Lung Cancer

WHAT WENT WRONG?
Lung cancer is the abnormal, uncontrolled cell growth in lung tissues, resulting in
a tumor. A tumor in the lung may be primary when it develops in lung tissue. It
may be secondary when it spreads (metastasizes) from cancer in other areas of the
body, such as the liver, brain, or kidneys. There are two major categories of lung
cancer—small cell and non-small cell. Repetitive exposure to inhaled irritants
increases a person’s risk for lung cancer. Cigarette smoke, occupational exposures,
air pollution containing benzopyrenes, and hydrocarbons have all been shown to
increase risk.
• Small cell:
• Oat cell—fast-growing, early metastasis
• Non-small cell:
• Adenocarcinoma—moderate growth rate, early metastasis
• Squamous cell—slow-growing, late metastasis
• Large cell—fast-growing, early metastasis

PROGNOSIS

Lung cancer is the leading cause of cancer death. Many patients with lung cancer
are diagnosed at a later stage, leading to the long-term (5-year) survival rate of less
than 20 percent. Earlier diagnosis is more beneficial for treatment and outcome.
The longer the cancer has been in the lungs, the greater the likelihood of metasta-
sis to other areas.

SIGNS AND SYMPTOMS

• Coughing due to irritation from mass. Presence of mucous or exudate may
not be until later in disease.
• Coughing up blood (hemoptysis).
• Fatigue.
• Weight loss due to the caloric needs of the tumor, taking away from the needs
of the body.
• Anorexia.
• Difficulty breathing (dyspnea) caused by damaged lung tissue. The patient
begins to have respiratory problems later in the disease.
• Chest pains as mass presses on surrounding tissue; may not be until late in
disease.
• Sputum production.
• Pleural effusion.

TEST RESULTS

• Mass in lung shown on chest x-ray.
• CT scan shows mass, lymph node involvement.
• Bronchoscopy may show cancer cells on bronchoscopic washings; may reveal
tumor site.
• Cancer cells seen in sputum.
• Biopsy will show cell type:
• Needle biopsy through chest wall for peripheral tumors.
• Tissue biopsy from lung for deeper tumors.
• Bone scan or CT scans shows metastasis of the disease.

TREATMENT

Treatment is focused on resolution of the tumor. Surgical removal is appropriate
for some patients, but not always necessary. Chemotherapy and radiation are both
methods that are used to destroy the cancerous cells. Oxygen therapy is used to aid
in meeting the current needs of the body, but not all patients will require supple-
the body. Pain control is an integral component of care in any type of cancer treat-
ment. Appropriate pain management needs to be individualized for the patient.
• Surgical removal of affected area of the lung (wedge resection, segmental
resection, lobectomy) or total lung (pneumonectomy).
• Radiation therapy to decrease tumor size.
• Chemotherapy often with a combination of drugs:
• cyclophosphamide, doxorubicin, vincristine, etoposide, cisplatin
• may see relapse after treatment
• Oxygen therapy to supplement the needs of the body.
• High-protein, high-calorie diet to meet the needs of the body.
• Administer antiemetics to combat side effects of chemotherapy:
• ondansetron, prochlorperazine
• Administer analgesics for pain control:
• morphine, fentanyl

NURSING DIAGNOSES

• Anxiety
• Activity intolerance
• Impaired gas exchange

NURSING INTERVENTION

• Monitor respiratory status, looking at rate, effort, use of accessory muscles,
and skin color; auscultate breath sounds.
• Monitor pain and administer analgesics appropriately.
• Monitor vital signs for changes, elevated pulse, elevated respiration, change
in BP, and elevated temperature, which may signal infection.
• Monitor pulse oximetery for decrease in oxygenation levels.
• Assist patient with turning, coughing, and deep-breathing exercises.
• Place patient in semi-Fowler’s position to ease respiratory effort.
• Explain to the patient:
• The importance of taking rest periods.
mental oxygen therapy. Attention to nutrition is important to meet the demands of