BREAST & LUNG

CANCER

Carcinoma in Situ

Warning Signs of Cancer

Warning Signs of Cancer

Warning Signs of Cancer

Warning Signs of Cancer

Warning Signs of Cancer

Warning Signs of Cancer

Warning Signs of Cancer

Warning Signs of Cancer

PHYSICAL ASSESSMENT

Effects of Cancer

BREAST CANCER

BREAST CANCER

BREAST CANCER

BREAST CANCER

Precipitating Factors

Prevention

BREAST CANCER

BREAST CANCER

BREAST CANCER

BREAST CANCER

BREAST CANCER

ASSESSMENT FINDINGS

ASSESSMENT FINDINGS

ASSESSMENT FINDINGS

ASSESSMENT FINDINGS

BREAST CANCER

NON-SURGICAL
INTERVENTIONS

SURGICAL INTERVWNTIONS

BREAST CANCER

LUNG CANCER

Types of Lung Cancer

Two main Types of Lung Cancer:
Small Cell Lung Cancer

(20-25% of all lung

cancers)
> round to oval cells, usually in clusters, highly malignant

Non Small Cell Lung Cancer (most common

~80%)

Small Cell Lung Cancer

Non-small cell lung cancer

1. Squamous cell carcinoma
2. Adenocarcinoma
3. Large cell carcinomas

Squamous cell carcinoma

Moderate to poor differentiation

makes up 30-40% of all lung cancers
more common in males
most occur centrally in the large bronchi
Uncommon metastasis that is slow effects the liver, adrenal glands
and lymph nodes.
Associated with smoking
Not easily visualized on xray (may delay dx)
Most likely presents as a Pancoasts tumor

Adenocarcinoma
Increasing in frequency. Most common type of Lung cancer (40-50%

of all lung cancers).

Clearly defined peripheral lesions (RLL lesion)
Glandular appearance under a microscope
Easily seen on a CXR
Can occur in non-smokers
Highly metastatic in nature
Pts present with or develop brain, liver,
adrenal or bone metastasis

Large cell carcinomas

makes up 15-20% of all lung cancers
Poorly differentiated cells
Tends to occur in the outer part (periphery) of lung,
invading sub-segmental bronchi or larger airways
Metastasis is slow BUT
Early metastasis occurs to the kidney, liver organs as well
as the adrenal glands

Lung
Cancer
Re-cap
Non-Small-Cell Lung Cancer
Small Cell Lung Cancer
Squamous cell

Adenocarinoma

LUNG CANCER

LUNG CANCER

Causes and Risk factors of Lung Cancer

Signs and Symptoms of Lung

Cancer
Sometimes lung cancer does not cause any symptoms and is only

found in a routine x-ray.

If a person with lung cancer does have symptoms, they will depend on
the location of the tumour in their lung.
It is also imperative to note that the same symptoms can be caused by
other conditions, so may not necessarily mean cancer.
Therefore it is important to consult a doctor when symptoms are
present.
Signs and symptoms also depend upon the location, size of the tumor,
degree of obstruction and existence of metastases

Signs and Symptoms of Lung Cancer

There are two types of signs and symptoms of

lung cancer:
1) Localized involving the lung.
2) Generalized involves other areas throughout
the body if the cancer has spread.

Localized Signs and Symptoms

Cough
Breathing Problems, SOB, stridor
Change in phlegm
Lung infection, hemoptysis
Hoarseness, Hiccups
Wt loss
Chest Pain and tightness
Pancoast Syndrome
Horners Syndrome
Pleural Effusion
Superior Vena Cava Syndrome
Fatigue

 LOCALIZED
The most common symptom is a persistent and non productive cough
breathing problems: shortness of breath

increased shortness of breath during physical activity

wheezing due to the bronchus being partially

obstructed

high pitched breathing sounds (stridor)

changes in phlegm (sputum): increased amount

blood in the phlegm (hemoptysis)

lung infection (pneumonia): frequent lung infections may develop

the lung infection might be found in the same

area as the tumour
Hoarseness:
hiccups
chest pain/tightness

 Pancoasts syndrome is coined as a collective presentation of arm and

shoulder pain, shrinking of the muscles of the hand and arm and Horners
syndrome. It is likely to arise with the presence of lung Cancer.

Horners syndrome: A condition that cause recessed eyeball, pupil

constriction, droopy upper eyelid and decreased perspiration on the

affected side of the face. This state is brought on my the paralysis of the
trunk of cervical sympathetic nerve by such things as a lung tumor.

