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33 Cards in this Set
- Front
- Back
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Lung Cancer: Risk Factors
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Smoking accounts for 80-90% lung cancer
Heavy smokers have 25% higher risk Tobacco contains over 20 carcinogens Second hand smoke has similar risk Smokers who quit after 15 yrs have same risk as nonsmokers |
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Lung Cancer: Risk Factors con't non-cigarette related
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Inhaled carcinogens
Exposure to asbestos, radon, nickel, uranium, hydrocarbons, chromatic, arsenic, air pollution Common in mining, smelting, chemical or petroleum industry. Preexisting pulmonary disease TB, pulmonary fibrosis, bronchiectosis, COPD |
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Symptoms of Lung C.,
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Early
Persistent cough Blood tinged sputum Chest pain Dyspnea wheezing Late Anorexia Fatigue Wt loss Nausea Vomiting hoarseness |
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Other Symptoms of Lung C,
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Nonsmokers cough that persist for over two weeks.
Persistent chest, shoulder, or back pain unrelated to pain from coughing. Change in color of sputum, increase volume of sputum. Wheezing, recurrent pneumonia or bronchitis Fatigue, loss of appetite Headache, bone pain, aching joints Neurological symptoms like unsteady gait, memory loss Neck and facial swelling Unexplained weight loss Bleeding or blood clots. |
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Diagnosis of Lung C
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Chest x-ray – tumor or atelectasis and pneumonia from bronchial obstruction.
CT scan – mass in chest and locate precisely. Lymph node involvement MRI – Used with CT- PET – Positron Emission Tomography – measures metabolic differences in tissues Sputum – for cytology, collect first morning sputum-oral care 1st then spit Bronchoscopy – visualize airways and biopsy |
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Classification of Lung Tumors
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12 different types of tumors under lung cancer. Usually grouped in non-small cell and small cell lung cancer
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Non-small cell lung cancer
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75% of lung cancers and includes the following types:
Squamous cell carcinoma Adenocarcinoma Large cell undifferentiated |
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Squamous cell carcinoma
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30% of bronchogenic Cargenic
Located near the hilus and projects into the bronchi. Nonproductive cough, hemoptysis, chest pain if tumor large. Metastasizes late. Treatment surgery if metastasis has not occurred. Chemo has limited effectiveness |
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Adenocarcinoma
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30-40% of lung cancers
Arises from glands Peripheral region of the lung and small Often asymptomatic, discovered on routine chest x-ray Pleural pain or weakness Weakest association with smoking**** Metastasizes early 5 yr survival rate less than 10% Treatment surgery, new chemo is promising |
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Large cell undifferentiated
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10-15% arise peripherally but also found centrally and grow to distant trachea and carina
If metastasized surgery not helpful Chemo and radiation limited usefulness |
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Small Cell lung cancer
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25% of lung cancers
Occurs centrally Strongest correlation with smoking*** Rapid growth and metastasis Worst prognosis*** 1-3 month survival if untreated Associated with ectopic hormone production b/c of endocrine tissue in bronch tree |
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Paraneoplastic syndrome
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Ectopic hormone production
Neuroendocrine cells exist in the tracheobronchial tree. Inappropriate production of neuro hormones Inappropriate ADH ** don’t need to know the info above SIADH ACTH atypical Cushing’s Syndrome with muscle weakness, facial edema. Hypokalemia, alkalosis, hyperglycemia, hypertension. |
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SIADH
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SIADH: major signs and symptoms
SIADH: Spasms Isn't any pitting edema (key DDx) Anorexia Disorientation (and other psychoses) Hyponatremia SIADH: causes SIADH: Surgery Intracranial: infection, head injury, CVA Alveolar: Ca, pus Drugs: opiates,antiepileptics, cytotoxics, anti-psychotics Hormonal: hypothyroid, low corticosteroid level |
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Surgical therapy for lung cancer
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Lobectomy – removal of a lobe of the lung. Requires chest tubes for post op drainage. Thoracotomy –get air out of chest with chest tube
Pneumonectomy – Removal of one entire lung. No chest tube. Chest cavity needs to fill with fluid and consolidate. Position on back or operative side. HOB elevated 45 degrees- don’t want drainage on stump of bronchus |
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A man newly diagnosed with lung cancer tells the nurse "I never smoked a cigarette in my life" what happened?
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he could have worked or live around abestos, radon, nickel, uranium, hydrocarbons,chromatic, asenic, air pollution or have TB, pulmonary fibrosis, bronchiectosis or COPD
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A male presents to the ER with severe coughing with blood tinged sputum, chest pain, fatique, weight loss and hoarseness. The nurse suspects the diagnosis will be?
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Lung cancer
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The nurse knows that the test ordered for this pt. will be?
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Chest x-ray
CT scan PET MRI used with CT (best) Sputum Bronchoscopy |
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What are the two major types of Lung cancer? and how many subtypes are there?
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SLC and NSLC
12 different types of tumors |
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The nurse knows that the pt diagnosed with NSLC will either have?
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Squamous cell
Adenocarcinoma or Large cell undifferentiated |
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The nurse knows that the prognosis of Squamous cell carcinoma is?
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treatment with surgery if not metastasis, and chemo is not very effective
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The chest x-ray of a male smoker shows cancer near the hilus that projects into the bronchi. The nurse knows that this is what type of NSLC?
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Squamous cell carcinoma
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When a patient is diagnozed with this cancer, the nurse is pretty sure that the pt is not a smoker?
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Adenocarcinoma
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The nurse knows that this type of cancer metastasises early and this one late
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Adenocarcinoma
Squamous cell |
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The nurse knows that the treatment for Adenocarcinoma is?
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surgery with a new chemo that has shown promise
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Which type of NSLC cancer is asymptomatic?
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Adenocarcinoma
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The nurse knows that Adenocarcinomma arises from which area and where?
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glands near the peripheal region of the lung
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Which NSLC type tumor can not be treated with surgery or chemo or radiation successfully if it metastasises?
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Large cell undifferentiated
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The nurse knows that the 40+ smoker who comes into the clinic complaining of coughing with blood probably will be diagnosed with?
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SLC - 25% off all lung cancers
strongest correlation with smoking |
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The nurse knows that the patho and prognosis for this cancer is?
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rapid growth and metatasis
has the worst prognosis 1-3 mth is untreated |
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The patient is confused when the doctor explains that the SLC tumor is producting etopic, endocrine hormones in the bronchial tree. He questions why lungs are producing endocrine hormones. The doctor explains? The example of type of dx that is caused by this is?
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That there is a small amount of endocrine tissue in the lungs and etopic means that tumors produce hormones that they should not be producing in a body system.
Cushings dx & SIADH |
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The nurse knows that etopic production of hormones is called?
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paraneoplastic syndrome
SIADH (syndrome of inappropriate Antiduirectic Hormone)is another example |
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The nurse knows that the treatment for Squamous cell carcinoma could be a?
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Pneumonectomy-complete removal of a lung
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Nursing interventions for a Pneumonectomy are?
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no chest tube
position on back or operative side (?) HOB elevated 45% (don't want drainage in stump of bronchus |
