Lung Cancer

1. Lung Cancer By: Tillie Little, Tresa Dorman, Valerie Estes, April Graham, & Jennifer Hierl

2. Description Cancer is when there is an abnormality in the cell. This uncontrolled cell division and proliferation, forms a mass or a tumor known as cancer. Cancer can take place in ANY part of the lung: • 90 to 95% of it occurs in the epithelial cells of the bronchi and bronchioles aka Bronchogenic Carcinoma. • Carcinoma can also form from the pleura or the outer lining of the lung which are termed mesotheliomas.

3. Incidence • Cigarette Smoking is the most important risk factor of developing lung cancer—responsible for 80-90% of all lung cancer. • Another major risk factor for lung ca is inhaled carcinogens, such as: Asbestos, radon, nickel, iron and iron oxides, uranium, polycyclic aromatic hydrocarbons, chromates, arsenic and air pollution; • Exposure to these chemicals is most commonly seen in employees in industries of mining, smelting, or chemical or petroleum manufacturing. • The cigarette smoker who is also exposed to one or more of these chemicals or to high amounts of air pollution is at significantly higher risk for lung cancer.

4. Incidence (cont’d) • Lung cancer is the leading cause of cancer deaths, accounting for 28% of all cancer deaths in the United States • About 172,570 new cases of lung cancer are diagnosed every year, in the United States.

5. Lung Cancer Incidence in Men • It is the leading cause of cancer death among men—58% of total lung cancer deaths, in the US, are in men. • According to studies performed by the CDC (centers for disease control and prevention): From 1968 to 1999 the mortality rate(the measure of the number of deaths in a specific population) for lung cancer related deaths in men, has risen 15%. • Men with lung cancer have a worse prognosis than women. • Lung cancer incidence and deaths are decreasing in men.

6. Lung Ca Incidence in Men: • African American’s have the highest death rate and Hispanics and Asian Pacific islanders have the lowest: • African American men get lung ca at a higher rate than men in other ethnic groups .

7. Lung Cancer Incidence in Women • Lung cancer is now the leading cause of death in women, surpassing breast cancer. • Surgeon General’s report, Women and Smoking: A Report of the Surgeon General—2001. Identified a 600% increase in women’s death rate from lung cancer since 1950, attributed to smoking. • According to the CDC , the mortality rates in women: Increased 266% from 1968 to 1999.

8. Lung ca and women (cont’d) • White women have a higher rate of lung ca than women of other ethnic groups—Asian Pacific Islanders and Hispanic women have the lowest rate.

9. Lung Ca incidence in Women • Women who smoke, are at 2x’s greater risk of developing lung ca then men who smoke. In comparison to men: • Develop lung cancer after fewer years of smoking; • Develop lung ca at a younger age; • Are more likely to develop small cell carcinoma. Non-smoking women: • Are at greater risk of developing lung ca than men.

10. Cultural and Ethnic related Lung Cancer Incidence • Cigarette consumption has decreased dramatically in developed countries such as the US and Canada; however, it is increasing in developing countries such as Africa , Asia and Latin America. • Close to 60% of the 5.77 billion cigarettes smoked each year and 75% of tobacco users are in developing countries

11. Children and Adolescents • Total of 36.5% of male and female teenagers smoke. • Environmental tobacco smoke (second-hand, residual left on clothing, upholstery, skin, etc.) inhaled by non-smokers (innocent bystanders—children, mentally impaired, etc.) poses a 35% increased risk of development of lung ca in non-smokers. • Children are more vulnerable to environment smoke because their respiratory and immune systems are not fully developed. • Children exposed to cigarette smoke are more likely to become smokers.

12. Lung ca Incidence and Genetics • There are marked variations in a person’s propensity to develop lung ca. • It is known that carcinogens in cigartette smoke directly damage DNA. • One theory is that people have different genetic carcinogen-metabolozing pathways. • To date no genetic abnormality has conclusively been identified for lung ca.

13. More incidence/statistics • Overall 5 year survival rate from lung cancer is 15%. • Lung cancer most commonly occurs in individuals 50 years of age with a long history of cigarette smoking. • Lung cancers is found most in person 40 to 75 years of age. • Peak incidence of Lung Cancer is found in individuals between 55 and 65 years of age.

14. Risk Factors • A risk factor is anything that increases a person's chance of getting a disease such as lung cancer. The number one risk for lung cancer is TOBACCO SMOKING!