Pleural effusion: build up of fluid in the space between the covering of

the lung and the lining of the chest wall

marked shortness of breath

persistent cough

pain in the chest that gets worse while breathing in

(pleurisy)

 Superior vena cava syndrome: This condition occurs when the SVC is

compressed or blocked by the tumor, resulting in little or no blood reaching

the heart. Look for :
shortness of breath
sensation of fullness in the head
facial swelling
arm swelling
chest pain
difficulty swallowing

Pericardial effusion which refers to fluid gathering in the pericardial space

which houses the lungs. This excess fluid around the lungs may lead to
cardiac tamponade. This is a life threatening event that weaken the bodys
ability to fill up with blood during the diastolic portion of the heart beat.
Hypoxia and dyspnea

Generalized Signs and

Symptoms
Bone pain
Headaches, mental status changes or neurologic
findings
Abdominal pain, elevated liver function tests,
enlarged liver, gastrointestinal disturbances
(anorexia, cachexia), jaundice, hepatomegaly r/t
liver involvement
Weight loss

Early/late Signs and Symptoms Of

Lung Cancer
Early Signs
Late signs
Cough/chronic cough

Bone pain, spinal cord

compression

Dyspnea

Chest pain/tightness

Hemoptysis

Dysphagia

Chest/shoulder pain

Head and neck edema

Recurring temperature

Blurred vision,
headaches

Recurring respiratory
infections

Weakness, anorexia,
weight-loss, cachexia
Pleural effusion
Liver
metastasis/regional
spread

Diagnostic
Tests
CXR

CT Scans
MRI
Sputum cytology
Fibreoptic bronchoscopy
Transthoracic fine needle aspiration

Laboratory
Tests
Blood Tests
*CBC-to check red/white blood cell &
platelets
-to check bone marrow and organ function
*Blood Chemistry Test-to assess how organs
are functioning such as liver and kidney
Biopsy-to determine if the tumor is cancer or
not
-to determine the type of cancer
-to determine the grade of cancer (slow
or fast)

Biopsy

Endoscopy
Bronchoscopy
Mediastinoscopy
VATS (video assisted thoracoscopic
surgery)

Bronchoscopy

Mediastinoscopy

Medical Management
The three main cancer
treatments are:
*surgery (lung resections)
*radiation therapy
*chemotherapy
Other types of treatment that are
used to treat certain cancers are
hormonal therapy, biological
therapy or stem cell transplant.

Side effects of treatments

Surgery

Radiation

Chemotherapy

Pain

fatigue

Anemia,
thrombocytopenia

Hemotomas

Decreased nutritional Fatigue

intake

Hemmorhage

Radiodermatitis

Alopecia, SOB

Altered respiratory
function

Decreased
hematopoietic
function

Cold, pale

Risk for atelectasis,

pneumonia, hypoxia

Risk for Pneumonitis,

esophagitis, cough

Tingling

Risk for DVT

N/V

Irritable

Grief

Dizzy, weak

Lung resections
Lobectomy: a single lobe of lung is removed
Bilobectomy: 2 lobes of the lung are removed (only on R side)
Sleeve resection: cancerous lobe is removed and segment of the main

bronchus is resected
Pneumonectomy: removal of entire lung
Segmentectomy: a segment of the lung is removed
Wedge resection: removal of a small, pie-shaped area of the segment
Chest wall resection with removal of cancerous lung tissue: for
cancers that have invaded the chest wall

Prognostic Factors
The best estimate on how a patient will do based on:
*type of cancer cells
*grade of the cancer
*size or location of the tumor
*stage of the cancer at the time of diagnosis
*age of the person
*gender
*results of blood or other tests
*a persons specific response to treatment
*overall health and physical condition

Prevention: Primary

Avoid the use of tobacco smoke

Personal and family hx are important risk factors
Know environmental carcinogens that increase
risk
Chemoprevention:
Consuming carotenoids, Vit A, retinoids Vit E, selenium,
Vit C, fat

Prevention: Secondary
Aim is to early diagnose high risk populations via
screening
CXR, MRI, CT scans, sputum cytology

Prevention: Tertiary
Targeted at people who survived a cancer disease
Assists them to retain an optimal level of functioning
regardless of their potential debilitating disease

Nurses Role with clients with lung

cancer

Coping with diagnosis

Pre/post treatment education
Education on managing breathlessness
Referrals for stop smoking advisor
Referring to services such as hospice care, dietitian, massage therapy,
counselors
Advocate for appointments, scans etc.
Educate client and family about disease process, treatment options and S/E
Provide resources for support groups and where information and be sought

Nursing Interventions
Management of N/V, weakness, fatigue, wt loss, appetite loss, altered taste
Pain management, education to avoid concern about addiction, pharmacological and nonpharmacological

Elevate HOB
Splinting to aid in coughing
Teach breathing exercises to diaphragmatic excursion and WOB
DB&C
Provide a vaporizer
Relaxation techniques to anxiety r/t SOB
Encourage energy conservation
Encourage small amts of high-calorie and Pn foods freq.