CA Lung

X-ray

coin lesion -> indicate cancer cells are grouping tgt

canon ball -> many coin lesion

consolidation (solid); infiltration (liquid)

moist surface -> becoz cancer cell secrete exudate

pathophysio

normal defense mechanism of our body

ciliated cells -> filter particles & bacteria from air & sweep up trapped microorganisms

mucus secreting cells -> trapped microorganisms

dysfunction

both cells undergo hyperplasia -> continue secrete large amount of sputum & ciliated cells do not move upward -> stick tgt & cause obstruction

ca lung -> arises from epithelial lining of major bronchi -> develop from a small mucosal lesion and follow several patterns to grow

3 patterns

from intraluminal masses that invade the bronchial tissue & infiltrate the peribronchial connective tissue (bld vessels) -> causes hemoptysis

infiltrate to bronchioles and alveoli -> and entered the pleural membrane -> pleural effusion

form large, bulky masses that extend into the adjacent lung tissue

4 types of ca lung in total

small cell lung cancer (SCLC)

non small cell lung cancer(NSCLC)

  1. small cell carcinoma (20-25%)
  1. Squamous cell carcinoma (25-40%)
  1. Adenocarcinoma (20-40%)
  1. Large cell carcinoma (10-15%)

when being diagnosed, usually already at late stage -> best treat with chemo (x surgery)

Round to oval shape

highly malignant, infiltrate widely

rarely resectable

highly associated with cigarette smoking

closely related to smoking

diagnosed by cytology of sputum

originated in central bronchi -> hemoptysis

less association to smoking

located either in bronchiolar/ alveolar tissue

constitute a group of neoplasm

poor prognosis

occur in the periphery of lung

Risk factors

smoking (active/ passive)

air pollution

exposure to ionizing radiation

occupational hazard

family history

generic mutation (e.g. chromosome 35)

s/s

persistent , worsening cough

wheezing sound due to diminished lumen of obstruction of large airway -> high pitch sound

SOB

Hemoptysis (due to 1. tumou damage blood vessles/ 2. damage of lung tissue due to persistent coughing)

unexplained fatigue

anorexia, weight loss

pleural effusion (may have)

diagnostic test/ assessment

history taking

CXR -> for size, histology & location of primary tumour, coin lesion/ canon ball (but scars in CXR is not equal to hving ca lung, can be TB)

CT Scan (3D study, e.g. surface is moist...)

sputum cytology -> determine present of maglignant e.g. squamous cell carcinoma

USG -> for water level (ie pleural effusion) only

staging (TMN) -> refer to the notes

management

surgery

lobectomy -> removal of the affected lobe; preferred in small tumours

segmental resection -> removal of one/more than one segments of lung lobe

pneumonectomy -> removal of entire affected lung; attention to ventilation & perfusion problem

Radiotherapy

suitable for stage 1&2 NSCLC

either pre-op (shrink the tumor)/ post-op (control node- positive patient, preventing cancer from migrating to other organs through lymph node)

*Prophylactic cranial irradiation -> prevent and retard incidence of brain metastasis in SCLC

Palliative treatment for symptom control (eg severe cough, hemoptysis, pain, spinal cord compression [cord com] -> low back pain)

Positioning: supine, abducted arms, customized cast

Side effects: skin reaction/ infection/ wound, fatigue, anorexia

chemotherapy

  1. disruption of angiogenesis (growth of bld vessles) -> to suppress tumor growth; deal with vascular endothelial growth factor (VEGF) & platelet-derived growth factor (PDGF)

Tyrosine kinase inhibitor (TKIs) oral med: Sorafenib, Beracizumab, Ramucirumab

Platinum containing anti-cancer drug (IV): Cisplatin, carboplatin (with pint NS)
Side effects; fatigue, diarrhoea, anorexia, NV, bone marrow suppession

Nursing management/ intervention

History taking: tobacco use (amount...), occupational & environmental exposure, onset & duration of s/s

physical examination: cough, hemoptysis, dyspnea, any shoulder pain/ back pain

Lab findings

ABG

PaCO2 -> 4.6-6.0 kpa/ 35-45 mmhg

PaO2 -> 11-13.5 kpa/ 80-100 mmhg

Peak flow rate

FEV1 (35-70% -> mild to moderate ventilatory impairment)

FEV1 (<35%) -> severe impairment

Breathing problem

high fowler position (allow expansion of lung)

o2 therapy

pursed lip breathing

relaxation exercise, emotional support

clear secretion by increase fluid intake/ suctioning (norish the airway)

use of morphine, steroid

Nutritional problem

increase intake of semi soft diet

small & frequent diet

replaced by high nutritious milk

eat when antiemetic has peak effect

activity problem

active/ passive range of motion

rest in chair

optimal rest and limit activity

Altered health pattern

ask about their smoking problem (motivational interviewing)

not urging them to quit smoking but rather discuss the pros & cons of smoking with them

nicotine replacement therapy

education: harmful effect of smoking, benefit of quitting

Oral mucositis

NV+ -> since vomits are acidic -> easily cause wound -> some pt (eg cord com) -> low rbc -> prone to have infection -> bacteria may enter bloodstream thru wound -> sepsis

intervention: oral hygiene

NS (mild antibacterial agent): cheap, readily available, 1 teaspoon with 1L water

thymol gargle (1:3), generally non irritating

NASID (Difflam): anti-inflammatory & analgesic effect; cause oral numbness & dryness, altered sense of taste, used for radiation mucositis

NSAID (aspirin gargle):anti-inflammatory & analgesic effect; crush the tab and dissolve in water; x for GI haemorrhage patient

*Coagulation factor-> transamine (tranaxemic acid 300/250mg): open capsule-> dissolved the power in 10ml water -> hold in mouthfor at least 2 min -> then swallow

managing side effect

Alopecia: psychological support, before chemo -> short hair & hat, changing pillow case prn

bone marrow suppression -> beware of infection, inform when temp increase, educate patient to avoid crowd, bleeding? avoid trauma

infertility: do inform the truth to pt; can be temporary; if >2 yrs-> permanent