Lung cancer: Risk Factor, Types, Stages of Cancer, Symptoms, Investigation, Nursing Management

Introduction | Definition |Risk factor |Types of Lung Cancer | Pathophysiology | Stages of Cancer | Clinical Manifestation | Diagnostic Evaluation | Management |Nursing Management |

Introduction:-

• Lung cancer is cancer that starts in the cells that make up the lungs. Many other types of cancer such as breast or kidney can spread to the lungs.
• lung cancer is the fourth most common cancer reportedly in Indian males. It accounts for 6.8% of all malignancies in India.
• The incidence is estimated to be about 6.6 per 100000 in males and 1.7 per 100000 in females.
• Commonly occur in individuals more than 50yrs of age who have a long history of cigarette smoking.

* What is the definition of lung cancer or define lung cancer?

Definition:-

• “Lung cancer also known as lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissue of the lung.”
• “Lung cancer is a neoplasm of the lung.”

* What are the causes of lung cancer?

Etiology:-

• The exact cause is unknown.

* What are the risk factors of lung cancer?

Risk factor:-

• Genetic (transformation from one generation to another generation.)
• Age (mostly in older age, 65 or older age, the average age is 70 year)
• Past lung disease ( can cause inflammation and scarring in the lung, eg: Tuberculosis, COPD)
• Radiation therapy to the chest (eg. breast therapy, Non-Hodgkin’s lymphoma)
• Second-Hand Smoking
• Smoking
• Diet (low intake of vitamin-A, unbalanced diet)
• Environmental factor :- Asbestosis,Radon,Tar,Arsenic,Vinyl chloride)

* What are the types of lung cancer? Or Enlist and explain the types of lung cancer?

* Explain NSCLC? What are the subtypes of NSCLC? Explain with its characteristics?

Types of Lung cancer:-

There are two types of lung cancer:-

1. Non-Small Cell Lung Cancer (NSCLC)
2. Small Cell Lung Cancer (SCLC)

Non-Small Cell Lung Cancer (NSCLC):-

• NSCLC is any type of epithelial lung cancer other than small cell lung carcinoma.
• NSCLC accounts for about 85% of all lung cancer.
• NSCLC is relatively insensitive to chemotherapy compared to small cell lung cancer.
• When possible they are primarily treated by surgical resection with curative intent, although chemotherapy has been used increasingly both pre-operative and post-operative.

The most common type of NSCLC are:-

• Squamous cell carcinoma
• Adenocarcinoma
• Large cell carcinoma

1. Squamous cell carcinoma:- Arrives from bronchial epithelium & is more centrally located and its growth rate is slow.

Characteristics:-

• Accounts for 20-30% of lung cancers.
• more common in men. Centrally located producing early symptoms of non-productive cough and hemoptysis.
• do not have a strong tendency to metastasis.

Response to therapy:-

• Surgically resection may be attempted.
• Adjuvant chemotherapy and radiation.

2. Adenocarcinoma:- It arrives from the periphery of the lung and looks like nodules often metastasized. Its growth rate is moderate.

Characteristics:-

• Accounts for 30-40% of lung cancer.
• The most common lung cancer in people.who has not smoked more common in women.
• Peripherally located often has no clinical manifestation until widespread metastasis is present.

Response to therapy:-

• Surgical resection may be attempted depending on the staging.
• Doesn’t respond well to chemotherapy.

3. Large cell carcinoma (undifferentiated):-

It is the fast-growing carcinoma that arrives from the periphery branches of bronchi.

characteristics:-

• Accounts for 10% of lung cancers.
• Composed of large cells that are anaplastic and often arise in the bronchi.
• It is highly metastatic via lymphatics and blood.

Response to therapy:-

• Surgery is not usually attempted.because of the high rate of metastasis.
• A tumor may be radiosensitive but often recurs.

Small cell lung cancer (SCLC):-

1. Small cell carcinoma (SCC):– Arrives from the major bronchi & spread by infiltration along with bronchial walls. The growth rate is very rapid.

Characteristics:-

• Accounts for about 20% of lung cancers.
• The most malignant form of the lung.
• Spread early via lymphatics & bloodstream, frequent metastasis to the brain.
• Associated with endocrine disturbances.

Response to therapy:-

• Chemotherapy’s mainstay of treatment but overall poor prognosis.
• Radiation is used as adjuvant therapy and palliative measure.

* Describe or explain the pathophysiology of lung cancer?

Pathophysiology:-

• The carcinogens bind to the DNA
• Damage it.
• Cellular changes and abnormal growth
• Malignant cells.

As the damaged DNA is passed on to daughter cells, the DNA undergoes further changes and becomes unstable with the accumulation of genetic changes the pulmonary epithelium undergoes a malignant transformation.

* What are the stages of cancer?

Stages of cancer:-

1. T o:- No evidence of tumor.
2. T x:- Tumor proved by cytologic studies, but visualize by radiography.
3. T is:- Carcinoma in situ.
4. T 1:- Tumor 3cm or less.
5. T 2:- Tumor greater than 3cm.
6. T 3:- Direct extension of the chest wall.
7. T 4:- Tumor invading mediastinal.
8. N o:- No nodule metastasis.
9. N 1-3:- According to the progress of nodule involvement.
10. M o:- NO known metastasis.
11. M 1:- Presence of distant metastasis.

* What are the clinical manifestation or Enlist clinical manifestation of cancer?

Enlist clinical manifestation:-

• Asymptomatic till diagnosis.
• Persistent.
• Non-productive cough at earlier and in later productive cough.
• Blood tinged sputum.
• Chest pain.
• Dyspnoea.
• Wheezes.
• Palpable lymphnodes in neck or axilla.
• Unilateral paralysis of the diaphragm.
• Superior vena cava obstruction. (Due to into the thoracic spread of malignancy )
• Pericardial effusion and dysrhythmia. (if mediastinum is involved)
• Anorexia.
• Fatigue.
• Weight loss.
• Fever.
• Nausea, Vomiting.

* What is the diagnostic evaluation or Enlist diagnostic evaluation of cancer?

Diagnostic Evaluation:-

• Chest x-ray:- shows the presence of tumor or evidence of metastasis to ribs or vertebrae.
• CT-Scan and MRI:- shows the location and extent of masses.
• PET:- Helps in early detection of cancer staging and monitoring effects of treatment.
• Sputum specimen for cellular studies.
• Bronchoscopy:-Helps in direct visualization, allows taking biopsy specimen.
• Mediastinoscopy:- Involve insertion of scope through a small anterior chest incision into the mediastinum. It is done to examine metastasis in the anterior mediastinum or in the chest extrapleural.
• Biopsy.
• Pulmonary Angiography.
• Lungs scan.
• Fine needle aspiration.

* What are the complications of lung cancer?

Complication:-

• Airway obstruction
• Atelectasis
• Plural effusion
• Pulmonary Abscess
• Pneumonia
• Paraneoplastic syndrome

Prognosis:-

Prognosis is generally poor,13%of patients with lung cancer survivors.

* Describe the management of lung cancer?

Management of Lung cancer:-

Surgical management:-

1. lobectomy
2. wedge resection
3. Pneumonectomy

Medical management:-

1. Radiation therapy
2. Chemotherapy
3. Laser surgery

Nursing management:-

1. Ineffective breathing pattern resulting from compression of lung tissue.
2. Impaired gas exchange resulting from retained secretion and occluded bronchial.
3. Acute pain related to surgical incision tissue trauma and disruption of inter-coastal nerves, presence of chest tube.
4. Fear and anxiety related to situational crises, change in health status, and perceived threat of death.

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