WOLLO UNIVERSITY CMHS

SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF ADULT HEALTH NURSING
Master Program
 1 
Topic: Breast and Lung Cancer

Prepared by: Abdurehman Ayele

ID- 0072/13
 Outline

 Introduction
 Definition
 Epidemiology
 Pathophysiology
 Etiology and risk factor
 Clinical manifestation
 Diagnosis
 Treatment and prevention
 Complication
 Summary
 Conclusion
 References 2
 Objectives
 At the end of this session the students will be able to;
 Define breast and lung cancer
 Describe the pathogenesis of breast and lung cancer
 Identify the sign and symptoms of breast and lung cancer
 Discuss the diagnostic methods of breast and lung cancer
 Explain the management protocols of breast and lung
cancer

3
 Introduction
 Cancer is a large group of disorders with different causes,
manifestations, treatments, and prognoses.
 cancer can involve any organ system and treatment approaches
have the potential for multisystem effects.
 Nursing management of the patient with oncologic disorders
includes care of patients throughout the cancer trajectory from
prevention through end-of-life care

4
 Introduction ….

 It is a disease of cell in which normal mechanism of control

of growth and proliferation are disturbed.
 It is a group of cells that grows out of control taking over
the function of the affected organ.
 It is a group of disease characterized by uncontrolled
cellular growth with systematic metastasis.

5
 Cancer grading

 Grading is the pathologic classification of tumor cells.

 Grading systems seek to define the type of tissue from
which the tumor originated and the degree to which the
tumor cells retain the functional and histologic
characteristics of the tissue of origin (differentiation)
 Grade X- Grade cannot be determined .
 Grade I-Cells differ slightly from normal cells and are well
differentiated (Mild Dysplasia).

6
 Cancer staging

 Staging determines the size of the tumor, the existence of

local invasion, lymph node involvement, and distant
metastasis.
 To help determine the best treatment options
 Not all cancers are staged. For example leukemias
 The American Joint Committee on Cancer (AJCC) and the
Union for International Cancer Control (UICC) maintain the
TNM classification system.

7
 Con’t…
 T -The extent of the primary tumor(cancer started).
 N -The absence or presence of regional lymph node
metastasis.
 M- The absence or presence of distant metastasis.

8
 Primary tumor (T)

 TX: primary tumor cannot be assessed(no information).

 T0: no evidence of primary tumor(it cannot be found).
 Tis: carcinoma in situ(in the layer of cell or pre-cancer
stage) .
 T1, T2, T3 and T4: increasing size and local extent of the
the primary tumor.
 The higher the T number, the larger the tumor.

9
 Regional lymph nodes (n)

 NX: regional lymph nodes cannot be assessed.

 N0: no regional lymph node metastasis.
 N1, N2, N3: increasing involvement of regional lymph
nodes.

10
 Distant metastasis (M)

 MX: distant metastasis cannot be assessed.

 M0: no metastasis
 M1: distant metastasis

11
12
 Con’t….

Post-surgical Resection Staging:

Pathological Staging:
-The extent of disease using all data available at the time of
surgery and on examination of a completely resected
specimen.
B. Re-treatment Staging:
-Restaging is necessary for additional or secondary
definitive treatment after a (disease-free) interval following
1st treatment.
C. Autopsy Staging:
-Used only when the cancer is 1st diagnosed at autopsy
13
Breast Cancer

14
 Introduction
 Breast cancer is the most common invasive cancer in
women and the second leading cause of cancer death in
women after lung cancer.
 Breast cancer can occur in both men and women, but
it's far more common in women.
 Substantial support for breast cancer awareness and
research funding has helped created advances in the
diagnosis and treatment of breast cancer

15
 Anatomy and Physiology of Breast
 The breasts are a secondary sex characteristic that develops
during puberty in response to estrogen and progesterone.
 It extend from the second to the sixth ribs.
 The extension of breast tissue into the upper-outer quadrant into
the axilla is an area referred to as the tail of Spence.
 The fully mature breast is dome shaped and has a pigmented
center called the areola.
 The areolar region contains Montgomery’s tubercles, which help
to lubricate the nipple.

