Adenocarcinomaof the lung

Niccole CouseUniversity of South Florida

College of Nursing

Introduction(Eldridge, 2010a)

• Adenocarcinoma refers to a cancer that originates in glandular tissue of the epithelium.

• It is a non-small cell cancer– These are the most common types of lung cancer

• It is the most common cancer effecting non-smokers and women.– 2nd most common overall

Pathopysiology(Eldridge, 2010a)

• Adenocarcinoma progresses in 4 stages1. Cancer is confined in the lung with no spread2. Cancer has spread within the lung and may be

affecting lymphnodes.3. Cancer has spread to nearby tissues or the other

lung.4. Cancer has spread to another part of the body.

Diagnosis(Eldridge, 2010a)

• Determined by biopsy

• Detected on – X-ray– Chest CT scan– Bronchoscopy– PET scan– Sputum cytology

Risk Factors

• Smoking (tobacco and marijuana) (Fayed, 2006)

– 15% of smokers develop lung cancer – 80% of lung cancer cases are smokers

• Female– Females are about 3X more likely (Gaspirino,2010)

• Radon Exposure (Fayed, 2006)

• Family History (Fayed, 2006)

• Inflammatory lung diseases (Fayed, 2006)

– Tuberculosis and pneumonia

Signs and Symptoms(Spiro, S. G., Gould, M. K., & Colice, G. L., 2010)

• Early– Fatigue– Shortness of Breath– Back/chest ache

• Late– Chronic cough****– Fatigue– Dyspnea– Back/chest pain– Hemoptosis– Weight loss

Assessment(Spiro et al., 2010)

• History:– Persistant cough, hemoptosis, dyspnea, chest pain, anorexia, weight

loss• Oxygenation:

– Nail angle – clubbing– Wheezing

• Assess for metastasis:– Lymph nodes: Supraclavicular node

• enlarged in 20% of metastasis

– Liver – common site• LFT – often not effected until late, jaundice, weakness, weight loss

– Intracranial – 10%• Headaches, nausea, vomiting, seizures, confusion, personality changes

Treatments

• Surgery – lobectomy, pneumonectomy • Chemotherapy ( Einhorn, 2008)

– Carboplatin & Paclitaxel• inhibits DNA synthesis causing death of rapidly dividing

sells (Deglin, Vallerand, & Sanoski , 2012)

– Bevacizumab• Inhibits new blood vessel growth causing decreased

metastasis (Deglin, Vallerand, & Sanoski , 2012)

• Radiation (Eldridge, 2012b)

Treatments – nursing considerations(Van Leeuwen, Poelhuis-Leth, & Bladh, 2012)

• Surgery – – HOB at 30-45degrees– Increase fluid intake– Monitor Airway– Suction airway as needed– Cough and deep breathing– Monitor oxygen saturation– Pain management– Chest tube monitoring– Early ambulation

Treatments – nursing considerations(Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, & Loscalzo, 2012)

• Chemotherapy – Hair loss– Healthy tissue necrosis– Immunodepression– Anemia

Treatments – nursing considerations(Edlridge, 2012b)

• Radiation– Skin irritation– Hair loss – Dry cough/shortness of breath• Lowered surfactant – steroids may be given

– Fatigue– Esophagitis• Dysphagia, heartburn

– Radiation pneumonitis• Inflammation – 5-15% - treated with steroids

Treatments – nursing considerations(Eldridge, 2012b)

• Radiation– Pulmonary fibrosis• Scar tissue formation

– Cardiac toxicity– Secondary cancers• Appear 5-10 years after treatment

– Leukemia, breast, and lung cancers most common

Prognosis(Bianchi, Nuciforo, Vecchi, Bernard, Tizzoni, Marchette, Buttitta, Felicioni, Nicassio, & Di Fiore, 2007)

• Overall: 15% survive 5 years– Often due to late diagnosis– Inoperable

• Stage 1 detection: 30-60% survive 5 years

Nursing Diagnosis(Ackley & Ladwig, 2011)

• Ineffective gas exchange

• Activity Intolerance

• Fear

• Disturbed body image

Clinical Example

80 year old Female. Lifetime never smoker. HPI: In 2007 she had a chest X-ray and her Dr. noticed a “nodule” in her right lower lobe. He decided to monitor it for any changes before attempting any surgical procedures. At a recent check-up, her Dr. noticed changes in the nodule and decided to biopsy the node and some surrounding lymph nodes. When a few biopsy results came back positive for cancer, her Dr. referred her to a specialist who operates out of Sarasota Memorial Hospital for the removal of her right lower lobe of the lung.

