Chest Tumors_NCM 104 1st Sem, 2010

8/3/2019 Chest Tumors_NCM 104 1st Sem, 2010

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CHEST TUMORS


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ANATOMY AND PHYSIOLOGY OF THE

RESPIRATORY SYSTEM
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LUNG CANCER (BRONCHOGENIC

CARCINOMA)

Leading cancer killer

Cancer that forms in tissues of lung,

usually in the cells lining air passages.


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LUNG CANCERCANCER FACTS HOW DOESLUNG CANCER DEVELOP

Pathophysiology
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CATEGORIES OF LUNG CANCER

Small cell lung cancer

a. small cell carcinoma (oat cell cancer)b. mixed small cell / large cell carcinoma

c. combined small cell carcinoma

Non-small cell lung cancera. Squamous cell cancer

b. Large cell carcinomac. Adenocarcinoma

d. Bronchoalveolar cell cancer


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CLASSIFICATIONS AND STAGING

Is decease in which malignant cancer cellsform in the tissues of the lung.

Most malignant form of lung cancer arises fromthe bronchi

Hypersecretes antidiuretic hormone leadinghyponatremia.

Metastesis is early hrough the bloodsteam andlynphatics to the mediastinum, liver, bone,bone marrow, CNS, adrenal glands, pancreas

and other endocrine organ.

Small Cell Lung Cancer


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Small cell Carcinoma

Combined small cell

carcinoma


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NON SMALL CELL LUNG CANCER

is a disease in which malignant cancercells form in the tissues of the lung tissue

grow uncontrollably and form tumors.


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a. Squamous cell cancer

centrally located andarises more commonlyin the segmental andsub segmental bronchi.

b. Large cell carcinoma(undifferentiatedcarcinoma) fast growing

tumor that tends to ariseperipherally.


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STAGES OF NON SMALL CELL LUNG

CANCER

Occult Stage cancer cells are found in asample of a patients coughed upsputum but no cancer cells have yet beendetected in the lungs.

Stage O are noninvasive cancers andonly a few layers of cancer cells aredetected within one local area.

Stage I the cancer cell has reachedhigher layers of the lung but has notspread into the lymph nodes or beyond thelung


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Stage II cancer cells have spread tonearby lymph nodes

Stage III - cancers cells have spreadbeyond the lung to the chest wall,diaphragm, or further lymph nodes.

Stage IV cancer has spread

(metastasized) to other parts of the body.


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RISK FACTORS

Tobacco Smoke

Second hand smoke

Environmental and occupationalexposure

Genetics

Dietary factors


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CLINICAL MANIFESTATIONS

Cough dry, persistent without sputum production Dysphea

Hemoptysis Chest or shoulder pain

Recurring fever Shortness of breath Chest pain and tightness Hoarseness

Dysphagia Head and neck edema Symptoms of Pleural or Pericardial Effusion


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! Nursing Alert

A cough that changes in charactershould arouse suspicion of lung

cancer.


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ASSESSMENT AND DIAGNOSTIC FINDINGS

Chest X-ray

A scan of the chest


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Sputum Cytology

Fiberopticbronchoscopy


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Endoscope with

esophagealultrasound

Positron Emission

Tomographs Scan(PET)


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Magnetic ResonanceImaging (MRI)

Mediatinoscopy /

Mediastinotomy


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MEDICAL MANAGEMENT

Surgical Resection preferred method oftreating patients with localized non-small celltumors.

Radiation Therapy useful in controlling

neoplasm that cannot be surgically resected. Chemotherapy used to alter tumor growth

patterns, to treat distant metastases or small cellcancer of the lung.

Palliative Therapy - to shrink the tumor toprovide pain relief, a variety of bronchoscopicinterventions and pain management and comfortmeasures.


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TYPES OF LUNG RESECTION

Lobectomy: a single lobe of lung is removed.

Bilobectomy: two lobes of the lung areremoved.

Sleeve Resection: Cancerous lobe(s) isremoved and a segment of the main bronchus is

resected. Pneumonectomy: removal of entire lung. Segmentectomy: a segment of the lung is

removed.

Wedge Resection: removal of a small, pie-shaped area of the segment.

Chest Wall Resection with Removal ofCancerous Lung Tissue: for cancers that have

invaded the chest wall.


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TREATMENT AND RELATED COMPLICATIONS

RespiratoryfailureDiminished cardiopulmonary

function

Pulmonary fibrosisMyelitis

Cor pulmonale

Pneumonitis Pulmonary toxicity


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NURSING MANAGEMENT

Managing Symptoms

Relieving Breathing Problems

Reducing Fatigue Providing Psychological

support


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GERONTOLOGICAL CONSIDERATIONS

Issues that must be considered in care ofelderly patient with lung cancer includefunctional status, comorbid conditions,

nutritional status, cognition, concomitantmedications, psychological and socialsupport.


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TUMORS OF MEDIASTINUM

Result from pressure of mass againstimportant intrathoracic organs is a growth inthe central chest cavity, which separate the

lungs and contains the heart, aorta,esophagus, thymus and trachea


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CLINICAL MANIFESTATION

Cough

Wheezing Dyspnea

Anterior chest or neck pain Bulging of the chest wall

Heart palpitations

Angina


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CIRCULATORY DISTURBANCES

Central cyanosis

Superior vena cava syndrome

Marked distension of veins ofneck and chest wall

Dysphagia

Weight loss


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ASSESSMENT AND DIAGNOSIS FINDINGS

Chest X-rays

CT Scan

MRI PET


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MEDICAL AND SURGICAL

MANAGEMENT

Median Sternomy is atype of surgicalprocedure in which

vertical line incision ismade along the sternum

Thoracotomy is a

open surgical procedurewhere all or part of thelung is removed.


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Bilateral AnteriorThoracotomy

(Clamshell incision)Largest incisioncommonly used inthorasic surgery.

Video AssistedThorascopic SurgeryUses small cameras and

instruments to see andoperate inside the bodywithout making largeincisions.


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COMPLICATIONS

Hemorrhage

Injury to phrenic

Recurrent laryngealnerve

Infection


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GODBLESS!!!!!

Thank you=)

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Chest Tumors_NCM 104 1st Sem, 2010