Lung Cancer

Introduction :-

• Lung cancer is cancer that start in the cells that make up the lungs.many other types of cancer such as breast or kidney can spread to the lungs.
• lung cancer are the fourth most common cancer reportedly in the Indian males.It account for 6.8% of all malignancies in india.
• The incidence is estimated to be about 6.6 per 100000 in males and 1.7 per 100000 in females.
• Commonly occur in individual more than 50yrs of age who have a long history of  cigrate smoking.

Definition :

• "Lung cnacer also known as lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissue of the lung."
• "Lung cancer is neoplasm of the lung."

Etiology :-

• Exact cause is unknown.

Risk factor :-

• Genetic (transformation from one generation to another generation.)
• Age (mostly in older age, 65 or older age, average age is 70 year)
  
• Past lung disease ( can cause inflammation and scarring in the lung, eg: Tuberculosis, COPD)
• Radiation therapy to the chest (eg. breast therapy,Non-hodgkin's lymphoma)
• Second Hand Smoking
• Smoking
• Diet (low intake of vitamin-A, unbalanced diet)
• Environmental factor :- Asbestosis,Radon,Tar,Arsenic,Vinyl chloride) 
  
     

Types of Lung cancer :-

Non-Small cell Lung Cancer (NSCLC) :-

•  NSCLC is any type of epithelial lung cancer other than small cell lung carcinoma.
• NSCLC is accounts for about 85% of all lung cancer.
• NSCLC are relatively insensitive to chemotherapy compared to small cell lung cancer.
• When possible they are primarily treated by surgical resection with curative intent ,although chemotherapy has been used increasingly both pre-operative and post operative.

The most common type of NSCLC are :-

• Squamous cell carcinoma
• Adenocarcinoma
• Large cell carcinoma

1. Squamous cell carcinoma :- Arrives from bronchial epithelium & is more centrally located and its growth rate is slow.

Characteristics :- 

• Accounts for 20-30% of lung cancers.
• more common in men. Centrally located producing early symptoms of non productive cough and hemoptysis.
• do not have strong tendency to metastasis.

Response to therapy :-

• Surgically resection may be attempted.
• Adjuvant chemotherapy and radiation .

      2. Adenocarcinoma :- It arrives from the perifery of the lung and looks like nodules often metastasizes.Its growth rate is moderate.

Characteristics :-

• Accounts for 30-40% of lung cancer.
• Most common lung cancer in people.who have not smoked more common in women.
• Peripherally located often has no clinical manifestation until widespread metastasis is present.

Response to therapy :-

• Surgical resection may be attempted depending on the staging.
• Does not respond well to chemotherapy.

      3. Large cell carcinoma (undifferentiated) :- It is the fast growing carcinoma that arrive from the periphery branches of bronchi.

characteristics:- 

• Accounts for 10% of lung cancers.
• Composed of large cell that are anaplastic and often arise in the bronchi.
• It is highly metastatic via lymphatics and blood.

Response to therapy :-

• Surgery is not usually attempted.because of high rate of metastasis.
• Tumor may be radio sensitive but often recurs.

Small cell lung cancer (SCLC):-

1. Small cell carcinoma (SCC):- Arrives from the major bronchi & spread by infiltration along with bronchial walls.Growth rate is very rapid.

Characteristics :-

• Accounts for about 20% of lung cancers.
• Most malignant form of lung.
• Spread early via lymphatics & blood stream,frequent metastasis to brain.
• Associated with endocrine disturbances.

Response to therapy :-

• Chemotherapy main stay of treatment but over all poor prognosis.
• Radiation is used as adjuvant therapy and palliative measure.

Pathophysiology :-

• The carcinogens binds to the DNA
• Damage it.
• Cellular changes and abnormal growth
• Malignant cells.

As the damaged DNA is passed on to daughter cells,the DNA under goes further changes and become unstable with the accumulation of genetic changes the pulmonary epithelium under goes malignant transformation.

Stages of cancer :-

1. T o :- No evidence of tumor.
2. T x :- Tumor proved by cytologic studies ,but visualize by radiography.
3. T is :- Carcinoma in situ.
4. T 1 :- Tumor 3cm or less.
5. T 2 :- Tumor grater than 3cm.
6. T 3 :- Direct extension of chest wall.
7. T 4 :- Tumor invading mediastinal.
8. N o :- No nodule metastasis.
9. N 1-3 :- According to the progress of nodule involvement.
10. M o :- NO known metastasis.
11. M 1 :- Presence of distant metastasis.  

Enlist clinical manifestation :-

• Asymptomatic till diagnosis.
• Persistent.
• Non productive cough at earlier and in later productive cough.
• Blood tinged sputum.
• Chest pain.
• Dyspnoea.
• Wheezes.
• Palpable lymphnodes in neck or axilla.
• Unilateral paralysis of diaphragm.
• Superior venacava obstruction.(Due to intx. thorasic spread of malignancy )
• Pericardial effusion and dysrrhythemia. (if media stinum is involved)
• Annorexia.
• Fatigue.
• Weight loss.
• Fever.
• Nausea,Vomitting.

Diagnostic evaluation :-

• Chest x-ray :- shows presence of tumor or evidence of metastasis to ribs or vertebrae.
• CT-Scan and MRI :- shows the location and extent of masses.
• PET :- Helps in early detection of cancer staging and monitoring effects of treatment.
• Sputum specimen for cellular studies.
• Bronchoscopy :-Helps in direct visualization ,allows to take biopsy specimen.
• Mediastenoscopy :- Involve insertion of scope through a small anterior chest incision into the mediastinum.It is done to examine metastasis in the anterior mediastinum or in the chest extrapluraly.
• Biopsy.
• Pulmonary Angiography.
• Lungs scan.
• Fine needle aspiration.

Management of Lung cancer :-

Surgical management :-

1. lobectomy
2. wedge resection
3. Pneumonectomy
   
   

Medical management :-

1. Radiation therapy 
2. Chemotherapy
3. Laser surgery
   

Complication :-

• Airway obstruction
• Atelectosis
• Plural effusion
• Pulmonary Abscess
• Pneumonia
• Paraneoplastic syndrome

Prognosis :- 

Prognosis is generally poor ,13%of patients with lung cancer survive.

Nursing management :-

1. Ineffective breathing pattern resulting from compression of lung tissue.
2. Impaired gas exchange resulting from retained secretion and occluded bronchial.
3. Acute pain related to surgical incision tissue trauma and disruption of inter-coastal nerves ,presence of chest tube.
4. Fear and anxiety related to situational crises, change in health status and perceived threat of death.