breast cancer

Lung Cancer Etiology

• Lung cancer often stems from mutations in damaged cells
• Environmental factors play a role
• Smoking is linked to 90% of lung cancer cases
• Prevention education involves cessation of smoking and avoiding secondhand smoke

Lung Cancer Etiology: Smoking

• Smoking can cause hyperplasia of the bronchial epithelial cells
• Smoking increases mucus production

Lung Cancer Classifications

• Non-small cell lung cancer is most common, accounting for 85% of all lung cancers
• Non-small cell sub-types include adenocarcinoma, squamous cell, and large-cell carcinoma
• Small cell lung cancer, also known as oat cell, spreads quickly

Lung Cancer Cell Types

• Small-cell carcinoma presents as a central lesion with hilar mass, often with early mediastinal involvement and no cavitation
• Small-cell carcinoma can cause syndrome of inappropriate antidiuretic hormone (SIADH), Cushing syndrome, and thrombophlebitis
• Small-cell carcinoma is an aggressive tumor, as over 40% of clients have distant metastasis at the time of presentation
• Adenocarcinoma presents as a peripheral mass involving bronchi with few local symptoms but may cause hypertrophic pulmonary osteoarthropathy
• Adenocarcinoma can lead to early metastasis to the central nervous system, skeleton, and adrenal glands
• Squamous cell carcinoma is a central lesion located in large bronchi, can lead to cough, dyspnea, atelectasis, and wheezing, and is often associated with hypercalcemia
• Squamous cell carcinoma spreads by local invasion
• Large-cell carcinoma is usually a peripheral lesion larger than that associated with adenocarcinoma, often cavitates, and can lead to gynecomastia and thrombophlebitis
• Large-cell carcinoma can lead to early metastasis

Lung Cancer Pathophysiology

• Lung cancer is mostly bronchogenic in origin
• Chronic irritation leads to hyperplasia of goblet cells, making cilia less effective
• Continued irritation causes basal cells to proliferate, invading areas occupied by goblet and columnar cells
• Breast, gastrointestinal (GI) tract, and genitourinary (GU) tract are common sites for secondary metastasis

Lung Cancer Stages

• In Stage I, the tumor is small, minimally invasive, and has not spread at all in one lung
• In Stage II, the tumor grows larger and starts to spread slightly in one lung
• In Stage III, cancer starts to spread from the lungs to lymph nodes and nearby organs like the esophagus and trachea
• In Stage IV, cancer has widely spread through the lungs and body and may affect outside organs

Lung Cancer Manifestations

• The location and spread of the tumor has dependence
• Symptoms often relate to the primary tumor, manifestations of metastasis, and systemic disease
• Clinical manifestations include chronic cough, hemoptysis, wheezing, shortness of breath, pain, weight loss, anorexia, and weakness

Lung Cancer Testing

• Diagnostic testing includes:
  • History and physical examination
  • Chest X-Ray (CXR)
  • Chest Computed Tomography (CT) scan
  • Bronchoscopy
  • Sputum specimen
  • Cytology
  • Pulmonary Function Tests (PFT's)
  • Arterial Blood Gases (ABG's)

Lung Cancer Treatment

• Treatment options include:
  • TNM staging
  • Chemotherapy
  • Radiation
  • Targeted drugs
  • Immunotherapy
  • Surgery, including lobectomy, pneumonectomy, wedge resection, and segmental resection

Lung Cancer TNM Staging

• T1 indicates a tumor less than 3 cm (1 1/2 inches) in size
• T2 indicates a tumor is greater than 3 cm
• T3 indicates a tumor of any size near the airway or spread to local areas like the chest wall or diaphragm
• T4 indicates a tumor of any size located in the airway or has invaded local structures like the heart or the esophagus
• N0 signifies that no lymph nodes are affected
• N1 indicates the tumor has spread to nearby nodes on the same side of the body
• N2 indicates the tumor has spread to nodes further away but on the same side of the body
• N3 indicates the presence of cancer cells in lymph nodes on the other side of the chest from the tumor or in nodes near the collarbone or neck muscles
• M0 means no metastases are present
• M1 means the tumor has spread (metastasized) to other regions of the body or the other lung

Lung Cancer Surgical Options

• Wedge resection removes a small portion of a lobe
• Segment resection removes a larger portion of a lobe
• Lobectomy removes an entire lobe
• Pneumonectomy removes the entire Lung

Lung Cancer Caring Interventions

• Interventions include:
  • Monitoring for paraneoplastic syndrome symptoms
  • Promoting effective cardio-respiratory function
  • Pain control
  • Emotional support
  • Increased nutritional state
  • Patient education on smoking cessation