1. Instructor Kathleen Gamblin, RN, BSN, OCN Oncology Nurse Navigator
Module 2: Lung Cancer
Instructor
Kathleen Gamblin, RN, BSN, OCN
Oncology Nurse Navigator
Unit 3: Major Cancers, Prevention, & Staging

2. Objectives Identify lung cancer incidence and mortality
Identify risk factors associated with lung cancer
Identify common lung cancer symptoms
Identify characteristics of non-small cell and small cell lung cancer
Discuss lung cancer screening and staging tests and procedures
Discuss role of oncology nurse navigator in care of the lung cancer patient
Unit 3: Major Cancers, Prevention, & Staging

3. Introduction
Lung cancer is the leading cause of cancer death in the United States among every ethnic group... 1 in every 3 cancer deaths
Lung cancer will kill:
Over three times as many men as prostate cancer
Nearly twice as many women as breast cancer
An average of 437 people a day
Mortality rates from Lung cancer are high because of diagnosis at advanced stage
Unit 3: Major Cancers, Prevention, & Staging

4. Risk Factors for Lung Cancer
Smoking is #1 risk factor for the development of lung cancer
Smoking responsible for causing 90% of lung cancers
Risk increases with number of lifetime cigarettes and number of years the person has smoked
Risk decreases over time when a person quits smoking but risk for Lung cancer remains elevated in former smokers
Secondhand smoke or passive smoke
Can increase lung cancer risk by 20-30%
Unit 3: Major Cancers, Prevention, & Staging

5. Risk Factors for Lung Cancer (cont’d)
Age
Occurs in older adults
Peaks at age 75
Occupational and Environmental chemicals
Tar, soot, arsenic, chromium, nickel, asbestos, beryllium, and uranium exposure more likely to cause lung cancer
Radiation Exposure
Radon
Radiation therapy to chest area

6. Prevention and Detection
Proven prevention strategies
Avoid initiation of smoking
Promote cessation of smoking among smokers
Substantial portion of adults diagnosed with early stage lung cancer can be cured
Chest x-rays and sputum cytology not proven to decrease lung cancer mortality rate
Low dose CT scan studies shows promise in early detection of lung cancer

7. Clinical Presentation
90% of lung cancer patients are symptomatic at presentation
Local symptoms
Cough
Dyspnea
Wheezing
Hemoptysis
Dysphagia
Hoarseness
Chest pain
Swelling face and arm
Nausea and vomiting

8. Clinical Presentation
Nonspecific Systemic or Metastatic Symptoms
Anorexia
Weight Loss
Fatigue
Clubbing
Fever
Bone Pain
Headache
Seizures

9. Diagnosis Diagnostic Work-Up Designed to Identify:
Specific Type of Lung Cancer
Non-Small Cell Lung Cancer (NSCLC)
Small Cell Lung Cancer (SCLC)
Stage of Disease
Ability of Patient to tolerate treatment

10. Non-Small Cell Lung Cancer (NSCLC)
Represents 80% of Lung Cancers
Three Major Histologic Types
Adenocarcinoma
Accounts for 40% of all cases of Lung Cancer
Peripheral in Nature
Squamous Cell
Occurs most frequently in central zone of the lung
Large Cell
Least Common of all NSCLC, making up only 15%

11. Small Cell Lung Cancer (SCLC)
Typically More Aggressive Than NSCLC
Distant Metastasis More Common At Presentation
Three Histologic Groupings
Pure Small Cell
Mixed Small Cell and Large Cell
Combined Small Cell
SCLC typical presentation central lesion with hilar, mediastinal invasion and regional adenopathy

12. Diagnostic Testing Can Include: Chest X-Ray
Computed Tomography (CT) Scan
Magnetic Resonance Imaging (MRI)
Positron Emission Tomography (PET) Scan
Biopsy
Sputum Cytology
Bronchoscopy
Thoracoscopy
Thoracentesis
Mediastinoscopy

13. Staging Tests and Procedures used to Stage Lung Cancer Imaging Tests
Pathology Reports
Surgical Biopsy
Laboratory Tests

14. Staging Two types of Lung Cancer are staged differently
Non-small cell lung carcinoma staged according to the TNM staging system (Revised in 2010)
Tumor
Node
Metastasis
Small cell lung carcinoma staged according to system developed by Veteran’s Administration Lung Cancer Study Guide
Limited Stage
Extensive Stage
Stage of cancer will determine treatment options for patient

15. Treatment of Non-Small Cell Lung Cancer
Treatment options for NSCLC patients include:
Surgery
Lobectomy, in which an entire section (lobe) of the lung is removed
Pneumonectomy, in which the entire lung is removed
Wedge or segmental resection, in which a small part of the lung is removed
Radiation
Chemotherapy

16. Treatment of Small Cell Lung Cancer
Treatment options for SCLC include:
Chemotherapy
Radiation
Surgical resection
Rare but occurs in patient with very limited SCLC
If complete response is achieved prophylactic cranial irradiation is offered to patient

17. Survivorship
Surveillance and follow-up for patients who have undergone curative treatment for Lung Cancer include:
Medical history
Physical examination
Imaging Study

18. Role of the Nurse Navigator
Focus of nursing care depends on stage of disease and the overall goal of care
Interventions directed at helping the patient and the family include
Smoking cessation education
Disease and treatment education
Promotion of symptom management
Assistance with psychosocial adjustment across illness trajectory
Education on available resources

19. Smoking Cessation
Most effective strategy for decreasing incidence of lung cancer
Smoking cessation after diagnosis related to increased survival and decreased incidence of second malignancy
Practice four “A’s” of smoking cessation

20. Patient and Family Education
Patient and Family Education can include
Teaching on diagnostic and staging tests and procedures
Teaching on surgery and post-operative course
Teaching on chemotherapy agents and potential side effects
Teaching on radiation therapy and potential side effects
Teaching on management of symptoms experienced secondary to treatment such as chemotherapy and radiation

21. Symptom Management
Patients with lung cancer experience multiple symptoms that change throughout illness trajectory
Pain
Fatigue
Changes in appetite
Respiratory Symptoms
Management of symptoms is essential
Uncontrolled symptoms have been related to increased emotional distress and decreased quality of life

22. Psychosocial Issues Emotional Distress Anxiety Depression
Spiritual Distress
Loss of personal control
Loss and Grief
Social Dysfunction

23. Available Resources Know National Resources Available for Patients
Some Lung Specific Resources Include
Lung Cancer Alliance at
Lung Cancer Circle of Hope
Lung Cancer Foundation of America
LUNGevity Foundation
National Lung Cancer Partnership
Know Local Resources Available for Patients
Hospital Resources
Community Resources