LUNG CANCER\ DEFINITION It arise from a single transformed epithelial cell in the tracheobronchial airways.

CHARACTERISTICS OF LUNG CANCER non-small cell carcinoma 70-75% of tumors - this includes sqamous cell carcinoma, large cell carcinoma, and adenocarcinoma (bronchioalveolar carcinoma) - staged as I to IV small cell carcinoma 15-20% of tumors - arise in the major bronchi and spread along the bronchial wall by infiltration - classified as limited or extensive Growth Rate CELL Slow Metastasis CARCINOMA** Late; mostly to hilar lymph nodes Biopsy, Sputum analysis, bronchoscopy, electron microscopy, immuno-histo chemistry Cough, hemoptysis, sputum production airway obstruction, hypercalcemia; treated surgically, chemotherapy, radiation as adjunctive therapy Pleural effusion; treated surgically, chemotherapy[y as adjunctive therapy Chest wall pain, pleural effusion, Means of Diagnosis Clinical Manifestations and Treatment

Tumor Type **NON-SMALL Squamous cell carcinoma

Adenocarcinoma

Moderate

Early; to lymph nodes, pleura, bone, adrenal glands & brain Early and wide spread

Radiography, fiberoptic bronchioscopy, electron microscopy Sputum analysis, Broncoscopy,

Large cell carcinoma

Rapid

electron microscopy(by exclusion of other cell types)

**SMALL Very rapid CELL CARCINOMA**

Very Early; to mediastinum, lymph nodes, brain, bone marrow

Radiography, sputum analysis, bronchoscopy, electron microscopy, immuno-histo chemistry

cough, sputum production, hemoptysis, airway obstruction resulting in pneumonia; treated surgically Cough, chest pain, dyspnea, hemoptysis, localized wheezing, airway obstruction, s/sx of excessive hormone secretion; treated by chemotherapy and ionizing radiation to thorax and CNS

RISK FACTORS People who practices smoking People who have partners who smokes or are exposed to people who are smoking (Passive Smoking) -people exposed to carcinogens such as asbestos, radon gas and etc. People who have familial predisposition of lung cancer People who does not practice proper diet and nutrition

ETIOLOGY Smoking 2nd hand smoking Environment Genetics Improper diet and nutrition

PATHOPHYSIOLOGY

DIAGNOSTIC PROCEDURES History and physical examination may reveal the presence of symptoms or signs that are suspicious for lung cancer. CHEST X-RAY is the most common first diagnostic step when any new symptoms of lung cancer are present. MRI (magnetic resonance imaging):In some patients, MRI will be used to evaluate the possibility of lung cancer. This procedure uses magnetism and does not involve radiation. CAUTION!:- Patients with metal implants (pacemakers, etc.) should not have MRI PET scan:A PET scan uses radioactive material to create colorful 3-dimensional images of a region of the body. This type of scan differs from the others in that it defines tumors that are actively growing. Research studies suggest that, among the lung cancer tests, PET scanning may detect tumors earlier even before they are visible anatomically through other studies. Sputum Cytology: This lung cancer test is the easiest way to confirm the lung cancer diagnosis and also for determining the type of cancer after a lung tumor is suspected based on imaging. Major Drawbacks: + Sputum cytology use is limited to those tumors that extend into the airways. + Sputum cytology is not always accurate and can miss some cancer cells. Bronchoscopy :In a bronchoscopy, a lung specialist inserts a tube into the airways to visualize and take a sample of the tumor. This procedure is used when the tumor is found in the large airways and can be reached by the scope. Needle Biopsy (fine needle aspiration) :For the tumors that cannot be reached by bronchoscopy, a hollow needle is inserted through the chest wall, usually guided by CT visualization, to take a sample of the tumor. Patients are given anesthesia during this procedure to minimize discomfort. Thoracentesis :When lung cancer affects the periphery of the lungs, it can create a fluid buildup between the lungs and the lung lining (pleural effusion). With local anesthesia, a larger needle is inserted into the pleural space from which either a diagnostic amount of fluid (small amount to test for cancer cells) or a therapeutic amount of fluid (large amount to improve pain/shortness of breath) is removed. Mediastinoscopy :This procedure is done in the operating room under general anesthesia. A scope is inserted just above the sternum (the breast bone) into the region between the lungs to take tissue samples from lymph nodes.

