accessible only by bronchoscopy.
2. Pulmonary resection:Complete resection of tumor remains the best
chance of cure.
3. Wedge resection:it is the removal of a localized area of diseased
tissue near the surface of the lung.
4. Segamental resection:It’s the removal of the one or more lung segment
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19. Contd……
5. Bronchoscopic laser therapy:It’s helps to remove the obstructing bronchial
lesions
6. Thoracotomy:It’s a surgical incision into the thorax.
7. Decortication:Decortication is a medical procedure
involving the surgical removal of the surface
layer, membrane , or fibrous cover of an organ.
The procedure is usually performed when
the lung is covered by a thick, inelastic pleural
peel restricting lung expansion.
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20. Contd……….
8. Lobectomy:it’s a removal of the lobe of the lung.
9. Pneumonectomy:it’s a partial or total removal of the lungs.
10.Thoracoplasty:it’s a repair of the thoracic cavity.
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21. NURSING MANAGEMENT
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Airway control:Assess the patency of airway.
Assess the respiratory status of the patient.
Provide high fowlers position.
Teach deep breathing and coughing exercises.
Administration of O2 therapy.
Pain control:Assess the intensity location and duration of pain.
Administer analgesics.
Provide psychological support.
Provide diversional therapy.
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22. 3.
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Provide balanced nutrition:Assess the nutrition status of the patient.
Provide small and frequent diet.
Check the weight regulerly.
Avoid to cold and too hot items.
Avoid spicy foods and beverages.
Provide frequent oral care.
Reduce anxiety:Assess the anxiety level of the patient.
Reassure the patient.
Encourage the patient to do some diversional
activities.
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23. NURSING DIAGNOSIS
• Ineffective airway clearance related to increased
trachio bronchial secretion and presence of
tumor as manifested by persistent cough and
dyspnoea.
• Acute pain related to metastasis of the tumor
tissue as manifested by facial expression and pain
score.
• Activity intolerance related to decreased O2
supply and demand as manifested by dyspnoea
and fatigue.
• Imbalanced nutritional status less than body
requirement related to anorexia as manifested by
decreased food intake and the ,condition of the
body weight.
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24. COMPLICATIONS
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Haemoptysis
Nerve damage.
Superior venecava syndrome.
Metastasis.
Pleural effusion.
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25. HEALTH EDUCATION
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Personal hygiene
Avoid exposure to irritants
Nutrition
Exercise
Medication
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26. BIBLIOGRAPHY
• Lewis S. The textbook of medical surgical
nursing. 2nd edition . Mosby publication. New
York 2002
• Robbins and Cortan. Pathologic basic of
disease 8th edition Elsevier. India 2010
• Siddarth and burner’s textbook of
medicine/surgical nursing 10th edition.
Lippincott Wilkims and Wilkims New york
2004
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