August 25, 2009 · 1 Comment
- Also called bronchogenic cancer.
- It is a malignant tumor of the lung arising within the bronchial wall or epithelium.
- Bronchogenic cancer is classified according to cell type: epidermoid (squamous cell – most common), adenocarcinoma, small cell (oat cell) carcinoma, and large cell (undifferentiated) carcinoma.
- The lung is also a common site of metastasis from cancer elsewhere in the body through venous circulation or lymphatic spread.
- The primary predisposing factor in lung cancer is cigarette smoking.
- Lung cancer risk is also high in people occupationally exposed to asbestos, arsenic, chromium, nickel, iron, radioactive substances, isopropyl oil, coal tar products, and petroleum oil mists.
- Complications include superior vena cava syndrome, hypercalcemia (from bone metastasis), syndrome of inappropriate antidiuretic hormone (SIADH), pleural effusion, pneumonia, brain metastasis, and spinal cord compression.
- New or changing cough, dyspnea, wheezing, excessive sputum production, hemoptysis, chest pain (aching, poorly localized), malaise, fever, weight loss, fatigue, or anorexia.
- Decreased breath sounds, wheezing, and possible pleural friction rub (with pleural effusion) on examination.
- Chest X-ray may be suspicious for mass; CT or position emission tomography scan will be better visualize tumor.
- Sputum and pleural fluid samples for cytologic examination may show malignant cells.
- Fiberoptic bronchoscopy determines the location and extent of the tumor and may be used to obtain a biopsy specimen.
- Lymph node biopsy and mediastinoscopy may be ordered to establish lymphatic spread and help plan treatment.
- Pulmonary function test, which may be combined with a split-function perfusion scan, determines if the patient will have adequate pulmonary reserve to withstand surgical procedure.
- Expectorants and antimicrobial agents to relieve dyspnea and infection.
- Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain control.
- Chemotherapy using cisplatin in combination with a variety of other agents and immunotherapy treatments may be indicated.
- Resection of tumor, lobe, or lung.
- Oxygen through nasal cannula based on level of dyspnea.
- Enteral or total parenteral nutrition for malnourished patient who is unable or unwilling to eat.
- Removal of the pleural fluid (by thoracentesis or tube thoracostomy) and instillation of sclerosing agent to obliterate pleural space and fluid recurrence.
- Radiation therapy in combination with other methods.
- Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in upper body (from superior vena cava syndrome).
- Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing.
- Augment the patient’s ability to cough effectively by splinting the patient’s chest manually.
- Instruct the patient to inspire fully and cough two to three times in one breath.
- Provide humidifier or vaporizer to provide moisture to loosen secretions.
- Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely dyspneic patient to sleep in reclining chair.
- Encourage the patient to conserve energy by decreasing activities.
- Ensure adequate protein intake such as milk, eggs, oral nutritional supplements; and chicken, fowl, and fish if other treatments are not tolerated – to promote healing and prevent edema.
- Advise the patient to eat small amounts of high-calorie and high-protein foods frequently, rather than three daily meals.
- Suggest eating the major meal in the morning if rapid satiety is the problem.
- Change the diet consistency to soft or liquid if patient has esophagitis from radiation therapy.
- Consider alternative pain control methods, such as biofeedback and relaxation methods, to increase the patient’s sense of control.
- Teach the patient to use prescribed medications as needed for pain without being overly concerned about addiction.