16
 Anatomy and Physiology…
 Inside the breasts are glands that produce and release milk
after a woman has a baby.
 The glands that make the milk are called lobules
 During lactation, the alveoli secrete milk which flows into
a ductal system and is transported to the lactiferous
sinuses.
 Tiny tubes that carry the milk from the lobules to the
nipple are called ducts.
 Fatty tissue, connective tissue, blood and lymphatic
vessels surrounding the ducts and lobules, is called
Stroma
17
Cont …..
 Breasts consist mainly
of fatty tissue
interspersed with
connective tissue
 There are also less
visible parts
 lobes
 ducts
 lymph nodes
18
 Cont…

Most of the lymph vessels of the breast drain into:

 Auxiliary nodes :- under the arm
 Supraclavicular and infraclavicular lymph nodes :-
around the collar bone
 Internal mammary lymph nodes :- inside the chest near
the breast bone

19
20
 Definition of Breast cancer
 Breast cancer arises in the lining cells (epithelium) of the
ducts (85%) or lobules (15%) in the glandular tissue of
the breast.
 Breast cancer begins in the breast tissue, and can be benign
or malignant.
Benign Tumors
 Not cancerous.
 Benign breast tumors are abnormal growths, but they do not
spread outside of the breast and they are not life threatening.
21
 Cont…
 Most lumps are caused by the combination of cysts and
fibrosis
 Cysts are fluid-filled sacs.
 Fibrosis is the formation of scar - like tissue.
 These changes can cause breast swelling and pain.

22
23
 Cont…

 A malignant (cancerous) tumor that starts in the cells of the

breast.
 It is found mostly in women, but men can get breast cancer,
too.
Non - Invasive
Invasive
 Pre – Cancerous
 Cancerous
 Still in its original
 Malignant
position
 Eventually develops
 Spreads to other
into invasive breast organs (metastasis)
cancer 24
25
26
 Epidemiology
 In 2020, there were 2.3 million women diagnosed with
breast cancer and 685 000 deaths globally.
 In Ethiopia, breast cancer incidence is rising and become
the foremost common cancer, causing high rates of
morbidity and mortality.
 The incidence of breast cancer accounts for 15,244
(22.6%) all cases of cancer and 8,159 (17%) cancer
mortality annually.

27
 Pathophysiology
 Breast cancer arises from the epithelial lining of the ducts
(ductal carcinoma) or from the epithelium of the lobules
(lobular carcinoma).
 Estrogen and progesterone receptors, present in some
breast cancers, are nuclear hormone receptors that
promote DNA replication and cell division when the
appropriate hormones bind to them.
 Human epidermal growth factor receptor 2 (HER-2) is a
protein that helps regulate cell growth.

28
29
 Causes of breast cancer
 The cause of most breast cancers is unknown.
 Most likely cause is related to changes in the genetic
material (DNA) in our cells.
 DNA changes are often related to our lifestyle, but some
can be due to age and other factors.

30
 Risk factor
Being female and increasing age.
A personal history of breast conditions-hyperplasia of
breast.
A personal history of breast cancer. 
A family history of breast cancer. 
Inherited genes that increase cancer risk. 
Postmenopausal hormone therapy.
Radiation exposure.
Beginning your period at a younger age. Beginning
menopause at an older age. 
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Types of breast cancer

32
 Cont….

Ductal carcinoma In situ

 Carcinoma confound in in
milk duct :-
 Non invasive

(pre cancer)

33
Invasive ductal carcinoma
 Cancer arises in the lining of the ducts Grows /invades the breast
tissues Spreads to lymph nodes and other organs

34
Inflammatory breast cancer (IBC)

 Uncommon (1% to 3% of all breast cancers)

 Invasive Brest Cancer.
 No lump or tumor.
 Mistaken for infection in its early stages.
 IBC makes the skin of the breast look red and feel warm.
 It also may make the skin look thick and pitted and may
have an orange peel feel.
 The breast may get bigger, hard, tender, or itchy

35
 Cont….
Normal breast vs Inflammatory Breast

36
 Lobular carcinoma in situ (LCIS)

 Non – Invasive.
 Contained in the lobules and does not spread to the
tissues of the breast.
 May become malignant Milk producing lobules

37
38
 Invasive (infiltrating) lobular carcinoma (ILC)

 Formed in the lobules.

 Grows through the wall of the lobules.
 Spreads

39
 Cont….
Breast Sarcoma
 Rare breast cancer
 It arises from the connective tissue or stroma of
breast
 E.g Angiosarcoma of breast.

