Cancer of the Lung

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Cancer of the Lung Powered By Docstoc
					   Lung Cancer

    MODULE G1
Chapter 26, pp. 354-367
                 Facts on Cancer
• Lung cancer is:
   • The second most common cancer in men (Prostate)
   • The second most common cancer in women (Breast)
   • The leading cause of death from cancer in men (3x > Prostate;
     almost 7x in MI)
   • The leading cause of death from cancer in women (almost 2x
     breast; 4.5x in MI)
   • More people die from lung cancer than colon, breast, and prostate
     COMBINED!
• 2008 estimate:
   • 215,000 new cases; males > females
   • 161,840 deaths
• 40 – 70 years of age
• Cancer is strongly associated with smoking (85% of
  cases)
   • Second hand smoke
   • Environmental/industrial hazards – asbestos, radon
             Cancer of the Lung
• Definition:
  • Progressive, uncontrolled multiplication of
    abnormal cells causing new tissue growth.
     • Result of stimuli that damage the genetic material
       (DNA) of cells.
     • Abnormal cells called a Neoplasm or Tumor
  • Tumors can be
     •   Localized
     •   Invasive
     •   Benign
     •   Malignant
                 Terminology
• - oma means benign tumor
  •   Fibroma (fibroid tumor)
  •   Myoma
  •   Lipoma
  •   Neuroma
• Carcinoma means malignant tumor
• - sarcoma means highly malignant tumor
  • Fibrosarcoma
  • leiomyosarcoma
              Benign Tumor
• Does not endanger life unless it interferes
  with organ function.
• It will push aside normal tissue but not
  invade it.
• Slow growth.
• Easily removed surgically.
            Malignant Tumor
• Cells grow in a disorganized manner and very
  rapidly.
• Invade normal tissue.
• Rob surrounding cells of nutrition.
• Result in necrosis, ulceration and cavity
  formation.
• Metastatic
   • Tumor cells travel to the bloodstream
     &/or lymphatic channels and invade or
     form secondary tumors in other organs.
        Malignant Tumors In the
                Lungs
• Most commonly originate in the bronchial
  mucosa of the TB tree.
  • Bronchogenic carcinoma or lung cancer.
• As the tumor enlarges it invades the
  airways, alveoli and blood vessels.
  •   Airway obstruction & increased secretions.
  •   Atelectasis & consolidation.
  •   Erosion of blood vessels cause hemoptysis.
  •   Pleural effusions.
  •   Cavity Formation.
                    Etiology
• Four major types of Bronchogenic Tumors:
  • Non-Small Cell Lung Cancer (NSCLC)
    • Squamous (epidermoid) cell
    • Adenocarcinoma
    • Large-cell carcinoma
  • Small-Cell Lung Cancer (SCLC)
    • Oat Cell
              Squamous Cell
• 30-35% of cases.
• Originates from the basal cells of the
  bronchial epithelium.
• Late metastatic tendency.
• Doubling time of 100 days.
• Located in large bronchi near the hilum.
  • 1/3 of cases originate in periphery of lung.
• Cavity formation is seen in 10-20%
• Linked to smoking.
             Adenocarcinoma
• 25-35% of cancers.
• Arises from mucus glands in the TB tree.
• Growth rate is moderate; doubling time is 180
  days.
• Found in the lung periphery.
• Cavity formation is common.
• Bronchoalveolar cell carcinoma is a type of
  adenocarcinoma (15% of adenocarcinomas) that
  affects the airspaces but does not extend beyond
  lung.
        Large Cell Carcinoma
• 10-15% of cases.
• Found in both the periphery or central
  region of the lung.
• Rapid growth rate.
• Early metastatic tendency.
• Doubling time of 100 days.
• Cavity formation is common.
          Small Cell – Oat Cell
• 13-15% of the lung cancers.
• Arises from Kulchitsky’s (K-type) cells in the
  bronchial epithelium.
• Found near the hilum region.
• Grows very rapidly; Doubling time is 30 days.
  • 60% of patients have widespread metastatic disease
    at the time of diagnosis
• Can create its own hormones.
• Metastasizes early (bone, liver, brain)
• Oval shaped.
                    Etiology
• Cigarette Smoking
  • 87% of cancers is due to cigarette smoking.
    • 90% in men, 80% in women.
    • Greatest incidence with Small Cell, Squamous, and
      adenocarcinoma.
• Occupational exposure
  • Inhalation of asbestos and other agents.
  • Usually has a smoking co-factor.
  • 15% incidence in men, 5% in women.
    • ? Radon
      Staging of Non-small Cell
            Lung Cancer
• Staging System
  • T – Tumor
     • Status of primary tumor (size & type).
  • N – Node
     • Local and regional lymph node involvement.
  • M – Metastases
     • Spread to other tissues.
• Prognostic Indicator
  • Survival rates
                Stages of Cancer
• See Handout
  •   Stage 0
  •   Stage IA & IB
  •   Stage IIA & IIB
  •   Stage III A & IIIB
  •   Stage IV
• Stage I and II: Surgery with or without
  adjuvant chemotherapy
• Stage IIIA: Surgery with or without adjuvant
  therapy or concurrent chemoradiation
• Stage IIIB: Radiation with or without
  chemotherapy
• Stage IV: Chemotherapy with or without
  palliative radiation)
         Staging of Small Cell
              Carcinoma
• 2 stages
  • Limited
  • Extensive
• Tx is chemotherapy.
• Survival is 8-14 months after
  chemotherapy.
           5-Year Survival Rates
                   LUNG        BREAST

