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Lung Cancer

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)

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Lung Cancer

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  1. Lung Cancer MODULE G1 Chapter 26, pp. 354-367

  2. 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

  3. 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 • Localized • Invasive • Benign • Malignant

  4. Terminology • - oma means benign tumor • Fibroma (fibroid tumor) • Myoma • Lipoma • Neuroma • Carcinoma means malignant tumor • - sarcoma means highly malignant tumor • Fibrosarcoma • leiomyosarcoma

  5. 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.

  6. 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.

  7. 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. • Airway obstruction & increased secretions. • Atelectasis & consolidation. • Erosion of blood vessels cause hemoptysis. • Pleural effusions. • Cavity Formation.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. Stages of Cancer • See Handout • 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)

  16. Staging of Small Cell Carcinoma • 2 stages • Limited • Extensive • Tx is chemotherapy. • Survival is 8-14 months after chemotherapy.

  17. 5-Year Survival Rates

  18. Pulmonary Functions • Restrictive Disease or Mixed Obstructive & Restrictive. • Decreased Volumes • Decreased Flows

  19. Symptoms • 25% are asymptomatic • Cough • Increased sputum production • Hemoptysis • Wheezing (localized) • Weight Loss • SOB/dyspnea • Hoarseness • Chest Pain (if tumor invades chest wall/pleura) • Clubbing

  20. Chest X-ray • Small oval or coin lesion • Solitary Pulmonary Nodule • Large irregular mass • Consolidation • Pleural effusions • Involvement of the mediastinum or diaphragm. • By the time lung cancer is seen on x-ray, it usually is in the invasive stage.

  21. 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.

  22. 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.

  23. 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

  24. 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

  25. Management • Curative • Palliative (relief of symptoms)

  26. Management • Radiation • 50% of cases. • High voltage x-ray beams deliver radiation to the tumor. • Radioactive particles kill tumor cells. • Can Cause Pulmonary Fibrosis.

  27. 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

  28. Management • Chemotherapy • Drugs are used to kill the cancer cells • Can cause pulmonary fibrosis • Immunotherapy and Interferon • Experimental

  29. 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

  30. Respiratory Management • Bronchial Hygiene Protocol • Hyperinflation Protocol • CPAP or BIPAP • Oxygen Therapy Protocol

  31. 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

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