|
Nurses play an important role in preventing lung cancer by
helping people identify their risks and by teaching them not to smoke cigarettes. This article describes the characteristics
and treatment for lung cancer, its treatment, and symptomatology. We follow with a short piece in which we describe smoking
cessation and online links on smoking cessation and lung cancer.
Description of Lung Cancer
Lung cancers are uncontrolled growths of abnormal cells in the
lung, caused primarily by smoking cigarettes. There are two types of lung cancer, small cell (about 80% of cases) and
non-small cell. Small cell lung cancer is also known as oat cell lung cancer, the most aggressive type of lung cancer.
Non-small cell lung cancer is either squamous cell carcinoma (usually beginning in one of the bronchi), adenocarcinoma
(occurring close to the outside of the lung), and large cell carcinoma (occurring on the surface of the lung). Diagnosis is
made through bronchoscopy or biopsy, and confirmed by chest x-ray, MRI, CAT scans, and other tests to determine whether there
is metastasis.
Staging of lung cancer is as follows:
- Occult - sputum contains cancer cells but
no tumor is obvious
- Stage 0 - Cancer in situ; localized in a
few cell layers
- Stage I - Cancer in the lung only
- Stage II - Cancer in lung and contiguous
lymph nodes
- Stage III - Cancer has spread to nearby
tissues; Stage IIIa if operable, Stage IIIb if inoperable
- Stage IV - Metastasis has occurred to other
parts of the body
|
Treatment
Treatment is individualized according to the case, consisting of
a combination of surgery, radiation, and chemotherapy, or radiation and chemotherapy when the tumor is inoperable.
Prevention
Lung cancer is almost always completely preventable. Risk
factors include:
Detection
Early detection is important. Teach people (especially
smokers) to see the doctor promptly for coughs, with or without hemoptysis. In advanced cases, the person with lung
cancer experiences weakness and fatigue, increased cough and dyspnea, decreased appetite, weight loss, and chest pain. On
assessment, you will hear wheezing and decreased breath sounds.
Other symptoms depend on the location and extent of the tumor and are grouped into syndromes as follows (note that
these are a few among many possibilities, depending on the location and size of the tumor):
- Superior vena cava syndrome, in which the tumor is
blocking venous drainage on the side where the tumor is. The result is edema of the face, conjunctiva,
neck, and upper body; inability to lie on the back; and central nervous system problems, such as headache, visual
disturbances, and unexpected loss of consciousness.
- Horner's syndrome occurs when the tumor invades the
cervical thoracic sympathetic nerves, resulting in contraction of the pupil
(miosis), dropping of the eyelid (ptosis), lack of sweating (anhidrosis) on the affected
side of the face.
- Pancoast syndrome occurs when the tumor invades the
brachial plexus, ribs, and/or vertebrae on the side of the tumor, causing pain in the arm, as well as numbness
and weakness.
- An esophageal fistula may result between the esophagus
and lung when the tumor invades the esophageal area.
- When the tumor impinges on the heart, the result is
cardiomegaly, pericardial effusion, and arrhythmias.
|
Bibliography
Merck Manual Online. (2002). Lung Cancer. Retrieved March 23, 2002. http://www.merck.com/pubs/mmanual/section6/chapter81/81a.htm
Praxis.md. (2002. Thoracic Neoplasms. Retrieved March 23, 2002. http://merck.praxis.md/bpm/bpm.asp?page=CPM01ON234
|
Hints for Smoking
Cessation |
The following suggestions are gleaned from the American Lung Association website and other sources:
- Remember that a smoker has both a psychological and a chemical (nicotine) addiction.
- Use multiple techniques when quitting -- try anything that does not compromise your health.
- Costs of smoking cessation programs vary. Check with your insurance company to see if the cost is covered.
- Why do you want to quit? Write it down.
- Set a date to quit but make it a usually low stress day.
- Make a list of things you can do instead of smoking (taking a walk, chomping on ice chips, playing with your children, anything you can come up with).
- Ask friends and family to help you by not tempting you and by giving you "space" when you need it.
- Visualize your very clean lungs.
- Think of yourself as a nonsmoker!
- Reward yourself for progress (avoid food, though).
- If you usually have a cigarette and drink after meals, stop. Get up from the table and clean up, or take a walk, or anything else on your list of things to do instead of smoking.
- Buddy up with someone who has quit and ask them to lend an ear when you feel you are weakening.
- Talk to your primary care provider about medications and patches.
|
|
Consumer Websites
American Lung Association. Check out "Freedom From Smoking
Online." http://www.lungusa.org
Kickbutt.org - A public action site emphasizing prevention of smoking in children.
http://www.kickbutt.org
CDC Tobacco Information and Prevention Source (TIPS) http://www.cdc.gov/tobacco>
American Society of Clinical Oncology's "A Patient's Guide:
Advanced Lung Cancer treatment" http://www.asco.org/people/rs/html/patguidelung.pdf
American Cancer Society. http://www.cancer.org
|