Stage I          60 to 80%       98%
Stage II         25 to 50%     76 to 88%

Stage IIIA       10 to 40%       56%

Stage IIIB      Less than 5%     49%

Stage IV        Less than 2%     16%
        Pulmonary Functions
• Restrictive Disease or Mixed Obstructive &
  Restrictive.
  • Decreased Volumes
  • Decreased Flows
                 Symptoms

• 25% are asymptomatic
• Cough
• Increased sputum production
• Hemoptysis
• Wheezing (localized)
• Weight Loss
• SOB/dyspnea
• Hoarseness
• Chest Pain (if tumor invades chest
  wall/pleura)
• Clubbing
                 Chest X-ray
• Small oval or coin lesion
    • Solitary Pulmonary Nodule
• Large irregular mass
• Consolidation
• Pleural effusions
• Involvement of the mediastinum or
  diaphragm.
• By the time lung cancer is seen on x-
  ray, it usually is in the invasive stage.
       Non-respiratory Findings
• Tumor invasion of the mediastinum
  • Recurrent laryngeal nerve
     • Hoarseness
  • Esophagus
     • Difficulty swallowing
• Electrolyte disturbances
  • High Ca levels
• Horner’s Syndrome – Compression of
  sympathetic nerve of the face leading to
  constriction of the pupil.
      Non-Respiratory Findings
• Superior Vena Cava Syndrome
  • Interrupts blood flow from head and upper
    body.
  • Swelling of face and neck and arms.
  • Dilation of chest and arm veins (collaterals).
• Muscle weakness.
• Endocrine disorders.
            Diagnostic Testing
• Chest x-ray
• Bronchoscopy & Laryngoscopy
  • Biopsy (Transbronchial needle aspiration)
• CT scan/MRI/Bone Scans
• Transthoracic needle aspiration (TTNA)
• Thoracentesis
  • Pleural fluid
• Sputum Culture
  • Cytology
          Positron Emission
        Tomography Scanning
• PET
  • Uses fluorodeoxyglucose (FDG)
  • A cancerous tumor is a highly active metabolic
    tissue with a great affinity for glucose which
    shows up as a signal during PET scanning
  • Cancerous tumors have greater uptake of the
    glucose than benign tumors
               Management
• Curative
• Palliative (relief of symptoms)
              Management
• Radiation
  • 50% of cases.
  • High voltage x-ray beams deliver radiation
    to the tumor.
  • Radioactive particles kill tumor cells.
  • Can Cause Pulmonary Fibrosis.
        Surgical Management

• Lung resection
  • Removal of a lung section
• Lobectomy
  • Removal of a lobe
• Pneumonectomy
  • Removal of a lung
• Only 1/3 of patients are candidates for
  surgery
  • May not be able to remove tumor
                Management
• Chemotherapy
  • Drugs are used to kill the cancer cells
  • Can cause pulmonary fibrosis
• Immunotherapy and Interferon
  • Experimental
    Evaluation of Surgical Risk
• FEV1 > 2L or 70% of predicted indicates
  good lung reserve & low surgical risk.
• FEV1 < 35% of predicted is a
  contraindication to surgery.
  • Radiation & Chemotherapy
     Respiratory Management
• Bronchial Hygiene Protocol
• Hyperinflation Protocol
  • CPAP or BIPAP
• Oxygen Therapy Protocol
        Special Considerations
• Cancer patients often have altered immune
  systems.
  • Susceptible to contacting other infections.
  • In the past pt’s were in “protective isolation”.
  • Private room.
• Psychological
  • Stages of Terminal Illness.
     • Denial, Anger, Bargaining, Depression, Acceptance

				
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posted:10/10/2011
language:English
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