15. Risk factor: Tobacco smoking • By far the most prominent risk factor is tobacco smoking. • The longer a person has been smoking and the more packs per day smoked, the greater the risk. • If a person stops smoking before a cancer develops, the damaged lung tissue starts to gradually return to normal. • Even after ten years, the ex-smoker's risk still does not equal the lower risk of a person who never smoked. • However, an ex-smoker's risk is about half the risk of people who continue to smoke.

16. Risk factors: Asbestos Related • Death from lung cancer is about seven times more likely to occur among asbestos workers than among the general population. • Asbestos workers who smoke have a very high lung cancer risk: 50 to 90 times greater than that of people in general. • Both smokers and nonsmokers exposed to asbestos also have a greater risk of developing a type of cancer which starts from the pleura (the layer of cells that line the outer surface of the lung) akamesothelioma. • In recent years, the government has nearly stopped the use of asbestos in commercial and industrial products. Because asbestos was used for so many years, it is a good idea to check and see if there might be asbestos in products or in houses before buying them.

18. Cancer Causing Agents in the Workplace: • People at risk include miners who may breathe in radioactive ores such as uranium. • Workers exposed to chemicals such as arsenic, vinyl chloride, radon, nickel chromates, coal products, mustard gas and chloromethyl ethers. • The government and industry have taken major steps in recent years to protect workers. Dangers are still present, and those who work in these conditions should be very careful to avoid exposure.

19. Personal and Family History: • People who have lung cancer have an increased risk of another lung cancer. • Brothers, sisters and children of those who have had lung cancer may have a slightly higher risk of lung cancer themselves. However, it is difficult to say how much of this excess risk is due to inherited factors and how much is due to environmental tobacco smoke.

20. Other Risk Factors: • Vitamin A Deficiency or Excess: People who do not get enough vitamin A are at increased risk of lung cancer. On the other hand, taking too much vitamin A may also increase lung cancer risk. • Air Pollution: Insome cities, air pollution may slightly increasethe risk of lung cancer. This risk is far less than that caused by smoking. • Industrial grade talcum powder. • Scarring from tuberculosis and pneumonia.

21. Use of Marijuana Cigarettes

22. LUNG CANCER SIGNS AND SYMPTOMS • Symptoms of lung cancer depend on the location of the tumor. • Up to 25% on clients have no symptoms of lung cancer. • Paraneoplasticsyndrome may result due to a production of hormone-like substances by the tumor cells. An example is where there is a secretion of ACTH leading to the over secretion of cortisol which then give the client symptoms of cushing’s syndrome.

23. Cushing’s Syndrome symptoms

24. S/S • shortness of breath • Wheezing • hemoptysis • smoker’s cough that is persistent or becomes worse • Persistent shoulder, neck or back pain unrelated to pain of coughing and also chest pain. • Increase volume in sputum • change in color of sputum

25. S/S • Non-smokers cough lasting longer than two weeks • Hoarseness • Difficult swallowing • repeated episodes of pneumonia or bronchitis • A lung may collapse if a large airway becomes obstructed.

26. Late Stage Lung Cancer Signs & Symptoms • fatigue • loss of appetite. • Bone pain • aching joints • bone fractures not related to injury. • Neck and facial swelling • unexplained weight loss

27. When Lung ca Mestatasis The most common sites for lung cancer metastasize (spread) include (but not limited to: • Brain • Adrenal glands • Liver • Bone If metastasis of the lung occurs it’s usually from another cancer originating in a different area of the body, NOT the lungs.

28. S/S Metastases Non-specific symptoms: • Weakness • weight loss • fatigue Specific symptoms: • Bone fractures • bleeding • blood clots

30. End Stage Lung Cancer (s/s): If spread to the brain: • headaches, • Stroke like symptoms • unsteady gait • episodic memory loss • blurred vision and seizures.

31. Medical Treatments Surgery • Only cure for lung cancer • Not recommended if the cancer has spread to other lobes of the lungs and parts of the body such as bone. • Have to be a candidate for surgery. The cardiovascular system and pulmonary function is assessed. • The presence of cardiac, renal, and liver disease is contraindicated.

32. Types of surgery • Lobectomy: Removes one or more lobes of lungs with the tumor • Pneumonectomy: (rare) Removal of one entire lung • Wedge resection: Removes only the section of the infected lung.

