Cancer of the lung.

A tumour is a new lump or neoplasm

Primary or secondary.

Common primary sites include, kidney,

prostate, breast, bone, GIT, cervix or ovary

Caused by a hyperplasia.

Benign or malignant?

Three ways to spread, metastases.

Local effects of tumour, pressure,

obstruction, haemorrhage, necrosis.

Systemic effects of tumour, anaemia,

cachexia, hormonal, metastases.

Cancer of the trachea, bronchus,

lung and pleura account for 25%

of all cancers and are the most

common single group.

Upper respiratory malignancies are

uncommon.

Bronchogenic carcinoma is the most

common tumour in men.

It arises in the epithelium that

lines the bronchus.

Primary tissue types % Metastases

non small cell carcinoma, 40 late

usually squamus or

epidermoid carcinoma

Large cell carcinoma 25 early

Adenocarcinoma, (from 10

mucous glands in the

small bronchi)

Alveolar cell carcinoma 1-2

Small cell carcinoma,(or 20-30 early

oat cell carcinoma)

Aetiology

Smoking is the principle aetiological

factor.

20 + a day increases risk by 40 times.

Asbestosis and radiation are also

important factors.

Town people have a higher incidence

than country dwellers.

Clinical features.

Clinical feature % of presenting feature

* cough 42%

* cough and pain 15%

* blood in sputum (haemoptysis) 7%

* pain from pleural involvement 22%

* subsequent chest infection 5%

* Malaise 5%

* Weight loss 5%

* Shortness of breath 5%

* Hoarseness 5%

* Distant spread 5%

* No symptoms 5%

* blockage of a large bronchi

* suspect in pneumonia which does not respond to antibacterials

* enlarged subclavicular lymph nodes

Investigations

- clinical picture,

- X ray,

- cytology,

- biopsy,

- radioisotope scan,

- CT, or MRI,

- biochemistry and haemotology.

- fibreoptic bronchoscopy

- transthoracic fine-needle aspiration

Complications

* Pain, locally and from spread

* Pleural effusion

* Vascular involvement, haemorrhage or obstruction, (eg. involving the superior vena cava).

* Dyspnoea

* Cough

* Collapse of a segment due to blockage

* Immunosuppression

* Infection

* Lung abscess

* PNS involvement

* Metastasis

* Malnutrition due to hypermetabolic state or side effects of treatments

* Anxiety, depression

* Grieving

* Death

Treatments,

depend on the primary tissue involved.

* Surgery

* Radiation therapy for cure

* Symptomatic radiation therapy, eg for bone pain,

* haemoptysis, or vascular involvement

* Chemotherapy

* Laser therapy

* Terminal care

Nursing considerations

Curative measures

- Pre and post op

- Support through therapies

Relief of respiratory symptoms

- Prepare pt for therapies

- Elevate head of the bed to drain upper body

- Teach breathing exercises

- Treat cough eg. expectorants and antibacterials

- Support during pleural tap.

Improvement of nutritional status

- Adequate balanced diet

- small regular meals

- Protein, vitamin and energy supplements

- Food from home

- Enteral support

- Observe for wasting and oedema

Prevent complications

- Observations for upper body venous congestion

- Pleural effusions

- Infections

- ADLs to promote comfort

Pain

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Affect

- Encourage expression of concerns

- Communication skills listening

- Promote independence and normal activity

- Get help, councellor, chaplain etc.

- Family and social care

- Use voluntary help

- Hospice and McMillan advice

Preventative measures

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