40
 Staging of breast cancer
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ (DCIS, or Paget disease of the
breast with no associated tumor mass)
T1 : Tumor is 2 cm (3/4 of an inch) or less across.
T2: Tumor is more than 2 cm but not more than 5 cm (2
inches) across.
T3: Tumor is more than 5 cm across.
T4 :any size growing into the chest wall or skin includes
inflammatory breast cancer.
41
 Con’t…
 NX: Nearby lymph nodes cannot be assessed (for
example, if they were removed previously).
 N0: Cancer has not spread to nearby lymph nodes.
 N1: spread to 1 to 3 axillary (underarm) lymph node(s),
and/or tiny amounts of cancer are found in internal
mammary lymph nodes (those near the breast bone).
 N2: Cancer has spread to 4 to 9 lymph nodes under the
arm, or cancer has enlarged the internal mammary lymph
nodes.
 N3:Metastases in ≥ 10 axillary lymph nodes; or in
infraclavicular (level III axillary) lymph nodes. 42
 Con’t…
 M indicates whether the cancer has spread to distant
organs -- for example, the lungs, liver, or bones.
 MX: Distant spread (metastasis) cannot be assessed.
 M0: No distant spread is found on x-rays (or other
imaging tests) or by physical exam.
 M1: Cancer has spread to distant organs (most often to
the bones, lungs, brain, or liver).

43
 Staging of Breast Cancer

 Stage 0 : Non – Invasive breast cancer. Has not spread

to breast tissues.
 Stage I: ≤ 2cm and has not spread to lymph nodes.
 Stage II
 Stage IIA: ≤ 2 cm and has spread to lymph nodes or
2-5 cm and has not spread to lymph nodes.
 Stage IIB: 2-5 cm and has spread to lymph nodes or
> 5 cm and has not spread to lymph nodes.

44
 Con’t…
Stage III
 Stage IIIA: ≤ 5cm and spread to lymph nodes
forming clumps or >5 cm and spread to lymph nodes
without forming clumps.
 Stage IIIB: Any size and spread to the skin or chest
wall. Swelling.
 Stage IIIC: Any size , spread to lymph nodes, skin
and chest wall.
Stage IV: Metastasized

45
 Signs and symptoms

 A lump in a breast.
 A pain in the armpits or breast (not related to
menstrual period).
 Pitting or redness of the skin of the breast; like the
skin of an orange.
 A rash around (or on) one of the nipples.
 A swelling (lump) in one of the armpits.

46
 Cont….
 An area of thickened tissue in a breast.
 One of the nipples has a discharge; sometimes it may
contain blood
 The nipple changes in appearance; it may become
sunken or inverted.
 The size or the shape of the breast changes.
 The nipple-skin or breast-skin may have started to peel,
scale or flake.

47
 Diagnosis
Diagnostic tests and procedures for breast cancer
include:
1. Breast exam
A. Breast Self Exam (BSE)
B. Clinical Breast Exam (CBE)
2. Mammograms
3. Breast ultrasound Imaging test
4. Breast MRI scan
5. Biopsy

48
 Con’t…
1. Breast Self Exam (BSE)
 BSE is an option for women starting in their 20s.
 Any changes detected should be reported to a
medical expert.
 BSE: Conducted standing or reclining

49
50
Inspect for:

51
Use the Middle of Your Fingers

52
Move your hand in small circles

53
 Then move to another location

• Work your way around the breast in a clockwise

fashion, using small circles of the hand as you go.
• Make sure the entire breast is felt.
54
55
56
 Con’t…
 The “Tail” of the Breast is not
perfectly round.
 A “Tail” of breast tissue
normally extends into the
armpit.
 Make sure to feel for lumps in
that portion of the breast.

57
 Feel the Armpit
 Use the same circular motions.
 Feel for breast lumps and lymph
nodes.
 Normal lymph nodes cannot be
felt.
 Enlarged lymph nodes are about
the size of a pencil eraser, but
longer and thinner

58
 Try to Express Nipple Discharge
 Strip the ducts towards the
nipple.
 Normally, one or two drops of
clear, milky or green-tinged
secretions.
 Should not be bloody or in
large quantity.

