Lung Cancer

Lung Cancer

LUNG CANCER – “Bronchogenic
Cancer” most common type is
EPIDERMOID (Squamous cell)
CARCINOMA
Prognosis is generally poor only about
13% of lung cancer can survive the 5
year diagnosis.

 RISK FACTORS:
 1. cigarette smoking
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Tobacco smoking; Second hand smoke

 2. exposure to carcinogenic industrial and air pollutant
(mining industry)
 Ex. radioactive gas, asbestos, uranium
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3. genetic - w/ family history, exact cause is unknown

1. Small Cell Lung Cancer (SCLC)
- represents 15-20% of lung cancers.
- also called oat cell carcinoma, can
create its own hormones, which alter
body chemistry.
- grow more quickly.

2. Non-Small Cell Lung Cancer (NSCLC)
- 60-75% of lung cancers.
- sometimes confined to the chest when
initially diagnosed and can be removed
with an operation.

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2.
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5.

Adenocarcinoma (NSCLC)
Squamous Cell Carcinoma (NSCLC)
Large Cell Cancer (20%)
Small Cell Lung Cancer (10%)
Carcinoid Lung Cancer (1%)

ASSESSMENT FINDINGS:
A. Late Stage (Respiratory symptoms)
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a.)”Smokers “cough” or “my cigarette cough”
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b.) hoarseness
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c.) wheezing
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d.) hemoptysis – results of extension of the tumor
along the peri-bronchial and
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peri-vascular lymphatics that penetrates the walls of
the vein.
 Tumor can cause Hemoptysis by:
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a.) necrosis or ulceration of the tumor itself resulting
in bleeding.
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b.) invasion of neighboring structures and erosion of
their blood vessels by the tumor.
 c.) rupture of blood vessels in the respiratory tract.
 B. Metastatic symptoms with bronchial obstruction
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1. hemoptysis
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2. atelectasis
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3. pneumonitis

Diagnostic Test:
 1. Chest x-ray
 2. Sputum cytology
 3. Bronchoscopy
 visualizing the airways through a thin probe
inserted in a tube through the nose or mouth

Bronchoscopy
 Direct inspection and observation of the
larynx, trachea and bronchi through
flexible or rigid scope
 Diagnostic uses: to collect secretion, to
determine location of pathologic process
and collect specimen.
 Therapeutic uses: remove foreign object
and excise lesions

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Nursing intervention before the
procedure:
1. Informed consent
2. Atropine, valium as premeds, topical
& local anesthesia
3. NPO for 6-8 hrs
4. Remove dentures, prosthesis, contact
lens

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Nursing intervention after the
procedure:
1. Side lying position
2. Check for coughing, gag reflex prior
to oral intake
3. Watch for signs of perforation of the
bronchial tree: cyanosis, hypotension,
tachycardia, hemoptysis, dyspnea

4. Thoracentesis
Aspiration of a sample of this fluid with
a thin needle.

Thoracentesis
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Aspiration of fluid or air from the pleural cavity
May be used for diagnosis or therapy
Nursing intervention before the procedure:
1. Secure consent
2. Take initial VS
3. Position: upright leaning on over bed table
4. Instruct to remain still during the procedure
5. Pressure sensation is felt upon needle
insertion

5. Biopsy
Needle biopsy is useful when the lung tumor is
peripherally located in the lung and not
accessible to sampling by bronchoscopy

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Nursing intervention after the
procedure:
1. Turn on unaffected side to prevent
leakage from the thoracic cavity
2. Bed rest
3. Check for expectoration of blood
4. Monitor VS

Treatment:
A. SURGERY
1. Lobectomy
2. Pneumonectomy

B. Radiation therapy
C. Chemotherapy
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Nursing Intervention:
1. supportive care
2. teach the patient to minimize complication
3. aid the patient from the recovery from
surgery, radiation & chemotherapy.

