Lung cancer is a type of cancer that begins in the lungs. Your lungs are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale. Lung cancer is the leading cause of cancer deaths in the United States, among both men and women

1. Lung cancer
PRESENTED BY:
ABHAY RAJPOOT

2. INTRODUCTION
Lung cancer is a type of cancer that begins in the
lungs. Your lungs are two spongy organs in your
chest that take in oxygen when you inhale and
release carbon dioxide when you exhale.
Lung cancer is the leading cause of cancer deaths
in the United States, among both men and
women.

4. DEFINITION
Cancer arising in the air passage (bronchial Cancer) which is
characterized by uncontrolled growth in tissues of lungs

5. INCIDENCE
 It is the leading cause of death among all racial groups in
US.
 Accounting for 31% of all ca deaths in men & 27% of
deaths in women.
 In 2005 more than 1,68,000 people died from lung ca in
US; an estimated 1,84000 new cases were diagnosed in
the same year.

6. RISK FACTORS:
 It increases with age, occurring most commonly in clients
over age 50.
 80% of lung ca are caused due to smoking.
 There is dose response relationship between the smoking &
lung ca.
 Exposure to ionizing radiation & inhaled irritants, asbestos.
 Exposure to radon (a radioactive gas).

7. ETIOLOGY:
 Cigarette smoking which contain 43 known
chemical carcinogens & ca promoters is most
significant cause of ca.
 Genetic abnormality chromosome 3 with loss of
genetic material.
 Alteration of tumor suppressor gene.

8. LUNG CA STAGING:
Stages Primary tumor(T stage) Regional lymph node (N) Distant metastasis
(M)
Stage-0 To-no evidence of primary tumor .
Tx- malignant cells in the bronchopulmonary
secretions, but no tumor visualized.
Mx- presence of
distant metastasis
cannot be assessed.
Stage -1 Tis-carcinoma in situ
T1- tumor that is 3 cm in diameter or less, with no
evidence of invasion
No- no regional lymph node
metastasis.
Mo- no distant
metastasis.
Stage-2 T2- tumor that is greater than 3 cm in diameter or
invades visceral pleura or has associated atelectesis or
pneumonia.
N1- metastasis or direct
extension to peribronchial or
ipsilateral hilar node
Stage -3 T3- tumor with direct extension into an adjacent
structure or any tumor with associated pleural
effusion or ipsilateral hilar nodes
N2- metastasis to ipsilateral
mediastinal nodes
Stage-4 T4 – tumor that invades mediastinum or involve the
heart , great vessels, trachea, esophagus, vertebral
body or carina; presence of malignant plural effusion.
N3- metastasis to contralateral M1- distant metastasis

9. PATHOPHYSIOLOGY:
Due to etiological factors
Damage of bronchial epithelial cells

Mutation of bronchial epithelial cells
Epithelial cells become neoplastic

10. TYPES OF LUNG CA
 Acc. To cell type tumor can divide into :
s.
no.
Cell type &
prevelence
Presentation & associated
manifestation
spread
1 Small-cell
carcinoma (20-25%)
Central lesion with hilar mass
common, early meditational
involvement,, no cavitations,
SIADH, Cushing syndrome
Aggressive tumor, more than
40% of clients have distant
metastasis at time of
presentation
2 Adenocarcinoma
(20-40%)
Peripheral mass involving; few
local symptoms
Early metastasis to CNS
skeleton, & adrenal glands
3 Squamus cell
carcinoma (30-32%)
Central lesion located in large
bronchi; clients presents with
cough, dyspnea, atelectasis &
wheezing
Spread by local invasion
4 Large cell
carcinoma (10-15%)
Usually peripheral lesion that is
larger than that associated with
adenocarcinoma & tends to
cavitate; gynecomastia
Early metastasis

11. CONTI…
For clinical purpose the three cell type are frequently
classified as –
 Non-small cell carcinoma: it accounts for 75% of lung
ca. each cell type differs in incidence, presentation &
manner of spread.
 Small cell lung ca:accounts for app. 25% of lung ca
grow rapidly & spread early. These tumors have
paraneoplstic properties, such as ACTH. ADH,
parathrome like hormone.
 Bronchogenic ca: tumors begin as mucosal lesions
that grow to form masses that obstruct the bronchi.
Frequently spread via lymph system to nodes & other
organs such as brain, bones & liver.

