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Module 2: Lung Cancer

Learn about lung cancer incidence, risk factors, symptoms, prevention strategies, screening tests, diagnostic procedures, staging, treatment options, and the role of oncology nurse navigators in caring for lung cancer patients.

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Module 2: Lung Cancer

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  1. Module 2: Lung Cancer Instructor Kathleen Gamblin, RN, BSN, OCN Oncology Nurse Navigator Unit 3: Major Cancers, Prevention, & Staging

  2. Objectives Identify lung cancer incidence and mortality Identify risk factors associated with lung cancer Identify common lung cancer symptoms Identify characteristics of non-small cell and small cell lung cancer Discuss lung cancer screening and staging tests and procedures Discuss role of oncology nurse navigator in care of the lung cancer patient Unit 3: Major Cancers, Prevention, & Staging

  3. Introduction Lung cancer is the leading cause of cancer death in the United States among every ethnic group... 1 in every 3 cancer deaths Lung cancer will kill: Over three times as many men as prostate cancer Nearly twice as many women as breast cancer An average of 437 people a day Mortality rates from Lung cancer are high because of diagnosis at advanced stage Unit 3: Major Cancers, Prevention, & Staging

  4. Risk Factors for Lung Cancer • Smoking is #1 risk factor for the development of lung cancer • Smoking responsible for causing 90% of lung cancers • Risk increases with number of lifetime cigarettes and number of years the person has smoked • Risk decreases over time when a person quits smoking but risk for Lung cancer remains elevated in former smokers • Secondhand smoke or passive smoke • Can increase lung cancer risk by 20-30% Unit 3: Major Cancers, Prevention, & Staging

  5. Risk Factors for Lung Cancer (cont’d) • Age • Occurs in older adults • Peaks at age 75 • Occupational and Environmental chemicals • Tar, soot, arsenic, chromium, nickel, asbestos, beryllium, and uranium exposure more likely to cause lung cancer • Radiation Exposure • Radon • Radiation therapy to chest area

  6. Prevention and Detection • Proven prevention strategies • Avoid initiation of smoking • Promote cessation of smoking among smokers • Substantial portion of adults diagnosed with early stage lung cancer can be cured • Chest x-rays and sputum cytology not proven to decrease lung cancer mortality rate • Low dose CT scan studies shows promise in early detection of lung cancer

  7. Clinical Presentation • 90% of lung cancer patients are symptomatic at presentation • Local symptoms • Cough • Dyspnea • Wheezing • Hemoptysis • Dysphagia • Hoarseness • Chest pain • Swelling face and arm • Nausea and vomiting

  8. Clinical Presentation • Nonspecific Systemic or Metastatic Symptoms • Anorexia • Weight Loss • Fatigue • Clubbing • Fever • Bone Pain • Headache • Seizures

  9. Diagnosis • Diagnostic Work-Up Designed to Identify: • Specific Type of Lung Cancer • Non-Small Cell Lung Cancer (NSCLC) • Small Cell Lung Cancer (SCLC) • Stage of Disease • Ability of Patient to tolerate treatment

  10. Non-Small Cell Lung Cancer (NSCLC) • Represents 80% of Lung Cancers • Three Major Histologic Types • Adenocarcinoma • Accounts for 40% of all cases of Lung Cancer • Peripheral in Nature • Squamous Cell • Occurs most frequently in central zone of the lung • Large Cell • Least Common of all NSCLC, making up only 15%

  11. Small Cell Lung Cancer (SCLC) • Typically More Aggressive Than NSCLC • Distant Metastasis More Common At Presentation • Three Histologic Groupings • Pure Small Cell • Mixed Small Cell and Large Cell • Combined Small Cell • SCLC typical presentation central lesion with hilar, mediastinal invasion and regional adenopathy

  12. Diagnostic Testing • Can Include: • Chest X-Ray • Computed Tomography (CT) Scan • Magnetic Resonance Imaging (MRI) • Positron Emission Tomography (PET) Scan • Biopsy • Sputum Cytology • Bronchoscopy • Thoracoscopy • Thoracentesis • Mediastinoscopy

  13. Staging • Tests and Procedures used to Stage Lung Cancer • Imaging Tests • Pathology Reports • Surgical Biopsy • Laboratory Tests

  14. Staging • Two types of Lung Cancer are staged differently • Non-small cell lung carcinoma staged according to the TNM staging system (Revised in 2010) • Tumor • Node • Metastasis • Small cell lung carcinoma staged according to system developed by Veteran’s Administration Lung Cancer Study Guide • Limited Stage • Extensive Stage • Stage of cancer will determine treatment options for patient

  15. Treatment of Non-Small Cell Lung Cancer • Treatment options for NSCLC patients include: • Surgery • Lobectomy, in which an entire section (lobe) of the lung is removed • Pneumonectomy, in which the entire lung is removed • Wedge or segmental resection, in which a small part of the lung is removed • Radiation • Chemotherapy

  16. Treatment of Small Cell Lung Cancer • Treatment options for SCLC include: • Chemotherapy • Radiation • Surgical resection • Rare but occurs in patient with very limited SCLC • If complete response is achieved prophylactic cranial irradiation is offered to patient

  17. Survivorship • Surveillance and follow-up for patients who have undergone curative treatment for Lung Cancer include: • Medical history • Physical examination • Imaging Study

  18. Role of the Nurse Navigator • Focus of nursing care depends on stage of disease and the overall goal of care • Interventions directed at helping the patient and the family include • Smoking cessation education • Disease and treatment education • Promotion of symptom management • Assistance with psychosocial adjustment across illness trajectory • Education on available resources

  19. Smoking Cessation • Most effective strategy for decreasing incidence of lung cancer • Smoking cessation after diagnosis related to increased survival and decreased incidence of second malignancy • Practice four “A’s” of smoking cessation

  20. Patient and Family Education • Patient and Family Education can include • Teaching on diagnostic and staging tests and procedures • Teaching on surgery and post-operative course • Teaching on chemotherapy agents and potential side effects • Teaching on radiation therapy and potential side effects • Teaching on management of symptoms experienced secondary to treatment such as chemotherapy and radiation

  21. Symptom Management • Patients with lung cancer experience multiple symptoms that change throughout illness trajectory • Pain • Fatigue • Changes in appetite • Respiratory Symptoms • Management of symptoms is essential • Uncontrolled symptoms have been related to increased emotional distress and decreased quality of life

  22. Psychosocial Issues • Emotional Distress • Anxiety • Depression • Spiritual Distress • Loss of personal control • Loss and Grief • Social Dysfunction

  23. Available Resources • Know National Resources Available for Patients • Some Lung Specific Resources Include • Lung Cancer Alliance at www.lungcanceralliance.org • Lung Cancer Circle of Hope www.lungcancercircleofhope.org • Lung Cancer Foundation of America www.lcfaamerica.org • LUNGevity Foundation www.lungevity.org • National Lung Cancer Partnership www.nationallungcancerpartnership.org • Know Local Resources Available for Patients • Hospital Resources • Community Resources

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