Cancer of the lung.
Cancer of the trachea, bronchus, lung and pleura account for 25% of all cancers.
Second most common tumour in men and women.
Bronchogenic malignancy usually arises in the epithelium that lines the bronchus.
First statistical correlation to indicate aetiology
Smoking is the principle aetiological factor - 80% of cases smoking related
20 + a day increases risk by 40 times - In ex-smokers the risk reduces over 20 years to near normal.
Passive smokers also have an increased incidence.
No identified familiar syndromes, due to overwhelming environmental aetiological factors
Consistent acquired genetic changes - oncosupressor gene deletion on 13q14 also two possible loci in 3p and 11p
Asbestos - potentiating with tobacco smoke, (a synergistic effect).
Good correlation between asbestos and mesothelioma, (a tumour of the pleura)
Town people have a higher incidence than country dwellers.
Definite carcinogens identified in petrol and diesel fumes
Radon, 222Rn, from soil and rocks - ground floor houses with restricted flow of air
The radon correlation is good after accounting for smoking, the effect is cumulative.
A tumour mass usually surrounds a main bronchus
Bronchial mucosa ulcerated or roughened and nodular
Evidence of lymphatic spread
Carcinoma narrows lumen of effected bronchus - obstruction - stasis - infection - bronchopneumonia - abscess formation.
Direct invasion of the pericardial sac and heart.
Compression of vena cava causing cyanosis
Metasteses - lymph nodes in neck, groin, axilla, adrenals, brain, liver, bones, thoracic, vertebrae.
Paraneoplasic syndromes include, neuropathy, myopathy, Cushings, hypercalcaemia and gnnaecomastia.
Metastatic routs from lung cancers;
Histology and cytology
Small cell, (oat cell), smoking related, neurosecretory cells à paraneoplastic effects
Non – small cell, squamous, adenocarcinoma, large cell
Metaplasia – columnar à squamous
Pain, locally and from spread
Necrosis and cavitation
Pleural effusion, (may be haemorrhagic).
Vascular involvement, haemorrhage or obstruction, (eg. involving the superior vena cava).
Collapse of a segment due to blockage Immunosuppression
Infection Lung abscess
PNS involvement Metastases
Malnutrition due to hypermetabolic state or side effects of treatments
Anxiety, depression Grieving and death
Clinical feature % of presenting feature
Cough and pain 15%
Blood in sputum (haemoptysis) 7%
Pain from pleural involvement 22%
Subsequent chest infection 5%
Malaise, (brain, bone) 5%
Weight loss 5%
Shortness of breath 5%
Distant spread 5%
No symptoms 5%
Blockage of a large bronchi
Suspect in pneumonia which does not respond to antibacterials
Enlarged subclavian lymph nodes
Change in volume or odour of sputum
Paraneoplastic effects, increased ADH and ACTH
clinical picture, X ray, cytology, biopsy, radioisotope scan, CT, or MRI,
biochemistry and haemotology. fibreoptic bronchoscopy transthoracic fine-needle aspiration
Surgery Radiation therapy for cure Symptomatic radiation therapy, eg. for bone pain, Chemotherapy Laser therapy Terminal care Possible immunotherapy
From primary neoplasms in the breast, abdominal organs, renal cells, testicles and lymphomas
More common than lung primaries
Pre and post op Support through therapies
Relief of respiratory symptoms
Prepare pt for therapies Elevate head of the bed to drain upper body
Teach breathing exercises Treat cough eg. expectorants and antibacterials
Support during pleural tap.
Improvement of nutritional status
Adequate balanced diet Small regular meals
Protein, vitamin and energy supplements Food from home
Enteral support Observe for wasting and oedema
Observations for upper body venous congestion Pleural effusions
Infections ADLs to promote comfort
Encourage expression of concerns Communication skills listening
Promote independence and normal activity Get help, councillor, chaplain etc.
Family and social care Use voluntary help
Hospice and McMillan advice