Clinical Example

• Positive Diagnosis: via biopsy after abnormal Xray

• Positive Risk Factors: Non smoker, female, family history, inflammatory lung disease (asthma and tuberculosis)

• Positive Symptoms: none• Treatment: lobectomy possible chemotherapy• Prognosis: Good

NCLEX style question• A female client is newly diagnosed with

adenocarcinoma of the lung. She asks “How can I have lung cancer? I never smoked!” What is an appropriate response to the patients concerns?a) You must have been exposed to cigarette smoke

at some point.b) You don’t have to lie about smoking. c) Adenocarcinoma is the most common lung

cancer in non-smoking persons. d) It’s O.K. Everything will be fine!

NCLEX style question• A female client is newly diagnosed with

adenocarcinoma of the lung. She asks “How can I have lung cancer? I never smoked!” What is an appropriate response to the patients concerns?a) You must have been exposed to cigarette smoke

at some point.b) You don’t have to lie about smoking. c) Adenocarcinoma is the most common lung

cancer in non-smoking persons. d) It’s O.K. Everything will be fine!

NCLEX style question

• Which of the following indicate stage 4 metastasis1. Jaundiced skin2. Seizures3. Palpable supraclavicular lymph nodes4. Chronic cough

a) 1,2,3b) 2,3c) 1,4d) 1,2

NCLEX style question

• Which of the following indicate stage 4 metastasis1. Jaundiced skin2. Seizures3. Palpable supraclavicular lymph nodes4. Chronic cough

a) 1,2,3b) 2,3c) 1,4d) 1,2

ReferencesAckley, B. J., & Ladwig, G. B., (2011) Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care ( 9th edition). St. Louis, MO: Mosby Inc.

Bianchi, F., Nuciforo, P., Vecchi, M., Bernard, L., Tizzoni, L., Marchette, A., Buttitta, F., Felicioni, L., Nicassio, F., & Di Fiore, P. P., (2007) Survival Prediction of Stage 1 Lung Adenocarcinomas by expression of 10 genes. The Journal of Clinical Investigation, 117(11).

Doi: 10.1172/JCI32007 Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2030461/

Deglin, J.D., Vallerand, A. H., & Sanoski, C. A., (2012) Davis Drug Guide.. Nursing Central.

Einhorn, L. H., (2008) First-Line Chemotherapy for Non–Small-Cell Lung Cancer: Is There a Superior Regimen Based on Histology? Journal of Clinical Oncology, 26(21).Doi: 10.1200/JCO.2008.17.2056Retrieved from: http://jco.ascopubs.org/content/26/21/3485.full

ReferencesEldridge, L., (2012a) Lung Adenocarcinoma: symptoms, treatments, and prognosis. About.com Guide. Retrieved from: http://lungcancer.about.com/od/typesoflungcancer/a/Lung-Adenocarcnoma.htm

Eldridge, L., (2012b) Side Effects of Radiation Therapy for Lung Cancer. About.com Guide. Retrieved from: http://lungcancer.about.com/od/treatmentoflungcancer/a/radsideeffects.htm

Fauci, A., Braunwald, E., Kasper, D., Hauser, S., Longo, D., Jameson, L., & Loscalzo, J., (2012) Harrison’s Manual of Medicine, Nursing Central

Fayed, L., (2006) Causes and Risk Factors for Lung Cancer. About.com Guide. Retrieved from: http://cancer.about.com/od/lungcancer/p/lungcancercause.htm

Gasperino, J., (2010) Gender is a Risk Factor for Lung Cancer. Medical Hypothesis, 76(3). Retrieved from: http://www.sciencedirect.com.ezproxy.lib.usf.edu/science/article/pii/S0306987710004433

ReferencesSpiro, S. G., Gould, M. K., & Colice, G. L., (2010) Initial Evaluation of the Patient With

Lung Cancer: Symptoms, Signs, Laboratory Tests, and Paraneoplastic Syndromes. CHEST Journal, 132(3).

Doi: 10.1378/chest.07-1358Retrieved from: http

://chestjournal.chestpubs.org/content/132/3_suppl/149S.full

Van Leeuwen, A. M., Poelhuis-Leth, D. J., & Bladh, M. L., (2012) Diseases and Disorders. Nursing Central

Questions?