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COMPLICATION OF LUNG CANCER:
1. Emphysema
2. Atelectasis
3. Bronchiectasis/lung abscess

HEALTH TEACHINGS:

A. Before Surgery
 1. Explain expected post-operative procedure
 2. Instruct the patient in coughing deep
diaphragmatic breathing
 3. Reassure patient that analgesics and proper
positioning will control post-op pain.
 4. Refers smokers who want to quite smoking
 5. Encourage patient with chronic respiratory
infection and those with chronic lung disease who
detect change in the character of cough to see their
doctors immediately.
 B. Before Discharge:
 1. Teach the patient about the use of home oxygen
and signs and symptoms of pulmonary infection.

LEUKEMIA:
Malignant disorder involving
the blood and blood forming tissue of
the bone marrow, lymph, and spleen.

RISK FACTORS:
1. Genetics
2. Chemical Carcinogen
3. Familial Tendency

Pathophysiology
 Predisposing Factor
 WBC, produces fever (Normal Cell)
abnormal leukocytes continue to multiply

infiltrate and damage the bone marrow,
lymph system and spleen

crowding of leukemic cells in the bone marrow
there is depression in the bone marrow

Classification of Leukemia
1. Acute Leukemia
2. Chronic Leukemia
MAJOR TYPES OF LEUKEMIA
1. AML – Acute Myogenous / Myoblastic Leukemia
2. ALL – Acute Lymphoblastic leukemia
3. CML – Chronic Myogenous leukemia (myeloid)
4. CLL - - Chronic Lymphoblastic Leukemia

 1. ACUTE MYOGENOUS LEUKEMIA (AML)
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* Acute Non – Lymphocytic Leukemia

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* 85 found in adults usually the myeloid
type.

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* the onset is abrupt
Predisposing Factors:
1. familial tendency
2. monozygotic twins
3. Congenital disorders such as:
Down’s syndrome
4. Ionizing radiation
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5. Exposure to chemicals (cytotoxin)
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6. Viruses
 Onset: ages 60 – 70 y/o (peak incidence)

Clinical Manifestation:
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1. fatigue and weakness
2. headache
3. mouth sore
4. minimal hepato-splenomegaly
5. lymph adenopathy
6. anemia
7. bleeding
8. infection
9. bruising

DIAGNOSTIC EXAM

Acute Lymphocytic
Leukemia
 1. Blood test
 Blast cells are also seen in the blood
 Decreased number of leukocytes,
erythrocytes and platelets
 Leukocyte may be low or high; high
proportion of immature cells
 Leukemic cell infiltration into other organs

 2.Bone marrow biopsy
 Confirms an abnormal number of blast cells

 3. Lumbar puncture
 When diagnosed, lumbar puncture is
performed to examine the CSF for the
presence of blast cells
 Meningeal involvement

Chronic Lymphocytic
Leukemia
 Large number of lymphocytes (all of the
same type) in blood and bone marrow
 Increase lymphocyte count
(lymphocytosis)
 RBC & platelet count may be normal,
later stage may decreased.
 Enlargement of lymph nodes
(lymphadenopathy)

Chronic Lymphocytic
Leukemia
 Splenomegaly
 Decreased or absent reaction to skin
sensitivity test
 Defects in humoral and cell-mediated
immune systems
 Liver enlargement

Acute Myeloid Leukemia
 CBC
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Decreased erythrocytes
Decreased platelets
Leukocyte may be low, normal or high
Percentage of normal cells is usually vastly
decreased

Chronic Myeloid Leukemia
 Blood test and bone marrow biopsy
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Increase number of granulocyte
Leukocytosis
WBC exceeds to 100,000/mm³
Leukostasis (the excessive amount of WBCs
inhibits blood flow to the capillaries)

Chronic Myeloid Leukemia
 Chromosome analysis
 Presence of Philadelphia chromosome
 A translocation of the long arm of chromosome
22, often seen in the abnormal myeloblasts,
erythroblasts, and megakaryoblasts of patients
who have chronic myelocytic leukemia

NURSING CARE
 Preventing bleeding – mouth care
 Preventing infection – REVERSE ISOLATION,
watch any signs of infection
monitor temp.
 Avoid giving aspirin
 Prevent constipation
 Easing pain and comfort
 Attaining and maintaining adequate nutrition
 Maintaining fluid and electrolyte balance – 2L/
min

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Decreasing fatigue
Improving self-care
Managing anxiety and grief
Promoting positive body image
Encouraging spiritual well-being