Lung cancer is the most common cancer worldwide, caused primarily by tobacco smoking. The main types are small cell lung cancer and non-small cell lung cancer. Diagnosis involves imaging tests and biopsy. Treatment may include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Nursing management focuses on symptom management, airway clearance, pain control, and psychological support.

1. LUNG CANCER

2. LUNG CANCER
Definition:
Lung carcinoma, is a malignant lung tumor characterized
by uncontrolled cell growth in tissues of the lung. If left
untreated, this growth can spread beyond the lung by
the process of metastasis into nearby tissue or other
parts of the body
Cancer arising from the respiratory epithelium (bronchi,
bronchioles, and alveoli).

3. Lung cancer

4. Incidence :
 Lung cancer is the most common cancer worldwide,
accounting for 1.2 million new cases annually;
 Most common cause of cancer death for men and
women
 Tobacco use accounts for 87% of lung cancer
 Lung cancer affect primarily in 5 or 6th decade of life
 In 2018 according to WHO worldwide 2.09 Million
people are affected with lung cancer and 1.76
million deaths occurred.

5. TYPES OF LUNG CANCER

7. Small cell lung cancer
 It generally starts in one of the larger breathing tubes,
grows fairly rapidly, and is likely to be large by the time
of diagnosis.
 Spreads more quickly and aggressively
 Accounts for 10-15% of cases
 Found mostly in heavy smokers.
OAT CELL CARCINOMA:
• Cells are small, round and resemble oats. Also called
small cell lung cancer
COMBINED SMALL CELL CARCINOMA:
It defined as small-cell carcinoma (SCLC) combined with
additional components that consist of any of the
histological types

8. Non-small cell lung cancer (NSCLC) :
 Most common type
 About 85-90% are NSCLC
 Grows more slowly
It is further classified into the following:-
Epidermoid carcinoma or Squamous cell carcinoma:
 30-35% of lung cancer
 Arise from bronchial epithelium
 Cavitations may also occur
 Slow growth, metastasis not common

9. Adenocarcinoma:
 25-30% of lung cancer
 Arise from bronchiole mucus gland
 Slow growth,
 Rarely cavity
 Strongly linked to cigarette smoking
Large cell caracinoma:
 10-20% of lung cancer
 Cavitation common
 Slow, metastasis may occur to kidney, liver and
adrenals
 May be located centrally, mid lung or peripherally

10. CAUSES AND RISK FACTORS
 Exact cause is unknown
 Genetic predisposition
 Smoking : The National Cancer Institute (NCI)
reports that tobacco smoking causes about nine in
10 cases of lung cancer in men and eight in 10 in
women.
 Active smoking 85-87 %
 Passive smoking 3-5 %
 Exposure to asbestos or other pollutant like arsenic
and uranium etc.
 diet low in fruits and vegetables

11. Pathophysiology
Carcinogens like smoking, occupational and
environmental agents, genetic mutation Binds with
cell’s DNA and damage the cells
Cellular changes and abnormal cell growth occur.
Malignant transformation of pulmonary epithelial cells
These cells grow slowly and covers the segmental
bronchi and lobes of the lung.
cont..,

12. Non specific inflammatory changes with hyper
secretion of mucus
Lesions formation in the lung’s tissues involving
the bronchi, bronchioles or even alveoli
Bronchogenic carcinoma.

13. Signs and symptoms
 There are two types of signs and symptoms
 1.localized-involving the lung
 2.Generalized : involves other areas throughout the
body if the cancer has spread
LOCALIZED SIGNS AND SYMPTOMS:
 Cough and fatigue
 Breathing problems
 Hemoptysis
 Chest pain and tightness
 Pleural effusion

14. GENERALIZED SIGNS AND SYMPTOMS:
 Bone pain
 Headache, mental status changes
 Abdominal pain
 Elevated liver enzymes
 Hepatomegaly
 Anorexia
 Jaundice
 Hoarseness ,hiccups
 Weight loss

15. Early and late Signs and
Symptoms Of Lung Cancer
Early Signs Late signs
Cough/chronic cough Bone pain, spinal cord compression
Dyspnea Chest pain/tightness
Hemoptysis Dysphagia
Chest/shoulder pain Head and neck edema
Recurring temperature Blurred vision, headaches
Recurring respiratory infections Weakness, anorexia, weight-loss,
cachexia
Pleural effusion
Liver metastasis/regional spread