34. Radiation Treatment • Used as an alternative to surgery (A poor candidate for surgery). • Improvement in survival rate when radiation, chemotherapy and surgery are used as combination therapy. • Uses a palliative approach to decrease the symptoms such as cough, hemoptysis, bronchial obstruction, and superior vena cava syndrome.

35. Chemotherapy • Used to treat nonresectable tumors or in combination therapy • Chemotherapeutic drugs: Etoposide(VePesid), Carboplatin(Paraplain), Cisplatin(platinol) to name a few… 

36. Alternative treatments include: • Biologic Therapy: Not used as much because of the side effects. • Bronchoscopic laser therapy: Shrinks tumor, but is a complicated procedure. • Phototherapy- safe, nonsurgical therapy. Photofrin is injected through an IV and after a set time (usually 48 hr) the tumor is exposed to laser light, this produces a toxic oxygen that destroys tumor cells. The necrotic tissue is removed through a bronchoscope. • Airway Stenting: Supports the airway against collapse. Used for cough, dyspnea or respiratory insufficiency. • Cryotherapy- Tissue is destroyed by freezing and then the dead tissue is removed.

37. How is Lung Cancer Diagnosed? After some of the (many) s/s of potentially having Lung Cancer presents, the diagnosis process must begin. Thanks to modern medicine, there are several means to diagnose such cancer: • Sputum cytology • Biopsy • Blood tests • Imaging studies

38. Imaging studies Your healthcare provider can get a picture of the tumor and also see if it has spread. These imaging studies allow the tissues, organs and bones to be looked at in more detail. • X-rays • ultrasounds • CT scans (computed tomography) • MRI (Magnetic Resonance Imaging) It’s not unusual for lung ca to be found on a routine chest x-ray or CT scan.

39. Dx Sputum Cytology • A patient produces a sputum sample by coughing up sputum from the lung’s which is then sent to the lab to be checked for cancer cells under microscopy. Biopsy •  Having a lung biopsy is often times the most necessary procedure in order to diagnose lung cancer. This is done by removing cells from the lungs then checking them under a microscope. If these cells come back as being cancerous, then further tests may be preformed. This biopsy can be preformed through needle aspiration—thoracocentesis of the pleural fluid or by a bronchoscopy—l ooking into the lungs.

40. Diagnoses (cont’d) Blood Tests • By doing a blood test, the blood can be further examined. Blood is studied to see if different types of blood cells are normal in number and appearance. Blood tests can also reveal how well your organs are working which, in turn, may suggest having, or not having cancer. The key to lung cancer, along with many other types of cancer, is early detection and diagnosis. It is very important to listen to your body when it is trying to tell you something is not right, and then follow up by seeing your medical provider.

41. Nursing Management Nursing Management for Lung Cancer: • Maintain a patent airway and monitor respiratory status. • Suction client as needed. • Place in upright or High-Fowler’s position to facilitate ventilation. • Assess breathing patterns and auscultate lung sounds. • Assess SaO2 ABG values. • Administer oxygen if needed. • Promote high-calorie, high-protein diet. • Provide information for smoking cessation classes if necessary.

42. SURGICAL Nursing Management: Pre-Op: • Educate client about incisions and any possible tubes (such as chest tubes). • Relieve anxiety. • Encourage verbalization of feelings about surgery.

43. SURGICAL Nursing Management: Post-Op : • Monitor VS, O2 levels. • Assess for signs of hemorrhage or bleeding. • Manage any tubes or drainage systems. • Administer O2 and maintain ventilation. :

44. Palliative Nursing Management: • Administer O2 (use humidity if needed). • Administer bronchodilators and corticosteroids for inflammation, bronchospasm, and edema. Administer mucolytics to aid with expectoration. • Assist with thoracentesis. • Monitor the client for complications (esp. from radiation therapy). • Assess pain (onset, duration, severity). Administer analgesics. • Provide emotional support. • Encourage verbalization of feelings. • Refer to hospice when patient is ready.

45. In Conclusion: • Regular visits to your primary care physician is your best measure in the prevention of lung cancer. • Don’t start smoking!!! • Stop smoking!!! • Don’t smoke around innocent bystanders!!!

47. Resources • http://womenshealth.about.com/cs/cancertypesaz/a/signsymlungcncr.htmhttp://www.medicinenet.com/lung_cancer/article.htm • http://www.mayoclinic.com/health/lung-cancer/DS00038/DSECTION=symptoms