Download Cancer of the Lung

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
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Localized
Invasive
Benign
Malignant
Terminology
• - oma means benign tumor
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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.
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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
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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
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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
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Large irregular mass
Consolidation
Pleural effusions
Involvement of the mediastinum or
diaphragm.
• By the time lung cancer is seen on xray, 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