16. STAGES OF LUNG CANCER
American Joint Committee on Cancer (AJCC) TNM system, which is
based on:
Sr.
No
STAGE FEATURES
The size
of the
main
(primary)
tumor
(T)
T0: There is no evidence of a primary tumor.
T1: The tumor is no larger than 3 centimeters,
not reached PLEURA
T2: The tumor has 1 or more, larger than 3 cm across but
not larger than 7 cm. BROCHUS
T3: The tumor has 1 or more of the following features, It is
larger than 7 cm across CHEST WALL
T4: The cancer has 1 or more, A tumor of any size has
grown into the space between the lungs

17. Sr.
No
STAGE FEATURES
Whether
the
cancer
has
spread
to
nearby
(regiona
l) lymph
nodes
(N).
N0: There is no spread to nearby lymph nodes.
N1: The cancer has spread to lymph nodes within
the lung , bronchus enters the lung
N2: The cancer has spread to lymph nodes
around the carina , mediastinum
N3: The cancer has spread to lymph nodes near
the collarbone on either side

18. Sr.
No
STAGE FEATURES
M
categ-
ories
for
lung
cance
r
M0:
No spread to distant organs or areas. This
includes the other lung, lymph nodes
away than those mentioned in the N stages
above, and other organs
M1a: The cancer has spread to the other lung.
•Cancer cells are found in the fluid around
the lung
M1b The cancer has spread to distant lymph
nodes or to other organs

19. Diagnostic evaluations
 History collection
 Physical examination
 Laboratory tests:
 Blood tests:
 CBC- To check RBC,WBC and platelets
 To check bone marrow and organ function
 Blood chemistry like RFT AND LFT
 BIOPSY
 BRONCHOSCOPY
 Endoscopy
 Mediastinoscopy

20. Chest X-ray
 Asymptomatic tumours may be seen on
chest X-ray if they are more than 1 cm in
diameter.
 Lateral views are useful to assess the hilum
and masses behind the heart.
Computed tomography CT:
 It is useful for identifying disease in the early
stages
 CT scanning should include the liver,
adrenal glands and the brain since these are
common sites for metastases.
.

21. Fibreoptic bronchoscopy :
 This technique is used to define the
bronchial anatomy and to obtain biopsy
and cytological specimens.
 Bone scan
 PET Scan

22. Nursing Management for post
endoscopic procedures
Bronchoscopy Mediastinoscopy
Monitor V/S; NPO status
maintained until return of
gag reflex.
Fever up to 101F can be
expected afterwards
Monitor VS; potential for
bleeding, infection and
dyspnea; NPO status
until return of gag reflex

23. Management
 The three main cancer treatments are:
Surgery (lung resections)
Radiation therapy
Chemotherapy
Targeted therapy
Immunotherapy

24. Lung resections
 Lobectomy: a single lobe of lung is
removed
 Bilobectomy: 2 lobes of the lung are
removed (only on R side)
 Sleeve resection: cancerous lobe is removed and
segment of the main bronchus is resected
 Pneumonectomy: removal of entire lung
 Segmentectomy: a segment of the lung is removed
 Wedge resection: removal of a small,
pie-shaped area of the segment
 Chest wall resection with removal of
cancerous lung tissue: for cancers that have invaded the chest
wall

25. Radiation therapy
 Useful in controlling the neoplasm that can not be
surgically removed
 Reduce the size of the tumor
 Relieve symptoms
 EXTERNAL BEAM RADIATION THERAPY
 IMRT/STEREOTACTIC RADIATION THERAPY

26. SR.NO CHEMOTHERAPY
TYPE OFDRUGS
DOSE SIDE EFFECT
1 • Cisplatin 75-100 mg/m² IV, 4Weeks
Hair loss
• Mouth sores
•Loss of
appetite
•Nausea and
vomiting
•Diarrhea/
constipatio
Easy bruising
or bleeding
(from having
too few blood
platelets)
• Fatigue
2 • Carboplatin 200 mg/m2 IV on day 1
3 • Paclitaxel (Taxol)
135 mg/m2, IV over 24
hours, every 3 weeks
4 • Albumin-b
25 g (5% or 25% solution)
IV infusion
5 • Docetaxel (Taxotere)
75 mg/m² IV over 1 hour
3Weeks
7 • Vinorelbine (Navelbine)
25 mg/sq.meter IV Week
with IV cisplatin 100
mg/sq.meter 4Weeks
9 Vinblastine 4 mg/sq. meter, 2week

