PULMONARY NEOPLASM

INTRODUCTION

Lung cancer is malignancy in the epithelium of

the respiratory tract

DEFINITION

Lung cancer accounts about 6.8% of all

malignancies in India The incidence is estimated to be about

6.6%per one lakh in males1.7per one lakh among in females

INCIDENCE

Cigarette smoking

Exposure with radioactive isotopes, polycyclic hydro carbons, vinyl chloride, metallurgical ores , and mustard gas.

RISK FACTORS

cigarette smoking include inhaled toxins, such as as bestos, and

pollutants. ,radon, nikal ,iron iron oxides uranium polycyclic aromatic

hydrocarbons chromates arsenic ,air pollution Working in mines smelting or chemical or petroleum manufacturing

Contd…

ETIOLOGY

polycyclic aromatic hydrocarbons

chromates,arcenic,air pollution, lung disease,TB pneumonia diet low in fruit and vegetables previous radiotherapy to the chest

Contd..

PATHOPHYSIOLOGY

Remote effects of malignancy occur in 10 to

20 per cent of lung cancerclients. These usually result from the secretion of sub stances (e.g., hormones, enzymes and antigens) by the tumor itself. These substances then act on target organs, producing a vari ety of symptoms called paraneoplastic symptoms

Paraneoplastic syndromes

small cell lung cancer, non-small cell lung cancer

Classification and Staging

T is the tumors size ,location and degree of

invasion N is the regional node involvement M is distant metastasis

Staging

Early Asymptomatic until late phase Persistent Cough Dyspnoea Chest and shoulder pain Recurrent temperature Recurrent infection Blood tinged sputum Wheeze Anorexia Weight loss Vomiting Hoarseness of voice  

Clinical Manifestations

Bone pain Spinal cord compression Chest pain Dysphasia Blurred vision Pleural effusion Horseness of voice Dysphagia Head and neck oedema

Late

Localized Cough mostly chronic dry cough Breathing symptoms -shortness of breath and strider Changes in sputum -increased amount Hemoptysis Pneumonia Hoarseness of voice chest pain and tightness

Signs symptoms depends upon location of lesion

Bone pain Head ache Mental status changes Abdominal pain Anorexia Idiopathic weight loss Pancots syndrome Horner's syndrome Pleural effusion Svenalar syndrome

generalized

CXR CT PET SCAN sputum cytology biopsy thoracoscopy bronchoscopy CBC-WBC RBC BIOPSY Contd..

Assessment and Diagnostic Findings

MRI FNAC Pleural aspirate cytology Mediastinoscopy Lymph node biopsy Open lung biopsy (rare) esophageal ultrasound (EUS) lung scan spirometry, video assisted

thoracoscopy, pulmonary angiography, lung scan

Contd..

treatment may involve surgery, radiation therapy, chemotherapy combination of these. immune system therapy (gene therapy, therapy with defined tumor

antigens biological response modifiers)

Management

includingalkylating agents (ifosfamide),

platinum analogues (cisplatin andcarboplatin), taxanes (paclitaxel, docetaxel), vinca alkaloids(vinblastine and vindesine), doxorubicin, gemcitabine, vinorelbine,irinotecan (CPT-11), and etoposide (VP-16)

CHEMOTHERAPY

Radiation is used to reduce the size of a

tumor, to make an inoperable tumor operable, relieve the pressure of the tumor on vital

structures. control symptoms of spinal cord metastasis

and superior vena caval compression Reduce bone and liver pain.

RADIATION THERAPY

diminished cardiopulmonary function pulmonary fibrosis, Pericarditis, myelitis cor pulmonale. pneumonitis. Pulmonary toxicity

 Treatment-Related Complications

lobotomy (removal of a lobe of the lung). Entire lung may be

removed(pneumonectomy)

SURGICAL MANAGEMENT

Wedge Resection. Segmental Resection. Segmental Resection. Pneumonectomy.

Types of surgical approaches

laser use is palliative for the relief of

endobronchial obstructions caused by non resectable lung tumors. Lasers do not produce systemic or cumulative toxic effects and are well tolerated.

LASER THERAPY

CLOSED CHEST DRAINAGE

Metastasis.

sarcomas, lymphomas, bronchial adenomas.

OTHER TYPES OF LUNG TUMORS

Hamartomas Chondromas Mesotheliomas

Benign tumors.

Nursing Management

Ineffective airway clearance related to

increased tracheobronchial secretions and presence of tumor

Anxiety related to lack of knowledge of diagnosis or unknown prognosis and treatments

Acute pain related to pressure of tumor on surrounding structures and erosion of tissues

Nursing Diagnoses

Imbalanced nutrition: less than body

requirements related to increased metabolic demands, increased secretions, weakness, and anorexia

Ineffective health maintenance related to lack of knowledge about the disease process and therapeutic regimen

Ineffective breathing pattern related to decreased lung capacity.

 

Contd..

health promotion, managing symptoms relieving breathing problems reducing fatigue providing psychological support acute intervention. ambulatory and home care

Nursing Implementation

Evidence based practice

CONCLUSION