pulmonary neoplasm final
TRANSCRIPT
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PULMONARY NEOPLASM
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INTRODUCTION
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Lung cancer is malignancy in the epithelium of
the respiratory tract
DEFINITION
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Lung cancer accounts about 6.8% of all
malignancies in India The incidence is estimated to be about
6.6%per one lakh in males1.7per one lakh among in females
INCIDENCE
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Cigarette smoking
Exposure with radioactive isotopes, polycyclic hydro carbons, vinyl chloride, metallurgical ores , and mustard gas.
RISK FACTORS
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cigarette smoking include inhaled toxins, such as as bestos, and
pollutants. ,radon, nikal ,iron iron oxides uranium polycyclic aromatic
hydrocarbons chromates arsenic ,air pollution Working in mines smelting or chemical or petroleum manufacturing
Contd…
ETIOLOGY
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polycyclic aromatic hydrocarbons
chromates,arcenic,air pollution, lung disease,TB pneumonia diet low in fruit and vegetables previous radiotherapy to the chest
Contd..
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PATHOPHYSIOLOGY
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Remote effects of malignancy occur in 10 to
20 per cent of lung cancerclients. These usually result from the secretion of sub stances (e.g., hormones, enzymes and antigens) by the tumor itself. These substances then act on target organs, producing a vari ety of symptoms called paraneoplastic symptoms
Paraneoplastic syndromes
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small cell lung cancer, non-small cell lung cancer
Classification and Staging
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T is the tumors size ,location and degree of
invasion N is the regional node involvement M is distant metastasis
Staging
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Early Asymptomatic until late phase Persistent Cough Dyspnoea Chest and shoulder pain Recurrent temperature Recurrent infection Blood tinged sputum Wheeze Anorexia Weight loss Vomiting Hoarseness of voice
Clinical Manifestations
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Bone pain Spinal cord compression Chest pain Dysphasia Blurred vision Pleural effusion Horseness of voice Dysphagia Head and neck oedema
Late
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Localized Cough mostly chronic dry cough Breathing symptoms -shortness of breath and strider Changes in sputum -increased amount Hemoptysis Pneumonia Hoarseness of voice chest pain and tightness
Signs symptoms depends upon location of lesion
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Bone pain Head ache Mental status changes Abdominal pain Anorexia Idiopathic weight loss Pancots syndrome Horner's syndrome Pleural effusion Svenalar syndrome
generalized
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CXR CT PET SCAN sputum cytology biopsy thoracoscopy bronchoscopy CBC-WBC RBC BIOPSY Contd..
Assessment and Diagnostic Findings
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MRI FNAC Pleural aspirate cytology Mediastinoscopy Lymph node biopsy Open lung biopsy (rare) esophageal ultrasound (EUS) lung scan spirometry, video assisted
thoracoscopy, pulmonary angiography, lung scan
Contd..
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treatment may involve surgery, radiation therapy, chemotherapy combination of these. immune system therapy (gene therapy, therapy with defined tumor
antigens biological response modifiers)
Management
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includingalkylating agents (ifosfamide),
platinum analogues (cisplatin andcarboplatin), taxanes (paclitaxel, docetaxel), vinca alkaloids(vinblastine and vindesine), doxorubicin, gemcitabine, vinorelbine,irinotecan (CPT-11), and etoposide (VP-16)
CHEMOTHERAPY
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Radiation is used to reduce the size of a
tumor, to make an inoperable tumor operable, relieve the pressure of the tumor on vital
structures. control symptoms of spinal cord metastasis
and superior vena caval compression Reduce bone and liver pain.
RADIATION THERAPY
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diminished cardiopulmonary function pulmonary fibrosis, Pericarditis, myelitis cor pulmonale. pneumonitis. Pulmonary toxicity
Treatment-Related Complications
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lobotomy (removal of a lobe of the lung). Entire lung may be
removed(pneumonectomy)
SURGICAL MANAGEMENT
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Wedge Resection. Segmental Resection. Segmental Resection. Pneumonectomy.
Types of surgical approaches
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laser use is palliative for the relief of
endobronchial obstructions caused by non resectable lung tumors. Lasers do not produce systemic or cumulative toxic effects and are well tolerated.
LASER THERAPY
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CLOSED CHEST DRAINAGE
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Metastasis.
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sarcomas, lymphomas, bronchial adenomas.
OTHER TYPES OF LUNG TUMORS
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Hamartomas Chondromas Mesotheliomas
Benign tumors.
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Nursing Management
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Ineffective airway clearance related to
increased tracheobronchial secretions and presence of tumor
Anxiety related to lack of knowledge of diagnosis or unknown prognosis and treatments
Acute pain related to pressure of tumor on surrounding structures and erosion of tissues
Nursing Diagnoses
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Imbalanced nutrition: less than body
requirements related to increased metabolic demands, increased secretions, weakness, and anorexia
Ineffective health maintenance related to lack of knowledge about the disease process and therapeutic regimen
Ineffective breathing pattern related to decreased lung capacity.
Contd..
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health promotion, managing symptoms relieving breathing problems reducing fatigue providing psychological support acute intervention. ambulatory and home care
Nursing Implementation
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Evidence based practice
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CONCLUSION