Lung Cancer Overview
Types and Risk Factors
- Non-small cell lung cancer (NSCLC) accounts for 85% of cases and includes adenocarcinoma, squamous cell, and large cell carcinoma. Small cell lung cancer (SCLC) is more aggressive and spreads rapidly.
- Primary risk factor is cigarette smoking (90% of cases), followed by secondhand smoke, radon exposure, asbestos, and family history.
Memory Aid - LUNG:
L - Late symptoms (often asymptomatic early)
U - Unintentional weight loss
N - New persistent cough
G - Gradual dyspnea progression
Clinical Manifestations
- Early signs include persistent cough, dyspnea, chest pain, and hemoptysis. Advanced disease presents with weight loss, fatigue, and bone pain from metastasis.
- Superior vena cava syndrome is an oncologic emergency causing facial swelling, neck vein distention, and dyspnea requiring immediate intervention.
Clinical Scenario: A 65-year-old smoker presents with a 3-month history of persistent cough, unintentional 15-pound weight loss, and recent hemoptysis. Priority nursing action is to assess respiratory status and prepare for diagnostic workup including chest CT and sputum cytology.
Key Points
- Lung cancer is often diagnosed in advanced stages due to lack of early symptoms
- Smoking cessation counseling is crucial even after diagnosis
- Monitor for signs of metastasis to brain, bone, and liver
Nursing Management
Priority Interventions
- Airway management is the highest priority, especially post-operatively with tracheostomy care, suctioning, and monitoring for respiratory distress.
- Pain management using multimodal approach including opioids, NSAIDs, and non-pharmacologic methods while monitoring for respiratory depression.
- Nutritional support through enteral feeding initially, progressing to oral intake with speech therapy guidance for swallowing assessment.
Tracheostomy Care - SUCTION:
S - Sterile technique
U - Use appropriate catheter size
C - Check oxygen saturation
T - Time limit 10-15 seconds
I - Insert without suction
O - Oxygenate before/after
N - Never force catheter
Patient Education
- Teach tracheostomy care including cleaning, suctioning, and emergency procedures for accidental decannulation.
- Emphasize importance of smoking cessation to prevent recurrence and improve healing outcomes.
Key Points
- Keep emergency tracheostomy kit at bedside
- Monitor for signs of infection at surgical site
- Provide emotional support for body image changes
Commonly Confused Concepts
| Lung Cancer | Laryngeal Cancer |
|---|
| Affects lung parenchyma | Affects voice box/throat |
| Hemoptysis common | Hoarseness primary symptom |
| Metastasizes widely | Usually localized initially |
| Lobectomy/pneumonectomy | Laryngectomy procedures |
Quick Check - Cancer Warning Signs:
□ Persistent cough >3 weeks
□ Hoarseness >2 weeks
□ Unexplained weight loss
□ Difficulty swallowing
□ Hemoptysis
Study Tips and Memory Aids
- Remember "ABC's" - Airway, Breathing, Circulation always take priority in respiratory cancers
- For laryngectomy patients: "No connection" between mouth/nose and lungs - they breathe through stoma only
- SCLC spreads quickly like "small but mighty" - more aggressive than NSCLC
Common Pitfall: Don't attempt mouth-to-mouth resuscitation on total laryngectomy patients - provide rescue breathing through the stoma opening.
NCLEX Success Tips
- Prioritize airway management questions
- Know the difference between partial and total laryngectomy outcomes
- Understand smoking cessation counseling importance