59
 Cont….
2. Clinical Breast Exam(CBE)
 Women in their 20s and 30s should have a clinical
breast exam every 3 years.
 After age 40, women should have a breast exam every
year

60
Cont….

61
 Type of Breast Biopsy

 Fine needle aspiration (FNA) biopsy-

 Core needle biopsy-Removes more tissues.
 Vacuum-assisted biopsies-assisted by MRI and A piece of
tissue is sucked out.
 Surgical (open) biopsy- Incision is made and sample
extracted.
 Lymph node biopsy
 Remove flood from LN Needle biopsy
 Remove LN  Surgical biopsy

62
 Cont …..
Tissues obtained during biopsy are examined to
determine:
 Malignant or Benign
 Type
 Invasive or Non - invasive
 Size
 Has it metastasized
 Is the lymph nodes affected
 Treatment

63
 Factors considered during an examination

I. Breast cancer grade

II. Hormone receptor status
III. HER2/neu status

64
 Cont …..
I. Breast cancer grade
 If a biopsy sample is cancer, it is given a grade from 1 to
3.
 A lower grade number means a slower-growing cancer,
while a higher number means a faster growing cancer.
 The grade helps predict the outcome.

65
 II. Hormone receptor status:

 Hormone receptors are proteins in cells that can attach to

hormones.
 Estrogen and progesterone are hormones that increase
breast cancer growth.
 Hormone status of breast cancer includes:-
 Estrogen receptor (ER) Positive
 Progesterone receptor (PR) positive
 Hormone receptor (HR) negative

66
 Cont …..
1. Estrogen receptor (ER) Positive
 The cells of breast cancer have receptors that allow to use
the estrogen hormone to grow.
 Treatment with anti estrogen hormone (endocrine)
therapy can block the growth of the cancer cells

67
 Cont …..

2. Progesterone receptor (PR) positive

 The type of breast cancer sensitive to progesterone, and
the cells have receptors that allow to use the hormone to
grow.
 Treatment with endocrine therapy blocks the growth of the
cancer cell

68
 Cont …..
3. Hormone receptor (HR) negative
 The type of cancer doesn’t have hormone receptors, so
it won’t be affected by endocrine treatments aimed at
blocking hormones in the body.

69
 Cont …..

III. Human Epidermal growth factor Receptor/ HER2

 HER2 gene makes HER2 proteins.
 Normally, HER2 receptors help to control a health
breast cell grows, divides, and repairs.
 However, in10-20% of breast, the HER2 genes
doesn’t work correctly and too many copies of itself
known as HER2 gene amplification.

70
 Tests to find metastasis breast cancer

 Chest x-ray: the lungs.

 Bone scan: the bones.
 CT scan (computed tomography): the chest and/or
abdomen.
 MRI : brain and spinal cord.
 Ultrasound: other parts

71
The goals of patient with breast cancer

(1) actively take part in the decision-making process related

to treatment.
(2) adhere to the therapeutic plan.
(3) communicate about and manage the side effects of
adjuvant therapy.
(4) access and benefit from the support provided by
significant others and HCPs, and
(5) adhere to recommended follow-up and surveillance after
treatment.

72
 Treatment
1. Surgery
2. Radiation therapy
3. Chemotherapy
4. Hormone therapy
5. Biological therapy (targeted drug therapy)

73
 1. Surgery
I. Surgery for breast cancer:
A. Lumpectomy
B. Mastectomy
II. Lymph node surgery:
A. Sentinel node biopsy
B. Axillary lymph node dissection
III. Breast reconstruction surgery

74
 Cont …..

I. Surgery for breast cancer

A. Lumpectomy
 Breast-conserving surgery (BCS) or partial/segmented
mastectomy.
 Surgically removing the tumor and a small margin of
healthy tissue around it.
 Followed by radiation therapy

75
 Mastectomy
 Surgically removing the breast and other infected
components.
 A simple mastectomy: removing the lobules, ducts,
fatty tissue, nipple, areola, and some skin.
 Modified radical mastectomy: simple mastectomy
combined with the removal of the axillary lymph
nodes.
 Radical mastectomy:simple mastectomy combined
with removing the lymph nodes and muscles of the
chest wall.
76
 Cont …..
II. Lympy node surgery
A. Axillary lymph node dissection:

 About 10 to 40 lymph nodes are removed.

 Usually done at the same time as the mastectomy or

breast-conserving surgery.

77
 Cont …..
B. Sentinel lymph node biopsy:
 is used to determine if cancer has spread to the lymph
nodes under the arm without removing many of
them.
 A blue dye/radioactive substance is injected in order
to identify the sentinel lymph nodes which drains
lymph from the tumor.
 They are then removed.

78
 Cont …..
III. Reconstructive / breast implant surgery
 Surgical procedures aimed at recreating a breast so that
it looks as much as possible like the other breast.
 The surgeon may use a breast implant, or tissue from
another part of the patient's body.