27. Targeted therapy
 cancer’s specific genes, proteins, or the tissue
environment that contributes to cancer growth and
survival.
 Anti-angiogenesis therapy. Eg: Bevacizumab,
Ramucirumab
 Epidermal growth factor receptor (EGFR)
inhibitors. Eg: Afatinib, Dacomitinib.
 Drugs that target other genetic changes:
Anaplastic lymphoma kinase (ALK) inhibitors.
Mutations in the ALK gene are found in about 5% of
patients with NSCLC.
Immunotherapy:
 Atezolizumab,

28. Complimentary Therapies
 Includes acupuncture and massage and
pharmacological approaches such as vitamins
and herbal medicine.
 One study showed that herbal medicine is used
by approximately 48% of lung cancer patients in
China.
 These herbal therapies combined with
chemotherapy increases survival in non-small-
cell lung cancer by up to 42%, compared with
chemotherapy alone.

29. Complimentary Therapies cont’d
 Foods: Green tea, N-acetyl cysteine, Curcumin,
Garlic, Fish Oil, Lactobacillus.

30. Complimentary Therapies cont’d
 Mind-body: help to reduce anxiety, mood
disturbance, or chronic pain in cancer patients
(audiotapes, videotapes, books, music,
relaxation, yoga, meditation, Hypnosis)

31. NURSING MANAGEMENT
NURSING ASSESSMENT:
 Past history
 Family history
 Exposure to smoke, airbrone carcinogens
 Nutritional habits
 Physical and systemic examination

32. NURSING DIAGNOSIS
 Impaired gas exchange related to removal of lung
tissue/decreased oxygen carrying capacity of blood as
evidenced by dysnea/restlessness/hypoxaemia
 Ineffective airway clearance related to increase viscosity of
secretions/restricted chest movements/fatigue as
evidenced by changes in rate /depth of
respiration/abnormal breath sounds/dyspnea
 Acute pain related to presence of chest tubes/surgical
incision/cancer invasion of pleura as evidenced by verbal
report of discomfort/restlessness /changes in vital signs
 Fear/anxiety related to perceived threat of death/situational
crisis as evidenced by anger/withdrawl.

33. Nursing interventions
 Nursing care includes strategies to ensure relief of
pain and discomfort and to prevent complications.
MANAGING SYMPTOMS
 The nurse instructs the patient and family about the
potential side effects of the specific treatment and
strategies to manage them
 IMPAIRED GAS EXCHANGE
 Vital signs,ABG
 Stop smoking
 Position changes
 Adequate hydration
 Nebulisation and suctioning

34. RELIEVING BREATHING PROBLEMS
 Airway clearance techniques are key to
maintaining airway patency
 through the removal of excess secretions
REDUCING FATIGUE
 Fatigue is a devastating symptom that affects
quality of life in the cancer patient.
 Educating the patient in energy conservation
techniques or referring the patient to a
 physical therapy, occupational therapy, or
pulmonary rehabilitation program may be helpful.

35. Nursing Interventions
 Management of N/V, weakness, fatigue, wt loss, appetite loss,
altered taste
 Pain management, education to avoid concern about
addiction, pharmacological and non-pharmacological
 Elevate HOB
 Splinting to aid in coughing
 Teach breathing exercises to ↑ diaphragmatic excursion and ↓
WOB
 DB&C
 Provide a vaporizer
 Relaxation techniques to ↓ anxiety r/t SOB
 Encourage energy conservation
 Encourage small amts of high-calorie and Pn foods freq.

36. Nursing pulmonary post-op
considerations/interventions
 Positioning in bed, Monitor V/S
 Prevention of respiratory complications
 Early ambulation, DB&C exercises, incentive
spirometer, managing dyspnea
Prevention of deep vein thrombosis
 Early ambulation
 Pain management
 Infection control

37. PROVIDING PSYCHOLOGICAL SUPPORT
 Another important part of the nursing
care of the patient with lung cancer is
psychological support and identification
of potential resources for the patient and
family