Lung Cancer

Most common cause of lung cancer is inhaling _. 

Carcinogens. 

_ of all lung cancers are caused by smoking. 

85-90% 

What are the risk factors of lung cancer? 

Cigarette smoke, genetic predisposition, dietary deficits (Vitamin A – beta carotene), underlying respiratory diseases (COPD, TB), environmental factors (asbestos, radon, arsenic). 

Small cell lung cancer (SCLC)

All cases are due to smoking; it is the most aggressive form of lung cancer and grows quickly. Brain metastases are common in this cancer.

What are the three categories of non-small cell lung cancer (NSCLC)? 

Squamous cell carcinoma, large cell carcinoma, and adenocarcinoma. 

Non-small cell lung cancer (NSCLC)

More common than small cell lung cancer, grows and spreads slower than SCLC.

Squamous cell carcinoma

Found commonly in men and related to a history of smoking.

Large cell carcinoma

The worst form of NSCLC.

Adenocarcinoma

Most common in both men and women, has a worse prognosis than squamous cell carcinoma.

What are the S/S of lung cancer? 

Cough or change in chronic cough, dyspnea, chest pain, hoarseness, weakness, anorexia, weight loss, wheezing, and blood in sputum. Often asymptomatic until late stage. 

Where does lung cancer typically metastasize to? 

The brain, bone, and liver. 

What potential imaging can be used for lung cancer? 

Chest x-ray, CT scan (will see smaller nodules than a x-ray), PET scan will search for metastasis. MRI can view metastasis to the brain. 

What potential procedures can be used for lung cancer? 

Biopsy, fiber optic bronchoscopy (bronchoscope is inserted into the lung to collect biopsy), transthoracic fine needle aspiration (uses a needle going into the chest wall to pull out a tissue sample using a CT scan as a guide). 

What potential labs may be used for lung cancer? 

Checking kidney function (BUN, creatinine), blood glucose, electrolytes, CBC, ABG, EKG or pulmonary function test. These are done when considering surgery. 

How is small cell lung cancer treated?  

Radiation, chemo, and possibly surgery if it has not spread yet.  

Pre-op interventions for a thoracotomy 

Assessment, diagnosis, patent airway, patient education, relieving anxiety, forced expiratory technique, diaphragmatic and pursed-lip breathing.  

Post-op interventions for a thoracotomy 

Respiratory assessments, vitals every 2-4 hrs, continuous electrocardiogram, elevate head of bed 30-40 degrees, encourage a cough routine and deep-breathing exercises, monitor chest drainage system. 

Annual lung cancer screening is recommended for those who: 

Have a 20 pack-year or more smoking history, and smoke now or have quit within the past 15 years, and are between 50-80 years old.  

What is a pack year? 

Smoking an average of one pack of cigarettes per day for one year.  

Pneumonectomy

The removal of an entire lung.

Lobectomy

Removal of a lobe of a lung, more common than pneumonectomy.

Segmentectomy (Segmental resection)

Removal of a segment of a lung.

Wedge resection

Removes a small wedge-shaped portion of lung tissue.

Sleeve resection

Removal of part of a lung along with part of the bronchus. Typically used to treat non-small cell lung cancer and an alternative to more extensive surgeries.

Lung volume reduction

Removal of 20-30% of a lung through a midsternal incision or video thoracoscopy.

Video thoracoscopy

an endoscopic procedure that allows the surgeon to look into the thorax without making a large incision. The procedure is performed to obtain specimens of tissue for biopsy, to treat recurrent spontaneous pneumothorax, and to diagnose either pleural effusions or pleural masses.

How should a patient post-thoracotomy return to normal function? 

Arm and shoulder exercises should be done 5 times daily at home. Practice a functionally erect position in front of a mirror. Assist out of bed to chair by evening of surgery. Encourage ROM exercises as tolerated.