Pulmonary neoplasm

PULMONARY NEOPLASM

INTRODUCTION

DEFINITION

• Lung cancer is malignancy in the epithelium of the respiratory tract

INCIDENCE

• Lung cancer accounts about 6.8% of all malignancies in India

• The incidence is estimated to be about 6.6%per one lakh in males1.7per one lakh among in females

RISK FACTORS

• Cigarette smoking Exposure with

• radioactive isotopes,• polycyclic hydro carbons,• vinyl chloride,• metallurgical ores• , and mustard gas.

ETIOLOGY

• cigarette smoking• include inhaled toxins, such as as bestos, and

pollutants. ,radon, nikal ,iron• iron oxides uranium polycyclic aromatic

hydrocarbons chromates arsenic ,air pollution Working in mines smelting or chemical or petroleum manufacturing

Contd…

Contd..

• polycyclic aromatic hydrocarbons chromates,arcenic,air pollution, lung disease,TB pneumonia diet low in fruit and vegetables previous radiotherapy to the chest

PATHOPHYSIOLOGY

Paraneoplastic syndromes

• Remote effects of malignancy occur in 10 to 20 per cent of lung cancerclients. These usually result from the secretion of sub stances (e.g., hormones, enzymes and antigens) by the tumor itself. These substances then act on target organs, producing a vari ety of symptoms called paraneoplastic symptoms

Classification and Staging

• small cell lung cancer, • non-small cell lung cancer

Staging

• T is the tumors size ,location and degree of invasion

• N is the regional node involvement• M is distant metastasis

Clinical Manifestations• Early• Asymptomatic until late phase• Persistent Cough • Dyspnoea• Chest and shoulder pain• Recurrent temperature• Recurrent infection• Blood tinged sputum• Wheeze• Anorexia• Weight loss• Vomiting• Hoarseness of voice•

Late

• Bone pain• Spinal cord compression• Chest pain• Dysphasia• Blurred vision• Pleural effusion• Horseness of voice • Dysphagia • Head and neck oedema

Signs symptoms depends upon location of lesion

• Localized• Cough mostly chronic dry cough• Breathing symptoms• -shortness of breath and strider• Changes in sputum• -increased amount Hemoptysis• Pneumonia• Hoarseness of voice• chest pain and tightness

generalized

• Bone pain• Head ache • Mental status changes• Abdominal pain• Anorexia• Idiopathic weight loss• Pancots syndrome • Horner's syndrome • Pleural effusion• Svenalar syndrome

Assessment and Diagnostic Findings• CXR• CT• PET SCAN• sputum cytology• biopsy• thoracoscopy• bronchoscopy• CBC-WBC RBC• BIOPSY• Contd..

Contd..

• MRI• FNAC• Pleural aspirate cytology• Mediastinoscopy• Lymph node biopsy• Open lung biopsy (rare)• esophageal ultrasound (EUS)• lung scan spirometry, video assisted thoracoscopy,

pulmonary angiography, lung scan

Management

• treatment may involve surgery,• radiation therapy, • chemotherapy • combination of these.• immune system therapy• (gene therapy, therapy with defined tumor

antigens biological response modifiers)

CHEMOTHERAPY

• includingalkylating agents (ifosfamide), platinum analogues (cisplatin andcarboplatin), taxanes (paclitaxel, docetaxel), vinca alkaloids(vinblastine and vindesine), doxorubicin, gemcitabine, vinorelbine,irinotecan (CPT-11), and etoposide (VP-16)

RADIATION THERAPY

• Radiation is used to reduce the size of a tumor,

• to make an inoperable tumor operable, • relieve the pressure of the tumor on vital

structures.• control symptoms of spinal cord metastasis

and superior vena caval compression• Reduce bone and liver pain.

Treatment-Related Complications

• diminished cardiopulmonary function • pulmonary fibrosis,• Pericarditis,• myelitis• cor pulmonale.• pneumonitis.• Pulmonary toxicity

SURGICAL MANAGEMENT

• lobotomy (removal of a lobe of the lung). • Entire lung may be

removed(pneumonectomy)

Types of surgical approaches

• Wedge Resection. • Segmental Resection. • Segmental Resection. • Pneumonectomy.

LASER THERAPY

• laser use is palliative for the relief of endobronchial obstructions caused by non resectable lung tumors. Lasers do not produce systemic or cumulative toxic effects and are well tolerated.

CLOSED CHEST DRAINAGE

Metastasis.

OTHER TYPES OF LUNG TUMORS

• sarcomas,• lymphomas,• bronchial adenomas.

Benign tumors.

• Hamartomas• Chondromas • Mesotheliomas

Nursing Management

•

Nursing Diagnoses

• Ineffective airway clearance related to increased tracheobronchial secretions and presence of tumor

• Anxiety related to lack of knowledge of diagnosis or unknown prognosis and treatments

• Acute pain related to pressure of tumor on surrounding structures and erosion of tissues

Contd..

• Imbalanced nutrition: less than body requirements related to increased metabolic demands, increased secretions, weakness, and anorexia

• Ineffective health maintenance related to lack of knowledge about the disease process and therapeutic regimen

• Ineffective breathing pattern related to decreased lung capacity.

Nursing Implementation

• health promotion, • managing symptoms• relieving breathing problems• reducing fatigue• providing psychological support• acute intervention. • ambulatory and home care

Evidence based practice

CONCLUSION