12. CLINICAL MANIFESTATION:
Respiratory:
 Cough
 Hemoptysis
 Wheezing & dyspnea
 Chest pain dull or pleuritic
 Hoarseness & dysphagia
 Pleural effusion

13. DIAGNOSTIC EVALUATION:
 Chest x-ray: usually provide the Ist evidence of lung cancer. It may
be used as a screening tool for lung ca.
 Sputum specimen: is sent for cytologic examination. The sputum
sample is collected on arising in the morning. If malignant cells are
found in the sputum more invasive examinations are required.
 Bronchoscopy: done to visualize & obtain tissue for biopsy from the
tumor.
 CT-scan: it is used to evaluate & localize tumors in the lung
parenchyma & pleura. CT scanning can also detect distant tumor
metastasis & evaluate tumor response to treatment.
 Cytologic examination: cells or tissues for cytologic examination &
biopsy may be obtained by aspirating fluid from a pleural effusion,
percutaneous needle biopsy & lymph node biopsy.

14. CONTI…
 CBC, liver function test & serum electrolytes:
Including ca are obtained to evaluate for evidence of
metastatic disease or paraneoplstic syndromes.
 Tuberculin test is performed to rule out TB as a cause of
symptoms.
 Pulmonary function test: may be performed prior to the
initiation of treatment if the client has manifestations of
respiratory insufficiency (e.g. dyspnea, low oxygen
saturation level).

15. MANAGEMENT:
Chemotherapy:
Used in combination, chemotherapeutic drugs to be attached at
different parts of the cell cycle & in different ways, increasing the
effectiveness of therapy. Chemotherapy drugs that commonly used
are- Vance Alkaloids (Vinblastine), Doxorubicin, Taxanes
(Docetaxel), Plantin analogus (Cisplantin, & Carboplantin).

16. CONTI…
Radiation therapy: It is used alone or in combination with
surgery & chemotherapy.
Goals-
 Treatment- prior to surgery, R/T may be used to debulk
tumors.
 Palliative- (symptom relief) it may also be used to relieve
manifestation such as cough, hemoptysis & dyspnea from
bronchial obstruction.
 R/T may be delivered by external beam radiation to the
primary tumor site or by intraluminal radiation or
brachytherapy.

17. SURGICAL MANAGEMENT
The goal of surgery is to remove all involved tissue while preserving
as much as functional lung as possible.
s.
no.
procedure description Used for
1 Laser bronchoscopy Bronchoscopy guided laser
used to resect tumor
Tumors localized in a main
bronchus
2 mediastinoscopy Visualization of
mediastinum using an
endoscope passed through a
suprasternal incision
Evaluation & biopsy of a
meditational tumors &
lymph nodes
3 thoracotomy Incision into the chest wall Access the lung & thoracic
cavity for surgery

18. 4 Wedge
resection
Removal of an
individual
bronchovascular
segment of a lobe
Peripheral lung tumor with no
evidence of extension to chest
wall or metastasis
5 Segmental
resection
Resection of a section of
a major bronchus with
reconstruction of
remaining normal
bronchus
Small lesion of major bronchus
6 Sleeve
resection
Resection of a section of
a major bronchus with
reconstruction of
remaining normal
bronchus
Small lesion of a major bronchus
7 lobectomy Removal of a single lung
lobe
Tumor confined to a single lobe
8 pneumonecto
my
Removal of an entire
lung
Tumor widespread throughout the
lung, involving the main bronchus or
fixed to the hilum

19. Nursing management:
 Ineffective breathing pattern r/t tumor &
treatment of tumor.
 Activity intolerance r/t resectional lung surgery
& inoperable lung ca.
 Acute pain r/t surgical procedure or terminal
stage of ca.
 Anticipatory grieving r/t advanced diagnosis of
lung ca.

20. THANK YOU