79
 Cont …..
Adjuvant and Neoadjuvant
Adjuvant therapy:
 After surgery
 Combat metastasis.
 Chemotherapy and hormone therapy.
Neo-adjuvant therapy:
 Before surgery
 Reduce tumors
 Radiation therapy

80
 2. Radiation therapy
 Radiation therapy is treatment with high energy rays
(such as x-rays) or particles to kill cancer cells.
 The patient may require three to five sessions per week
for three to six weeks.
 The type of breast cancer will determine the type of
radiation therapy used.

81
 Cont …..
Type of radiation therapy for breast Ca
 Breast radiation therapy – applied after a lumpectomy,.
 Chest wall radiation therapy – applied after a
mastectomy
 Breast boost - a high-dose of radiation therapy is
applied to where the tumor was surgically removed.
 Lymph nodes radiation therapy - aimed at the axilla
and surrounding area to destroy cancer cells that have
reached the lymph nodes

82
 Cont …..

Type of radiation
 Brachytherapy
 Radiation to the breast by place radioactive seeds
(pellets) into the breast tissue.
 The most common type brachytherapy used to
treat breast cancer is called intracavitary
brachytherapy.
 A device is put into the space left from breast
conserving surgery, a source of radiation is then
placed in the device for a short time and then
removed. 83
 3. Chemotherapy

 Chemotherapy (chemo) is the use of cancer-killing

drugs.
 Intravenously, given as a shot, or taken as a pill or
liquid.
 They enter the bloodstream and reach most parts of
the body.
 Combats metastasis.
 Damage some normal cells.

84
 4. Hormone therapy
 Used for breast cancers that are sensitive to hormones.
 These types of cancer are often referred to as ER positive
and PR positive cancers.
 Estrogen and progesterone promotes cancer growth.
 Drugs used to block estrogen
 Tamoxifen
 Toremifene (Fareston®)
 Fulvestran

85
 Cont …..
Drugs used to change hormone levels:
 Aromatase inhibitors (AIs): stop fat tissue from making
estrogen after menopause
 Luteinizing hormone-releasing hormone (LHRH)
analogs: shuts down the ovaries

86
Con’t….

87
 5. Biological/ Targeted Therapy


 Drugs that target HER2

 Endocrine therapy is the preferred choice for ER+
metastatic breast cancer
 Less side effects than chemotherapy
 HER2: protein that increase cancer growth.
 Trastuzumab (Herceptin): IV
 Pertuzumab (Perjeta®): IV
 Ado-trastuzumab emtansine (Kadcyla™)
 Lapatinib (Tykerb): pill

88
 Breast cancer treatment groups

Group 1 (luminal A):-

 This group includes tumors that are ER positive and
PR positive, but negative for HER2.
 A breast cancer are likely to benefit from hormone
therapy and may benefit from chemotherapy.

89
 Cont…
Group 2 (luminal B):-
 This type includes tumors that are ER positive, PR
negative, and HER2 positive.
 A breast cancer are likely to benefit from
chemotherapy, and may benefit from hormone therapy
and targeted to HER2 .

90
 Cont….

Group 3 (HER2 Positive):-

 This type includes tumors that are ER negative and PR
negative, but HER2 positive.
 HER2 breast cancer are likely to benefit from
chemotherapy and treatment targeted to HER2

91
 Cont….

Group 4 (Basal like):-

 This type which also called triple negative breast
cancer, includes tumors that are ER negative, PR
negative, and HER2 negative.
 Basal-like breast cancer are likely to benefit from
chemotherapy.

92
 Nursing Management
Monitor for adverse effects of radiation therapy.
Monitor for adverse effects of chemotherapy .R
ealize that a diagnosis of breast cancer is a devastating
emotional shock to the woman.
Provide psychological support to the patient throughout
the diagnostic and treatment process.
Involve the patient in planning and treatment.
Describe surgical procedures to alleviate fear.

93
 Nursing Management…
Prepare the patient for the effects of chemotherapy, and
plan ahead for alopecia, fatigue.
Administer antiemetics prophylactically, as directed, for
patients receiving chemotherapy.
Administer I.V. fluids and hyper alimentation as indicated.
Help patient identify and use support persons or family or
community.
Suggest to the patient that psychological interventions may
be necessary for anxiety, depression, or sexual problems.
Teach all women the recommended cancer-screening
procedures. 94
 Complications

 The main complication of breast cancer is recurrence.

