Lung cancer part 2

Question 1

What are the biopsy options for lung cancer?

Answer 1

• CT guided needle aspiration
• bronchoscopy
• Mediastinoscopy: goes in through the neck
• video assisted thoracoscopic surgery (VATS)
• thoracentesis: fluid analyzed for malignant cells (position over bedside table)

Question 2

How is NSCLC staged?

Answer 2

-TNM
-I - IV
-A&B: A = tumors size < 3cm
B = 3-5 cm

Question 3

How is SCLC staged?

Answer 3

• limited to extensive
• limited: one side and regional lymph nodes only
• extensive: 65-75% have this type and they have 6 weeks to 12 month survival

Question 4

What are the surgery treatment options for NSCLC stage one or 2?

Answer 4

• lobectomy: removes a section or lobe, after 5 years 30-50% survival rate
• pneumonectomy: removes entire lung
• wedge or segmental resection: removes part of lobe: tx of choice for stage I thru IIIA NSCLC
• video assisted thoracic surgery (VATS): for stage I

Question 5

Why is radiation used and not used for treatment of lung cancer?

Answer 5

• may be primary if pt can’t tolerate surgery
• can be used for NSCLC and SCLC
• used more to relieve dyspnea and treat superior vena cava syndrome
• can be very harsh for this area of the body

Question 6

What are the benefits of stereotactic body radiotherapy?

Answer 6

• high dose
• pinpoint placement
• less damage to surrounding tissue
• used for 5cm or less tumors

Question 7

How does targeted therapy inhibit growth of cancer cells?

Answer 7

• inhibits abnormal genes from growth
• inhibits blood vessel growth
• given if other drugs won’t work and attacks the arteries feeding the cancer cells

Question 8

-boosts immune response against cancer cells
-blocks protein that thwart out T-cell response
increased immune response against cancer cells

Answer 8

immunotherapy

Question 9

Why is a chest tube placed after lung surgery?

Answer 9

• re-inflate the luges
• drain fluid and/or air out
• the fluid or air in the pleural space changes the negative to positive pressure
• these are placed post-op or at bedside

Question 10

What is nursing responsibility for chest tube placement at bedside?

Answer 10

• pre-medicate
• support pt
• set up pleurvac before procedure
• vitals/ continuous pulse Ox, leave BP cuff on
• bedside supplies: suction, O2, etc.

Question 11

Explain air bubbles related to chest tube.

Answer 11

• initial bubbles are common (more so with pneumothorax) esp. when connected to suction
• some bubbles may escape with exhalation
• non stop bubbles or an increase may indicate a leak in system
• tidal chamber should go up with inhalation and down with exhalation. If there is no rise an fall of the tidal chamber something is wrong

Question 12

Explain tidaling chamber for chest tubes.

Answer 12

• turn off suction if on
• have pt take a deep breath while you watch tidaling chamber
• tidal chamber should go up with inhalation and down with exhalation. If there is no rise an fall of the tidal chamber something is wrong
• the rise and fall should decrease over time but not stop suddenly