LUNG CANCER Flashcards
Tobacco smoke
Exposure to tobacco smoke causes changes in the bronchial epithelium, which usually returns to normal when smoking is discontinued.
contains 60 carcinogens in addition to substances (carbon monoxide, nicotine) that interfere with normal cell development.
The risk of lung cancer gradually decreases
with smoking cessation, reaching that of nonsmokers within 10 to 15 years of quitting.
The risk of developing lung cancer is directly related to
total exposure to tobacco smoke, measured by total number of cigarettes smoked in a lifetime, age of smoking onset, depth of inhalation, tar and nicotine content, and the use of unfiltered cigarettes. Both smokers and nonsmokers can develop lung cancer.
Other common causes of lung cancer include
high levels of pollution, radiation (especially radon exposure), and asbestos.
Heavy or prolonged exposure to industrial agents such as ionizing radiation, coal dust, nickel, uranium, chromium, formaldehyde, and arsenic can also increase the risk of lung cancer
Gender Differences Lung Cancer Men
- More men than women are diagnosed with lung cancer.
- More men than women die from lung cancer.
- Male smokers are 10 times more likely to develop lung cancer than nonsmokers.
- Men with lung cancer have a worse prognosis than women.
- Lung cancer incidence and deaths are decreasing in men.
Gender Differences Lung Cancer Women
• Lung cancer incidence and deaths are increasing in women. • Women develop lung cancer after fewer years of smoking than men do. • Women develop lung cancer at a younger age than men. • Nonsmoking women are at greater risk of developing lung cancer than men. • Women with lung cancer live, on the average, 12 months longer than men.
Cultural & Ethnic Health Disparities Lung Cancer
African Americans • Have the highest incidence of lung cancer • Are more likely to die from lung cancer than any other ethnic group • Have a higher rate of lung cancer among men than in other ethnic groups
Whites • Have the second-highest death rate from lung cancer • Have a higher rate of lung cancer among women than in other ethnic group
Lung Cancer Pathophysiology
- believed to arise from mutated epithelial cells.
- development of mutations, which are caused by carcinogens, is also influenced by various genetic factors.
- Once underway, tumor development is promoted by epidermal growth factor.
- cells grow slowly, taking 8 to 10 years for a tumor to reach 1 cm in size
- Lung cancers occur primarily in the segmental bronchi or beyond and usually occur in the upper lobes of the lungs
Primary lung cancers are categorized into two broad subtypes
non–lung cancer (NSCLC) (80%) and small cell lung cancer (SCLC) (20%).
The common sites for metastasis are the lymph nodes
liver, brain, bones, and adrenal glands.
(NSCLC) Squamous cell carcinoma
Slow • Centrally located, producing early symptoms of nonproductive cough and hemoptysis • Does not have a strong tendency to metastasize. • Surgical resection may be attempted. • Adjuvant chemotherapy and radiation
(NSCLC) Adenocarcinoma
Moderate • Most common lung cancer in people who have not smoked • Peripherally located • Often has no clinical manifestations until widespread metastasis is present • Surgical resection may be attempted depending on staging. • Does not respond well to chemotherapy
(NSCLC) Large cell (undifferentiated) carcinoma
Rapid• Composed of large cells that are anaplastic and often arise in bronchi • Is highly metastatic via lymphatics and blood • Surgery is not usually attempted because of high rate of metastases. • Tumor may be radiosensitive but often recurs.
(SCLC) Small cell carcinoma
Very rapid • Most malignant form of lung cancer • Spreads early via lymphatics and bloodstream • Frequent metastasis to brain • Associated with endocrine disturbances • Chemotherapy mainstay of treatment but overall poor prognosis • Radiation is used as adjuvant therapy and palliative measure.
Paraneoplastic Syndrome
caused by hormones, cytokines, or enzymes (secreted by tumor cells) or by antibodies (produced by the body in response to the tumor) that destroy healthy cells
-SCLCs are most often associated with the paraneoplastic syndrome.
Paraneoplastic Syndrome examples
hypercalcemia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), adrenal hypersecretion, polycythemia, and Cushing syndrome.
The clinical manifestations of lung cancer are usually
nonspecific and appear late in the disease process. Symptoms may be masked by a chronic cough attributed to smoking or smoking-related lung disease. Manifestations depend on the type of primary lung cancer, its location, and metastatic spread. Lung cancer frequently manifests as a lobar pneumonia that does not respond to treatment.
One of the most common symptoms of lung cancer
persistent cough. Blood-tinged sputum may be produced because of bleeding caused by the cancer. The patient may complain of dyspnea or wheezing. Chest pain, if present, may be localized or unilateral, ranging from mild to severe.
Lung cancer late manifestations
anorexia, fatigue, weight loss, and nausea and vomiting. Hoarseness. Unilateral paralysis of the diaphragm, dysphagia, and superior vena cava obstruction may occur. Sometimes there are palpable lymph nodes in the neck or axillae. pericardial effusion, cardiac tamponade, and dysrhythmias.
