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Module 2: Lung Cancer

Module 2: Lung Cancer. Instructor Kathleen Gamblin, RN, BSN, OCN Oncology Nurse Navigator. Unit 3: Major Cancers, Prevention, & Staging. Objectives. Identify lung cancer incidence and mortality Identify risk factors associated with lung cancer Identify common lung cancer symptoms

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Module 2: Lung Cancer

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  1. Module 2: Lung Cancer Instructor Kathleen Gamblin, RN, BSN, OCN Oncology Nurse Navigator Unit 3: Major Cancers, Prevention, & Staging

  2. Objectives Identify lung cancer incidence and mortality Identify risk factors associated with lung cancer Identify common lung cancer symptoms Identify characteristics of non-small cell and small cell lung cancer Discuss lung cancer screening and staging tests and procedures Discuss role of oncology nurse navigator in care of the lung cancer patient Unit 3: Major Cancers, Prevention, & Staging

  3. Introduction Lung cancer is the leading cause of cancer death in the United States among every ethnic group... 1 in every 3 cancer deaths Lung cancer will kill: Over three times as many men as prostate cancer Nearly twice as many women as breast cancer An average of 437 people a day Mortality rates from Lung cancer are high because of diagnosis at advanced stage Unit 3: Major Cancers, Prevention, & Staging

  4. Risk Factors for Lung Cancer • Smoking is #1 risk factor for the development of lung cancer • Smoking responsible for causing 90% of lung cancers • Risk increases with number of lifetime cigarettes and number of years the person has smoked • Risk decreases over time when a person quits smoking but risk for Lung cancer remains elevated in former smokers • Secondhand smoke or passive smoke • Can increase lung cancer risk by 20-30% Unit 3: Major Cancers, Prevention, & Staging

  5. Risk Factors for Lung Cancer (cont’d) • Age • Occurs in older adults • Peaks at age 75 • Occupational and Environmental chemicals • Tar, soot, arsenic, chromium, nickel, asbestos, beryllium, and uranium exposure more likely to cause lung cancer • Radiation Exposure • Radon • Radiation therapy to chest area

  6. Prevention and Detection • Proven prevention strategies • Avoid initiation of smoking • Promote cessation of smoking among smokers • Substantial portion of adults diagnosed with early stage lung cancer can be cured • Chest x-rays and sputum cytology not proven to decrease lung cancer mortality rate • Low dose CT scan studies shows promise in early detection of lung cancer

  7. Clinical Presentation • 90% of lung cancer patients are symptomatic at presentation • Local symptoms • Cough • Dyspnea • Wheezing • Hemoptysis • Dysphagia • Hoarseness • Chest pain • Swelling face and arm • Nausea and vomiting

  8. Clinical Presentation • Nonspecific Systemic or Metastatic Symptoms • Anorexia • Weight Loss • Fatigue • Clubbing • Fever • Bone Pain • Headache • Seizures

  9. Diagnosis • Diagnostic Work-Up Designed to Identify: • Specific Type of Lung Cancer • Non-Small Cell Lung Cancer (NSCLC) • Small Cell Lung Cancer (SCLC) • Stage of Disease • Ability of Patient to tolerate treatment

  10. Non-Small Cell Lung Cancer (NSCLC) • Represents 80% of Lung Cancers • Three Major Histologic Types • Adenocarcinoma • Accounts for 40% of all cases of Lung Cancer • Peripheral in Nature • Squamous Cell • Occurs most frequently in central zone of the lung • Large Cell • Least Common of all NSCLC, making up only 15%

  11. Small Cell Lung Cancer (SCLC) • Typically More Aggressive Than NSCLC • Distant Metastasis More Common At Presentation • Three Histologic Groupings • Pure Small Cell • Mixed Small Cell and Large Cell • Combined Small Cell • SCLC typical presentation central lesion with hilar, mediastinal invasion and regional adenopathy

  12. Diagnostic Testing • Can Include: • Chest X-Ray • Computed Tomography (CT) Scan • Magnetic Resonance Imaging (MRI) • Positron Emission Tomography (PET) Scan • Biopsy • Sputum Cytology • Bronchoscopy • Thoracoscopy • Thoracentesis • Mediastinoscopy

  13. Staging • Tests and Procedures used to Stage Lung Cancer • Imaging Tests • Pathology Reports • Surgical Biopsy • Laboratory Tests

  14. Staging • Two types of Lung Cancer are staged differently • Non-small cell lung carcinoma staged according to the TNM staging system (Revised in 2010) • Tumor • Node • Metastasis • Small cell lung carcinoma staged according to system developed by Veteran’s Administration Lung Cancer Study Guide • Limited Stage • Extensive Stage • Stage of cancer will determine treatment options for patient

  15. Treatment of Non-Small Cell Lung Cancer • Treatment options for NSCLC patients include: • Surgery • Lobectomy, in which an entire section (lobe) of the lung is removed • Pneumonectomy, in which the entire lung is removed • Wedge or segmental resection, in which a small part of the lung is removed • Radiation • Chemotherapy

  16. Treatment of Small Cell Lung Cancer • Treatment options for SCLC include: • Chemotherapy • Radiation • Surgical resection • Rare but occurs in patient with very limited SCLC • If complete response is achieved prophylactic cranial irradiation is offered to patient

  17. Survivorship • Surveillance and follow-up for patients who have undergone curative treatment for Lung Cancer include: • Medical history • Physical examination • Imaging Study

  18. Role of the Nurse Navigator • Focus of nursing care depends on stage of disease and the overall goal of care • Interventions directed at helping the patient and the family include • Smoking cessation education • Disease and treatment education • Promotion of symptom management • Assistance with psychosocial adjustment across illness trajectory • Education on available resources

  19. Smoking Cessation • Most effective strategy for decreasing incidence of lung cancer • Smoking cessation after diagnosis related to increased survival and decreased incidence of second malignancy • Practice four “A’s” of smoking cessation

  20. Patient and Family Education • Patient and Family Education can include • Teaching on diagnostic and staging tests and procedures • Teaching on surgery and post-operative course • Teaching on chemotherapy agents and potential side effects • Teaching on radiation therapy and potential side effects • Teaching on management of symptoms experienced secondary to treatment such as chemotherapy and radiation

  21. Symptom Management • Patients with lung cancer experience multiple symptoms that change throughout illness trajectory • Pain • Fatigue • Changes in appetite • Respiratory Symptoms • Management of symptoms is essential • Uncontrolled symptoms have been related to increased emotional distress and decreased quality of life

  22. Psychosocial Issues • Emotional Distress • Anxiety • Depression • Spiritual Distress • Loss of personal control • Loss and Grief • Social Dysfunction

  23. Available Resources • Know National Resources Available for Patients • Some Lung Specific Resources Include • Lung Cancer Alliance at www.lungcanceralliance.org • Lung Cancer Circle of Hope www.lungcancercircleofhope.org • Lung Cancer Foundation of America www.lcfaamerica.org • LUNGevity Foundation www.lungevity.org • National Lung Cancer Partnership www.nationallungcancerpartnership.org • Know Local Resources Available for Patients • Hospital Resources • Community Resources

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