NS2P2 Lung Cancer

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NS2P2 Lung Cancer
2015-04-25 19:21:32
NS2 NS2P2 Lung Cancer Oncology Michelle

Lung Cancer.
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  1. **Epidemiology
    Number 1 cancer killer of men and women in the United States (more than breast, colon, and prostate combined)

    => The American Cancer Society’s 2014 estimates:About 224,210 new cases of lung cancer (116,000 in men and 108,210 in women)

    An estimated 159,260 deaths from lung cancer (86,930 in men and 72,330 among women).

    80-90% of lung cancers are caused by smoking; Secondhand smoke increases risk by 30%

    Remainder of lung cancers attributed to air pollution, radiation, radon, and industrial exposure (e.g. asbestos, arsenic, sulfur dioxide, formaldehyde, silica, nickel)

    Survival rate depends on type, extent of disease at diagnosis-avg diagnosis: is 70 years; 16% survival rate
  2. **Etiology
    Exposure to carcinogens:Cigarette smoke,Environmental toxins, Occupational toxins

    No conclusive genetic abnormality

    Theory - people have different genetic carcinogen-metabolizing pathways
  3. **Screening for Lung Cancer--USPSTF recommendations (united states preventative Service Task Force)
    • =>Annual screening with LDCT (low dose CT scan) in adults aged 55-80 with a 30 pack year smoking history and currently smoke/quit last 15 years;Must be asymptomatic and medically fit for surgery
    • -can diagnose a lump the size of a grain of rice (asymptomatic)
    • -xrays: size of a dime.
    • -LDCT uses five times less radiation, 20% reduction of decreased radiation in CT versus regular chest xray

    =>Adequate evidence that screening in high risk populations can prevent a statistically significant number of lung cancer-related deaths

    =>Supported by American Cancer Society
  4. **Pathophysiology
    Most cancers arise from bronchial epithelial cells

    Slow growing tumors; asymptomatic most of the time

    Inflammatory changes as well

    Metastasize directly and via blood/lymph (lot of vasculature in lungs)

    Paraneoplastic syndromes common: disorder caused by a cancer (like an immune response or by hormones) in response to cancer
  5. **Histologic classification
    • =>Non-small cell lung carcinoma-80% (NSCLC)
    • Adenocarcinoma- most common; Women>men
    • Squamous cell carcinoma ; Men>women
    • Large cell undifferentiated- least common;Highly metastatic

    • =>Small cell lung carcinoma-20% (SCLC)
    • Most malignant form
    • Spreads via lymphatic system and bloodstream (direct spread)
    • -oat cell (another name)
  6. **Assessment
    • History of smoking
    • Exposure to industrial toxins
    • Family history of cancer
    • May be asymptomatic

    • =>Generalized symptoms
    • Weakness
    • Weight loss
    • Anemia
    • Anorexia
    • Frequent infections

    =>Pulmonary symptoms

    Cough (persistent): Primary symptom & most significant, and first symptom

    Chest wall pain--pleuritic (mild to severe): Localized/unilateral

    Hemoptysis: Late signs

    Wheezing (if there's a bronchial obstruction)



    Pleural effusions
  7. **Diagnostics
    • H&P
    • CXR
    • CT/MRI
    • Sputum cytology: washing under microscop
    • Confirmation via biopsy (DIFINITIVE DIAGNOSIS!)

    • =>Other tests
    • Bone scan
    • BMP (metabolic pattern)
    • Tumor markers: CEA
  8. **Staging
    • =>NSCLC (non small cell)
    • Uses TNM staging system
    • Stage I, II, and IIIA surgical candidates
    • 50% of stage 1 survive
    • <1% survive is stage 4.

    • =>SCLC (small cell)
    • TNM not as useful
    • Limited vs. extensive for treatment purposes
    • 30% if stage 1
    • and 1-2% for stages 4
  9. **Nursing Diagnoses
    Ineffective airway clearance RT increased tracheobronchial secretions & presence of tumor

    Impaired gas exchange RT altered O2 supply 2° hypoventilation

    Ineffective breathing pattern RT decreased lung capacity

    Acute pain RT pressure of tumor on surrounding structures

    Imbalance nutrition < body requirements RT increased metabolic demands & anorexia

    Ineffective health maintenance RT lack of knowledge of disease process & therapeutic regimen

    Fear/anxiety RT threat of death & unknown prognosis
  10. **Collaborative Care
    General Management



    Radiation Therapy
  11. **General Management
    =>Stabilize pulmonary function

    • =>Maximize nutrition
    • High calorie, high protein diet
    • Monitor for malnutrition, anemia
    • If weight loss >5% start supplementation
    • Megesterol for anorexia
    • Cachexia: term for being very skinny, malnutritioned

    =>Monitor for depression/anxiety (SSRIs)

    =>Provide pain relief

    • =>Treat N/V
    • Metoclopramide (Reglan)
    • Ondansetron (Zofran)
    • Dexamethasone
  12. **Surgery
    Treatment of choice for NSCLC I and II

    May be used with chemotherapy or radiation



    Segmental or wedge resection

  13. **Chemotherapy
    • =>NSCLC
    • Stage IIIB - chemotherapy + radiotherapy

    Stage IV - platinum-based combination chemotherapy

    • =>SCLC
    • Limited stage – chemoradiation
    • Extensive stage - platinum-based chemotherapy
  14. **Radiation Therapy
    =>NSCLC responds well to radiation when combined with chemotherapy in terms of survival benefit

    =>SCLC responds well to radiation, but the extension of survival time is better with chemotherapy (so they use both)
  15. **The recommended treatment for Stage I lung cancer is:
    Radiation therapy
    Laser therapy