 Recurrence may be local or regional (skin or soft tissue
near the mastectomy site, axillary or internal mammary
lymph nodes) or distant.
 Widely disseminated or metastatic disease involves the
growth of cancerous breast cells in parts of the body
distant from the breast (most often involving the bone,
lung, brain, liver).

95
 Screening and early detection

 Yearly mammograms are recommended starting at age 40

and continuing for as long as a woman is in good health
 Clinical breast exam (CBE) about every 3 years for
women in their 20s and 30s and every year for women 40
and over.
 Women should know how their breasts normally look and
feel and report any breast change promptly to their health
care provider.
 Breast self-exam (BSE) is an option for women starting in
their 20s.
96
 Prevention
 Life style modification
o Eliminating alcohol and tobacco consumption
o Maintaining ideal weight
o Exercising on a regular basis
 Risk reduction surgeries ( bilateral total mastectomy
and salpingo-oopharectomy)
o If positive family history and genetic testing reveals
BRACA 1 Positivity,

97
 Differential Diagnosis
 Fibro adenoma
 Breast cyst
 Galactocele
 Breast abscess
 Mastitis
 Duct ectasia

98
Lung cancer
99
 Introduction
 Lung cancer is the leading cause of cancer-related deaths
in the United States.
 Lung cancer accounts for 26% of all cancer deaths, more
than those caused by breast and colon cancer combined.
 Lung cancer can be fatal, but effective diagnoses and
treatments are improving the outlook.

100
Anatomy and Physiologic Overview
 The respiratory system includes
 lungs
 system of tubes
 muscles
 Used for ventilation
 A ventilation mechanism, consisting of the
thoracic cage,intercostal muscles, diaphragm, and elastic
and collagen components of the lungs.

101
Anatomy of Lung

102
 Functions of respiratory System
 Breathing (pulmonary ventilation):
 consists of two cyclic phases:
 inhalation, also called inspiration:-Inhalation draws
 gases into the lungs
 exhalation, also called expiration:-Exhalation forces
 gases out of the lungs
 Gas exchange: O2 and CO2

103
 Definition of lung cancer
 Lung cancer (bronchogenic cancer) is defined as a
malignant tumor of the lung arising within the wall or
epithelium of the bronchus.
 Lung cancer occurs when cells divide in the lungs
uncontrollably.
 As the tumor the surrounding bronchial airways and
alveoli become irritated ,inflamed and swollen.
 As the tumor protrudes in to the tracheobronchial tree,
excessive mucus production and airways obstruction
develops.
104
 Epidemiology
  Lung cancer remained the leading cause of cancer death,
with an estimated 1.8 million deaths (18%).
 Lung cancer is the most commonly diagnosed cancer,
with an estimated new case of 11.4%.
 According to the latest WHO data published in 2018
Lung Cancers Deaths in Ethiopia reached 1,682 or 0.28%
of total deaths. 
 Twenty-five percent of all cases of lung cancer
worldwide are diagnosed in people who have never
smoked.
105
 Pathophysiology

 Most primary lung tumors are believed to arise from mutated

epithelial cells.
 The growth of mutations, which are caused by carcinogens, is
influenced by various genetic factors.
 Tumor development is promoted by epidermal growth factor.
 Lung cancers occur primarily in the segmental bronchi and
usually occur in the upper lobes of the lungs.
 Lung cancers metastasize primarily by direct extension and
through the blood and lymph system.

106
 Pathophysiology…
Cancerous lung tissue cannot exchange oxygen & carbon dioxide

It impairs the functioning of the lung

Tumor cells grow & invade surrounding lung tissue

Air way invaded & obstructing the flow of the air

Cancerous cells invade local lymph nodes & thoracic duct

Significant growth of the tumor

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 Causes
 Lung cancer may be because of :-
 Cigarette smoking
 Occupational carcinogens
 Nutritional deficiencies
 Non - neoplastic diseases such as Tb, chronic bronchitis &
emphysema
 Dietary deficiency

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 Risk factors
 Tobacco smoking(85% smokers, 15% non-smokers)
 Second hand smoke
 Genetic factors: 8%, in relative the risk is doubled
 Radon gas: radio active chemical element
 Asbestos: fibrous mineral forms of magnesium silicate
 Air pollution: chemical release from burning fossil fuel

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 Classification

There are two main types of lung cancer

Small Cell Lung Cancer (SCLC)– which accounts for
20% of all lung cancers and which tends to be more
aggressive and often diagnosed at an advanced stage.
It is sometimes called oat cell cancer and tends to grow
and spread faster than NSCLC.
It tends to respond well to chemotherapy and radiation
therapy  
Non-Small Cell Lung Cancer (NSCLC) – which accounts
for 80% of all lung cancers.

