LUNG CANCER

Question 1

DIFFERENTIATE THE 3 TYPES OF SMOKERS

Answer 1

FIRST-HAND smoke is inhaled directly by the smoker
SECOND-HAND is the smoke exhaled (and inhaled by others)
THIRD-HAND smoke is the residue from second-hand smoke
Carcinogen can adhere to curtains, walls, carpet, furniture for days, weeks, or months.
Studies have revealed that tobacco residue that lingers on surfaces can react with other chemicals in the air to form POTENT CARCINOGENS

Question 2

WHAT ARE THE 2 CATEGORIES OF LUNG CA AND DIFFERENTIATE

Answer 2

SMALL-CELL LUNG CANCER (SCLC)
Prognosis is poor (not good; give complications)
Prognosis: outcome or result of the disorder
Accounts for 18-20% of all primary lung tumors
Very aggressive and always considered systemic
Tends to spread bilaterally
This means that if left lung is affected, it will also involve the right lung
Always considered METASTATIC
Patients have POOR PROGNOSIS

NON-SMALL-CELL LUNG CANCER (NSCLC)
Represents 80% of lung cancers
Most common

Question 3

WHAT ARE THE 3 MAIN HISTOLOGIC GROUPINGS OF NSCLC?

Answer 3

1. ADENOCARCINOMA
   - BOTH GENDER
   -Grows in the LUNG PERIPHERY and metastasizes widely to other parts of the body
   -The predominant type on NONSMOKERS and the most frequent type of lung cancer found in WOMEN
   -Accounts for 18-20% of all primary lung tumors
2. SQUAMOUS CELL CARCINOMA
   -Accounts for 30% of all cases of all lung cancers
   Occurs most frequently in the CENTRAL ZONE OF THE LUNG
   -Closely linked to SMOKING
   -Tends to grow locally and cause ATELECTASIS (collapse of the lungs)
   -Since it is SLOW growing, it has BETTER PROGNOSIS
3. LARGE CELL CARCINOMA
   -Accounts for about 15% of all lung cancers
   -Peripheral lung tumor that is:
   Poorly differentiated
   Aggressive
   Quick to metastasize
   -Survival rate: POOR

Question 4

WHAT ARE THE DIFFERENT DIAGNOSTIC ASSESSMENT FOR LUNG CA?

Answer 4

Currently, no effective screening test exist to detect LUNG CANCER early enough to cure it
Chest X-ray
Sputum cytology
Percutaneous fine-needle aspiration
CT scan

Question 5

CHEST X-RAY

Answer 5

To identify a lung mass or infiltrate
Chest x-ray will be negative → but health history and s&s is positive → doctor will subject you to another test → why? → b/c if cancer is so small, it can’t be seen in the x-ray.
OR the tumor is there, however, it is covered by a large structure in the lungs.

Question 6

SPUTUM CYTOLOGY

Answer 6

Only useful when the tumor is located in the CENTRAL PART of the lung.
3 early-morning sputum specimen for microscopic examination

Question 7

PERCUTANEOUS FINE-NEEDLE ASPIRATION

Answer 7

Only good if the tumor is growing in the LUNG PERIPHERY.

Question 8

COMPUTED TOMOGRAPHY (CT SCAN)

Answer 8

Can detect small-size tumors in early stages of development.

Question 9

WHAT IS THE LAST RESORT IF ALL THE DIAGNOSTIC TEST IS NEGATIVE?

Answer 9

BRONCHOSCOPY
Also only good if tumor grows CENTRALLY
Last diagnostic test if everything is negative
Tumor is centrally (effective)

Question 10

IRESSA(250 MG TABLET)

Answer 10

Suppression of cell proliferation and promotion of apoptosis (programmed cell death)
A cancer medication that interferes with the growth and spread of cancer cells in the body
Used to treat non-small cell lung cancer

INTERSTITIAL LUNG DISEASE is the most serious adverse effect
There is: acute-onset dyspnea, cough and fever
The drug should be discontinued

Avoid taking an antacid or stomach acid reducer (Nexium, Pepcid, Prevacid, Prilosec, Zantac, and others) within 6 hours before or 6 hours after you take Iressa

Question 11

WHAT IS THE INDICATION FOR LOBECTOMY

Answer 11

Performed if there is lesion confirmed to a single lobe
PTB
Lung abscesses or cysts
Bronchiectasis

Question 12

WHAT IS THE INDICATION FOR SEGMENTAL RESECTION?

Answer 12

Done if there is small peripheral lesion (adenocarcinoma)
Congenital cyst or blebs
Bronchiectasis

Question 13

WHAT IS THE INDCICATION FOR PNEUMONECTOMY?

Answer 13

Removal of one lung
Done if cancer is already malignant
Unilateral TB
Multiple lung abscesses
Massive hemoptysis

Question 14

WHAT IS THE BEST POSITION FOR PATIENT UNDERGONE SEGMENTECTOMY OR LOBECTOMY?

Answer 14

turn pt on his back → then turn him on a right SIMS POSITION → operated site up → for the remaining lung to expand.

Avoid positioning patient on operative side if a WEDGE RESECTION or SEGMENTECTOMY has been performed
It impedes expansion of remaining lung tissue and may impede normal gas exchange

Question 15

WHAT IS THE BEST POSITION FOR PATIENT UNDERGONE PNEUMONECTOMY

Answer 15

The patient may lie on the BACK OR OPERATED SIDE ONLY

Patient undergone right pneumonectomy → position on his back → then turn him on his OPERATIVE SIDE

Question 16

CHEST TUBES

Answer 16

To remove the blood for the wound to heal → chest tubes will be connected

The drainage will initially appear BLOODY → becoming SEROSANGUINEOUS → then SEROUS over the first 2 or 3 days postoperatively

Approximately 100 to 300 ml of drainage will occur during first 2 hours postoperatively, which will decrease to less than 50 ml/hour over the next several hours

Question 16

CHEST TUBES

Answer 16

To remove the blood for the wound to heal → chest tubes will be connected

The drainage will initially appear BLOODY → becoming SEROSANGUINEOUS → then SEROUS over the first 2 or 3 days postoperatively

Approximately 100 to 300 ml of drainage will occur during first 2 hours postoperatively, which will decrease to less than 50 ml/hour over the next several hours

POSITION: UPRIGHT OR LYING ON THE ABDOMEN

Question 17

HOW WILL YOU PREVENT ANKYLOSIS AFTER 24 HRS OF SURGERY?

Answer 17

Elevating the scapula and clavicle (prevent frozen shoulder and contractures)
OR you can retract your shoulders on the back
Bringing the scapula as close together as possible

Hyperextending the arm
Give pain medications first before you let the patient do the exercises