Spread of lung cancer (Metastasis) Lung cancer most commonly spreads to the liver, the adrenal glands, the brain, and the bones. Common tests include: CT scan of the abdomen to check for spread to the liver or adrenal glands CT scan of the brain to look for metastases to the brain Bone Scan to test for bone involvement, especially the back hips and ribs Other tests during diagnosis: Additional non-diagnostic tests are frequently performed during the diagnosis of lung cancer as

well. These can include: Pulmonary function tests these test lung capacity and can determine how much the tumor is interfering with breathing, and sometimes, whether it is safe to perform surgery Blood tests certain blood tests can detect biochemical abnormalities caused by lung cancers, and can also suggest spread of the tumor MEDICAL MANAGEMENT Treatment of lung cancer depends on the type of tumor, its location and how far it has spread, as well as the persons general health. A process known as staging is used in each case to asses these factors and recommend appropriate treatment, which may include surgery, chemotherapy and radiotherapy. Surgery. When the tumor is away from the center of the chest and there is little or no spread typically non-small cell lung cancer (NSCLC), surgery is often used. It is used to remove all of the cancer in hope of a cure. Depending on the type and stage of the cancer, surgery may be used to remove the tumor and some of the lung tissue around it. If a lobe (section) of the lung is removed, the surgery is called a lobectomy. Removing only part of the lobe is called a wedge resection. If the entire lung is removed, the surgery is called a pneumonectomy. Chemotherapy. This is a course of anti-cancer drugs given to destroy cancer cells. They work by disrupting the growth of cancer cells. Chemotherapy drugs are mainly given through a catheter, which is a thin tube that is placed into a large vein. The catheter may be left in place for the duration of the treatment or removed after each treatment session. A number of drugs are available as a pill. Small cell lung cancer is treated with chemotherapy. It has side-effects, particularly nausea, vomiting and hair loss. However there are very good drugs to control these side effects. Hair always grows again about three months after the chemotherapy courses have finished. Radiation therapy. Radiotherapy is either 'radical' or 'palliative'. Radical is used in selected patients with localized tumors who are inoperable, and involves using high doses of radiation. Palliative radiotherapy is widely used. It involves using lower doses of radiation - often in just one or two doses. It is very good for relieving symptoms, such as blood in the sputum (hemoptysis), bone pain, and also for helping obstruction to the airway or large veins in the chest. NURSING MANAGEMENT Managing Symptoms o Instruct patient and family about the side effects of specific treatments and strategies to manage them. Relieving Breathing Patterns

o Maintain airway patency; remove secretions through breathing exercise, chest physiotherapy, directed cough, suctioning and in some instances bronchoscopy. o Administer bronchodilator medications; supplemental oxygenation will probably be necessary. o Encourage patients to assume positions that promote lung expansion and to perform breathing exercise for lung expansion and relaxation. o Teach energy conservation and airway clearance techniques. Reducing Fatigue o Assess level of fatigue; identify potentially treatable causes. o Educate patient in energy conservation techniques and guided exercise as appropriate. Providing Physiological Support o Help patient and family deal with poor prognosis and progression of the disease, if indicated. o Assist patient to undergo diagnostic procedure. o Support patient and family in end-of-life decisions and treatment options. o Help identify potential resources for the patient and family.

COMPLICATIONS Lung cancer may cause: Blockage of an airway by a tumor may lead to the collapse of the part of the lung that the airway supplies, a condition called atelectasis. Other consequences of a blocked airway are shortness of breath and pneumonia, which may result in coughing, fever, and chest pain.

If the tumor grows into the chest wall, it may produce persistent, unrelenting chest pain. Fluid containing cancerous cells can accumulate in the space between the lung and the chest wall (pleural effusions) Large amounts of fluid can lead to shortness of breath. If the cancer spreads throughout the lungs, the levels of oxygen in the blood drop and become low, causing shortness of breath and eventually enlargement of the right side of the heart and possible heart failure (cor pulmonale)

 Lung cancer may grow into certain nerves in the neck, causing a droopy eyelid, small pupil, sunken eye, and reduced perspiration on one side of the facetogether these symptoms are called Horner's syndrome. Cancers at the top of the lung may grow into the nerves that supply the arm, making the arm painful, numb, and weak. Tumors in this location are often called Pancoas't tumors. When the tumor grows into nerves in the center of the chest, the nerve to the voice box may become damaged, making the voice hoarse. Lung cancer may grow into or near the esophagus, leading to difficulty swallowing or pain with swallowing. Lung cancer may grow into the heart or in the midchest (mediastinal) region, causing abnormal heart rhythms, blockage of blood flow through the heart, or fluid in the sac surrounding the heart (pericardial sac). The cancer may grow into or compress one of the large veins in the chest (the superior vena cava); this condition is called superior vena cava syndrome. Obstruction of the superior vena cava causes blood to back up in other veins of the upper body. The veins in the chest wall enlarge. The face, neck, and upper chest wallincluding the breastscan swell, causing pain. The condition can also produce shortness of breath, headache, distorted vision, dizziness, and drowsiness. These symptoms usually worsen when the person bends forward or lies down. Lung cancer may also spread through the bloodstream to other parts of the body, most commonly the liver, brain, adrenal glands, spinal cord, or bones. The spread of lung cancer may occur early in the course of disease, especially with small cell lung cancer. Symptomssuch as headache, confusion, seizures, and bone painmay develop before any lung problems become evident, making an early diagnosis more complicated. Paraneoplastic syndromes consist of effects that are caused by cancer but occur far from the cancer itself, such as in nerves and muscles. These syndromes are not related to the size or location of the lung cancer and do not necessarily indicate that the cancer has spread outside the chest. These syndromes are caused by substances secreted by the cancer (such as hormones, cytokines, and various other proteins).