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 Adenocarcinoma
 Start in the cells that would normally secrete substances
such as mucus.
 Occurs mainly in current or former smokers, but it is
also the most common type of lung cancer seen in non-
smokers.
 It is more common in women than in men.
 Usually found in the outer parts of the lung and is more
likely to be found before it has spread.
 People with  adenocarcinoma in situ ( bronchioloalveolar
carcinoma) tend to have a better outlook than other types
of lung cancer.
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 Con’t…
 Squamous cell carcinoma: start in squamous cells, which
are flat cells that line the inside of the airways in the lungs.
linked to a history of smoking and tend to be found in the
central part of the lungs, near a main airway (bronchus).
 Large cell (undifferentiated) carcinoma:  appear in any
part of the lung.
 It tends to grow and spread quickly, which can make it
harder to treat.
 A subtype , known as large cell neuroendocrine
carcinoma, is a fast-growing cancer that is very similar to
small cell lung cancer. 113
 Difference between SCLC & NSCLC
SCLC NSCLC
Smaller portion Centrally located

Small immature neuroendocrine Associated with smoking

cells

Strongly associate with smoking Squamous cells carcinoma

realease parathyroid hormone
and Adenocarcinomas

Develops near main bronchi Large cell carcinoma and

bronchial carcinoid throughout
the lung
Secrete hormones, paraneoplastic
syndrome
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115
Con’t….

116
Con’t…

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 Clinical Manifestations

Symptoms may be masked by a chronic cough attributed to

smoking or smoking-related lung disease.
persistent cough dyspnea or wheezing
Blood-tinged sputum
Chest pain (localized or unilateral), ranging from mild to severe.
Later manifestations include , anorexia, nausea and vomiting,
fatigue, and weight loss.
Hoarseness
Lymph nodes are often palpable in the neck or axillae

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 Diagnosis
A chest x-ray is the first diagnostic test done for suspected lung
cancer.
Evidence of metastasis t and a pleural effusion may be seen on
chest x-ray.
CT scans identify location and extent of masses in the chest.
Sputum cytologic studies can identify cancer cells.
A definitive diagnosis is biopsy.
Thoracentesis , the fluid is analyzed for cancer cells.
Bronchoscopy
Mediastinoscopy

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 Management of Lung Cancer
-Chemotherapy:
 Chemotherapy is the main treatment for SCLC.
 In NSCLC, may be used in the treatment of non-resectable
tumors or as adjuvant therapy to surgery.
 Chemotherapy for lung cancer typically consists of
combinations of 2 of the following drugs:
etoposide (VP-16), carboplatin, cisplatin, paclitaxel
(Taxol),vinorelbine (Navelbine), docetaxel (Taxotere),
gemcitabine (Gemzar), and pemetrexed (Alimta).

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 Radiation therapy

 Used as a primary treatment, or in combination with

chemotherapy (with or without surgery).
 Used as primary therapy in the person who is unable to
tolerate surgical resection because of co-morbidities.
 Can play an important role in advanced cancer patients by
providing relief from pain, blockage of the airways,
shortness of breath or coughing.
 Stereotactic body radiotherapy (SBRT), is a newer lung
cancer treatment , uses high doses of radiation delivered to
tumors outside the CNS.
 It does not destroy the tumor, but damages tumor DNA
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 Surgical Management
 Lobectomy-most common curable procedure for small
tumor.
 Pneumonectomy-surgical removal of lung.
 Sleeve resection-Surgery to remove a lung tumor in a
lobe of the lung and a part of the main bronchus
(airway).
 Segmentectomy-Removing a section of a lobe of the
lung
 Wedge resection-Surgery to remove a triangle-shaped
slice of tissue.
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 Targeted Therapy

uses
 drugs that block the growth of molecules involved in specific
aspects of tumor growth.
Inhibits growth rather than directly killing cancer cells, less toxic than

chemotherapy.
Used for patients with NSCLC inhibits tyrosine kinase, an enzyme

associated with speeding up molecular reactions.
Another type of kinase inhibitor is used to treat patients with NSCLC

who have an abnormal anaplastic lymphoma kinase (ALK)
gene. E.g crizotinib
inhibits the growth of new blood vessels by targeting vascular

endothelial growth factor. Bevacizumab

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 Immunotherapy

 Nivolumab (Opdivo), atezolizumab (Tecentriq), and

pembrolizumab (Keytruda) are drugs that target PD-1, a
protein on T cells that normally helps keep these cells from
attacking other cells in the body.
 By blocking PD-1, these drugs boost the immune response
against cancer cells.
 Nivolumab and pembrolizumab can be used in people with
metastatic NSCLC whose cancer has progressed after other
treatments and with tumors that express PD-1

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 Other Therapies

Prophylactic
 Cranial Irradiation
Patients with SCLC have early metastases, especially to the CNS


Decrease the incidence of brain metastases .



