04/12/2023

PRESENTED BY, ANU JAMES. MSc (N)

LUNG CANCER

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LUNG CANCER.

• DEFINITION: Chest tumor or lung cancer is the

malignancy in the epithelium of the respiratory tract.

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ANATOMY AND PHYSIOLOGY.

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LUNGS

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LOBES OF LUNG

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BLOOD SUPPLY

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FUNCTIONSBRONCHI AND BRONCHIOLES:-• Control of air entry.• Warming and humidity• Support and patency.• Cough reflexRESPIRATORY BRONCHIOLES:-• External respiration.• Defense against microbes.• Warming and humidifying.

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ETIOLOGY AND RISK FACTORS.

• 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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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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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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CLINICAL MANIFESTATIONS

• 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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DIAGNOSTIC EVALUATIONS• 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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MANAGEMENT

MEDICAL MANAGEMENT:-

1. Radiation therapy2. Chemo therapy3. Supportive management

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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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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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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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SURGICAL MANAGEMENT1. 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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Contd……5. Bronchoscopic laser therapy:- It’s helps to remove the obstructing bronchial

lesions6. 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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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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NURSING MANAGEMENT1. 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.2. Pain control:-• Assess the intensity location and duration of pain.• Administer analgesics.• Provide psychological support.• Provide diversional therapy.

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3. 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.4. Reduce anxiety:-• Assess the anxiety level of the patient.• Reassure the patient.• Encourage the patient to do some diversional

activities.

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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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COMPLICATIONS

• Haemoptysis • Nerve damage.• Superior venecava syndrome.• Metastasis.• Pleural effusion.

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• Personal hygiene• Avoid exposure to irritants• Nutrition• Exercise• Medication

HEALTH EDUCATION

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• 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

BIBLIOGRAPHY