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Lung Cancer, Cites: Ignatavicius, D., Workman, L., Rebar, C., &…
Lung Cancer
Pathophysiology
Lung cancer is one of the leading causes of cancer related deaths
Prognosis is very poor because the cancer is often found late, after metastasis has occurred
The 5 year survival rate for all patients with lung cancer is 19%
Most cancers arise as a result of failure of cellular regulation in bronchial epithelium
These cancers are called bronchogenic carcinomas and there are 2 types:
Small cell lung cancer (SCLC) is fast growing and linked to patient history of smoking cigarettes
Non-small cell lung cancers (NSCLC) are more common than small cell
These patients often get paraneoplastic syndromes, which complicate the cancer. This is caused by hormones secreted by tumor cells
Lung cancers occur as a result of exposure to inhaled substances that cause tissue irritation and inflammation that interferes with cellular regulation
Cigarette smoke is the biggest risk factor and has caused 81% of lung cancer deaths
Risk Factors:
chronic exposure to asbestos, beryllium, chromium, coal distillates, cobalt, iron oxide, mustard gas, petroleum distillates, radiation, tar, nickel, and uranium
The adenocarcinoma form of NSCLC can occur in never smokers. These are often young women that have had exposure to environmental carcinogens, second hand smoke, genetic differences, familial predisposition, and advancing age
Patient Education
Promote smoking cessation
Teach patient to use proper mask and protective equipment when working in environments with carcinogens in the air
Encourage the client to take rest periods as needed, and don't overdo it
Educate on getting good nutrition (high calorie diet) to increase energy, and drink adequate fluids for hydration
Educate patient on what they should expect, and make sure they don't have questions on their options
Refer patient to counselor so that if they have any anxiety, they can be helped
Educate patient on positive coping mechanisms, and inform them that grief is expected with a terminal cancer diagnosis
Assessment
Determine pack year history (number of packs of cigarettes smoked per day x number of years smoked)
Ask about use of any tobacco products
Monitor for any cough that changes in pattern
manifestations (usually late in the disease)
fatigue, weight loss, fever, persistent cough with or without hemoptysis, altered breathing pattern, diminished or absent breath sounds, chest pain or tightness, muffled heart sounds (cardiac tamponade), pleural friction rub, clubbing of fingers, accessory muscle use, and decreased bone density
Testing:
cytologic testing - sputum specimen, looking for cancer cells
thoracoscopy, bronchoscopy, mediastinoscopy - most likely will take a biopsy from these for cancer cells
X-ray, CT scan - looking for lung lesions/tumor
Thoracentesis with pleural biopsy, MRI, PET scan - looking for presence of cancer, as well as if it metastasized
Interventions
Screen patients at high risk for lung cancer yearly with a CT
Most lung cancers are found late in the disease, so the focus is mostly on palliative care. Some palliative procedures are:
thoracentesis to ease breathing
laser therapy and photodynamic therapy to open airways blocked by tumors
pericardiocentesis or pericardial window to improve cardiac function
oxygen therapy
Non surgical management:
chemotherapy
targeted therapy (mostly with NSCLC) - takes advantage of slight differences in cancer cell growth or metabolism that aren't present in normal cells, you have to do testing before to determine if the cells are different
radiation
photodynamic therapy - performed through bronchoscopy to treat small, accessible tumors
surgical management
main treatment, trying to remove the tumors, often involves removal of the lung (pneumonectomy), lobe (lobectomy), segment (segmentectomy), or peripheral lung tissue (wedge resection)
Cites:
Ignatavicius, D., Workman, L., Rebar, C., & Heimgartner, N. (2021). Medical-surgical nursing:
Patient-centered collaborative care.
Evolve
, (10th ed.). ISBN: 978-0-323-61242-5
Holman, H. C., Williams, D., Johnson, J., Ball, B. S., Wheless, L., Leehy, P., & Lemon, T. (2019). RN Adult medical surgical nursing: Review module. Assessment Technologies Institute