Lung Cancer

- Also called bronchogenic cancer

- Is a disease of uncontrolled cell growth in tissues of the lung which may lead to
metastasis
- Is the most common cause of cancer-related death in men and women, is
responsible for 1.3 million deaths worldwide annually, as of 2004

Types of lung cancer

Doctors divide lung cancer into two major types based on the appearance of lung cancer
cells under the microscope. The doctor makes treatment decisions based on which major
type of lung cancer one has. The two general types of lung cancer include:
• Small cell lung cancer. Small cell lung cancer occurs almost exclusively in
heavy smokers and is less common than non-small cell lung cancer.

Stages of non-small cell lung cancer

 Stage I. Cancer at this stage has invaded the underlying lung tissue but hasn't
spread to the lymph nodes.
 Stage II. This stage cancer has spread to neighboring lymph nodes or invaded
the chest wall or other nearby structures.
 Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes in
the center of the chest.
 Stage IIIB. The cancer has spread locally to areas such as the heart, blood
vessels, trachea and esophagus — all within the chest — or to lymph nodes in
the area of the collarbone or to the tissue that surrounds the lungs within the
rib cage (pleura).
 Stage IV. The cancer has spread to other parts of the body, such as the liver,
bones or brain.

• Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for
several types of lung cancers that behave in a similar way. Non-small cell lung
cancers include squamous cell carcinoma, adenocarcinoma and large cell
carcinoma.

Stages of small cell lung cancer

 Limited. Cancer is confined to one lung and to its neighboring lymph nodes.
 Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and
may have invaded both lungs, more-remote lymph nodes, or other organs,
such as the liver or brain.
 Signs and Symptoms

 dyspnea (shortness of breath)

 hemoptysis (coughing up blood)
 chronic coughing or change in regular coughing pattern
 wheezing
 chest pain or pain in the abdomen
 cachexia (weight loss), fatigue, and loss of appetite
 dysphonia (hoarse voice)
 clubbing of the fingernails (uncommon)
 dysphagia (difficulty swallowing)

Causes

 Smoking
 Radon Gas
 Asbestos
 Viruses
 Particulate Matter

Risk Factors

 Smoking
 Exposure to secondhand smoke
 Exposure to radon gas
 Exposure to asbestos and other chemicals
 Family history of lung cancer
 Excessive alcohol use
 Certain lung diseases

Complications

 Shortness of breath
 Hemoptysis (coughing up blood)
 Pain
 Pleural effusion (fluid in the chest)
 Metastasis
 Death

Screening
Screening refers to the use of medical tests to detect disease in asymptomatic people.
Possible screening tests for lung cancer include chest radiograph or computed
tomography (CT). As of December 2009, screening programs for lung cancer have not
demonstrated any benefit.

Tests and Diagnosis

 Imaging tests – x-ray

 Sputum cytology
 Biopsy

Treatment and Drugs

 Surgery
o Wedge resection to remove a small section of lung that contains the
tumor along with a margin of healthy tissue
o Segmental resection to remove a larger portion of lung, but not an entire
lobe
o Lobectomy to remove the entire lobe of one lung
o Pneumonectomy to remove an entire lung

 Chemotherapy – uses drugs to kill cancer

 Radiation Therapy – Radiation therapy uses high-powered energy beams, such as

X-rays, to kill cancer cells.
o External beam radiation – Radiation therapy directed at the lung cancer
from outside the body
o Brachytherapy – Radiation put inside needles, seeds or catheters and
placed inside the body near the cancer

 Targeted Drug Therapy – Targeted therapies are newer cancer

treatments that work by targeting specific abnormalities in cancer cells. Targeted
therapy options for treating lung cancer include:
o Bevacizumab (Avastin). Bevacizumab stops a tumor from creating a new
blood supply. Blood vessels that connect to tumors can supply oxygen and
nutrients to the tumor, allowing it to grow. Bevacizumab is usually used in
combination with chemotherapy and is approved for advanced and
recurrent non-small cell lung cancer. Bevacizumab carries a risk of
bleeding, blood clots and high blood pressure.
o Erlotinib (Tarceva). Erlotinib blocks chemicals that signal the cancer
cells to grow and divide. Erlotinib is approved for people with advanced
and recurrent non-small cell lung cancer that haven't been helped by
chemotherapy. Erlotinib side effects include a skin rash and diarrhea.
 Treatment options for non-small cell lung cancers
Stage Common options
I Surgery, sometimes chemotherapy
II Surgery, chemotherapy, radiation
Combined chemotherapy and radiation, sometimes surgery based on results of
IIIA
treatment
IIIB Chemotherapy, sometimes radiation
IV Chemotherapy, targeted drug therapy, clinical trials, supportive care
Treatment options for small cell lung cancers
Stage Common options
Limited Combined chemotherapy and radiation, sometimes surgery
Extensive Chemotherapy, clinical trials, supportive care

Prevention

There's no sure way to prevent lung cancer, but you can reduce your risk if you:

• Don't smoke
• Stop smoking
• Avoid secondhand smokeTest your home for radon
• Avoid carcinogens at work
• Eat a diet full of fruits and vegetables
• Drink alcohol in moderation, if at all
• Exercise

Assessment

• New or changing cough, dyspnea, wheezing, excessive sputum production,

hemoptysis, chest pain (aching, poorly localized), malaise, fever, weight loss,
fatigue, or anorexia.
• Decreased breath sounds, wheezing, and possible pleural friction rub (with pleural
effusion) on examination.

Nursing Interventions
1. Elevate the head of the bed to ease the work of breathing and to prevent fluid
collection in upper body (from superior vena cava syndrome).
2. Teach breathing retraining exercises to increase diaphragmatic excursion and
reduce work of breathing.
3. Augment the patient’s ability to cough effectively by splinting the patient’s chest
manually.
4. Instruct the patient to inspire fully and cough two to three times in one breath.
5. Provide humidifier or vaporizer to provide moisture to loosen secretions.
6. Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the
severely dyspneic patient to sleep in reclining chair.
7. Encourage the patient to conserve energy by decreasing activities.
8. Ensure adequate protein intake such as milk, eggs, oral nutritional supplements;
and chicken, fowl, and fish if other treatments are not tolerated – to promote
healing and prevent edema.
9. Advise the patient to eat small amounts of high-calorie and high-protein foods
frequently, rather than three daily meals.
10. Suggest eating the major meal in the morning if rapid satiety is the problem.
11. Change the diet consistency to soft or liquid if patient has esophagitis from
radiation therapy.
12. Consider alternative pain control methods, such as biofeedback and relaxation
methods, to increase the patient’s sense of control.
13. Teach the patient to use prescribed medications as needed for pain without being
overly concerned about addiction.
Cross section of a human lung. The white area in the upper lobe is cancer; the black areas are
discoloration due to smoking.

Chest radiograph showing a cancerous tumor in the left lung.

CT scan showing a cancerous tumor in the left lung