Bronchoscopic Laser Therapy -safe and effective treatment of


endobronchial obstructions from tumors.
Photodynamic therapy (PDT) is a form of treatment for early-stage

lung cancers that uses a combination of a drug and a specific type of
light.
PDT affect nutrient delivery to cancer cells and stimulate the immune

system to attack the cancer cells.

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126
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 Nursing management

Improving breathing pattern

 Elevate head of bed to promote gravity drainage
 Teach breathing retraining exercises
 Give prescribed treatment such as antimicrobial agents
chemotherapy
 Augment the patient’s ability to cough
 Administer oxygen if prescribed
 Allow patient to sleep in reclining chair or with head of
bed elevated if severely dyspenic

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 Nursing management…

Improving nutritional status

Encourage small amounts of high calorie & high protein
food.
Ensure adequate protein intake : milk, eg gs, chicken,
fish, cheese.
Administer or encourage prescribed vitamin supplement.
Change consistency of diet to soft or liquid.
Give enteral or total parenteral nutrition for
malnourished patients who is unable to eat.

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 Nursing management…

Controlling pain
Assess condition of the patient.
Give analgesics to the patient.
Evaluate problems of insomnia, depression, anxiety
etc.
Minimizing anxiety :
Tr y to have the patient express concerns ; share these
concerns.
Expect some feelings of anxiety.
Encourage the patient to communicate feelings.

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 Health education

Help the patient to realize that every pain & ache is caused
by lung cancer
Take NSAIDS or other prescribed medication
Tell the patient about treatment
Advise the patient to report new or persistent pain

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 Complication
 1. Excess Fluid Around Lungs-additional fluid and
cancer cells can build up and crowd the space
 2. Higher Risk of Infection-chemotherapy kills WBC
along cancer cells.
 3. Blood Clots- Lung cancer can increase the risk of
venous thromboembolism (VTE),

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 Early detection and Screening
 The American Cancer Society (ACS) has a lung cancer screening
guideline for people with a higher risk of getting lung cancer, who
also meet the following conditions:
Are current smokers or smokers who have quit in the past 15 years.
Have at least a 30 pack-year smoking history. (This is the number
of years you smoked multiplied by the number of packs of
cigarettes per day.
Receive counseling to quit smoking if they are current smokers.
Have been told by their doctor about the possible benefits, limits,
and harms of screening with LDCT scans.
Have a facility where they can go that has experience in lung
cancer screening and treatment.
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 Prevention
 There's no sure way to prevent lung cancer, but you can
reduce your risk if you:
 Don't smoke. 
 Stop smoking and Avoid second hand smoke
 Test your home for radon. 
 Avoid carcinogens at work. 
 Eat a diet full of fruits and vegetables. 
 Exercise most days of the week. 
 Regular lung cancer screening

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 Differential Diagnosis
 TB
 Sarcoidosis
 Fungal infection of lung
 Abscesses
 Lung infarction
 Fibrosis
 Hamartomas
 Primary malignancy in mediastinum, i.e lymphoma

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 Summary
Today We have discussed about
 Definition
 Causes
 Clinical manifestation
 Diagnosis
 Management and prevention of breast and lung cancer.

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 Conclusion
 Breast cancer is the most common invasive cancer in
women and the second leading cause of cancer death
in women after lung cancer.
 In Ethiopia, breast cancer incidence is rising and
become the foremost common cancer, causing
high rates of morbidity and mortality.
 Lung cancer can be fatal, but effective diagnoses and
treatments are improving the outlook.

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 References
1. Harrison principle of internal medicine 20th edition
2. Lewis medical surgical nursing 11th edition
3. American cancer society
4. Medscape
5. Uptodate 21.6
6. https://www.mayoclinic.org
7. https://who.int

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 Thank you!!

01/31/2023 By Gizew B. 141