Introduction | Definition |Risk factor |Types of Lung Cancer | Pathophysiology | Stages of Cancer | Clinical Manifestation | Diagnostic Evaluation | Management |Nursing Management |
- 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?
- “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?
- The exact cause is unknown.
* What are the risk factors of lung cancer?
- 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
- 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:-
- Non-Small Cell Lung Cancer (NSCLC)
- 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
- Large cell carcinoma
- Squamous cell carcinoma:- Arrives from bronchial epithelium & is more centrally located and its growth rate is slow.
- 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.
- 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.
- 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):-
- Small cell carcinoma (SCC):– Arrives from the major bronchi & spread by infiltration along with bronchial walls. The growth rate is very rapid.
- 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?
- 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:-
- T o:- No evidence of tumor.
- T x:- Tumor proved by cytologic studies, but visualize by radiography.
- T is:- Carcinoma in situ.
- T 1:- Tumor 3cm or less.
- T 2:- Tumor greater than 3cm.
- T 3:- Direct extension of the chest wall.
- T 4:- Tumor invading mediastinal.
- N o:- No nodule metastasis.
- N 1-3:- According to the progress of nodule involvement.
- M o:- NO known metastasis.
- M 1:- Presence of distant metastasis.
* What are the clinical manifestation or Enlist clinical manifestation of cancer?
Enlist clinical manifestation:-
- Asymptomatic till diagnosis.
- Non-productive cough at earlier and in later productive cough.
- Blood tinged sputum.
- Chest pain.
- 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)
- Weight loss.
- Nausea, Vomiting.
* What is the diagnostic evaluation or Enlist diagnostic evaluation of cancer?
- 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.
- Pulmonary Angiography.
- Lungs scan.
- Fine needle aspiration.
* What are the complications of lung cancer?
- Airway obstruction
- Plural effusion
- Pulmonary Abscess
- Paraneoplastic syndrome
Prognosis is generally poor,13%of patients with lung cancer survivors.
* Describe the management of lung cancer?
Management of Lung cancer:-
- wedge resection
- Radiation therapy
- Laser surgery
- Ineffective breathing pattern resulting from compression of lung tissue.
- Impaired gas exchange resulting from retained secretion and occluded bronchial.
- Acute pain related to surgical incision tissue trauma and disruption of inter-coastal nerves, presence of chest tube.
- Fear and anxiety related to situational crises, change in health status, and perceived threat of death.