a. Usually develops within the wall or epithelium of the
b. Prolonged exposure to cancer-promoting agents causes
damage to ciliated cells and mucus-producing cells, leading
to genetic mutations and development of dysplastic cells.
II. Classification (Memorial Sloan-Kettering Cancer Center,
2008; National Cancer Institute, 2008)
a. Small cell lung cancers (SCLCs), or oat cell lung cancer
i. Represent about 15% to 25% of lung cancer cases
(Elias & Baldini, 2008)
ii. Occur almost exclusively in smokers
iii. Aggressive and fast growing with surgery seldom a
b. Non–small cell lung cancers (NSCLCs)
i. Most common type of lung cancer (75% to 85%, Elias
& Baldini, 2008)
ii. Include adenocarcinoma, squamous cell, and large cell
iii. Frequently associated with metastases, but are generally
III. Staging (National Cancer Institute, 2008)
a. Stage 0—cancer cells only found in the innermost lining of
b. Stage IA—tumor has grown through the innermost lining
of the lung into deeper lung tissue, but does not invade the
bronchus; no cancer cells found in nearby lymph nodes
c. Stage IB—tumor is larger, may be more than 3 cm across;
may have grown into the main bronchus; may have grown
into the pleura, but no cancer cells found in nearby lymph
d. Stage IIB—tumor has invaded the chest wall, diaphragm,
pleura, main bronchus, or tissue that surrounds the heart;
cancer cells found in nearby lymph nodes
e. Stage IIIA—tumor may be any size; cancer cells found in
the lymph nodes near the lungs and bronchi and between
the lungs on the same side of the chest as the tumor
f. Stage IIIB—tumor may be any size; cancer cells found on
the opposite side of the chest from the tumor, with possible
invasion into nearby organs
g. Stage IV—malignant growths may be found in more than
one lobe or may have metastasized to other organs
IV. Etiology (American Cancer Society, 2008)
a. Risk factors include cigarette smoking or being exposed to
secondhand smoke; radon, asbestos, other occupational
exposures, including radioactive ores such as uranium,
inhaled chemicals or minerals, such as nickel compounds,
silica, coal dust, and cromates, or diesel exhaust; high
levels of arsenic in drinking water; and family history of
b. Chronic obstructive pulmonary disease (COPD) and
pulmonary fibrosis may increase susceptibility.
a. Morbidity: Second most commonly diagnosed cancer
accounting for 13% of all cases (American Association
for Cancer Research, 2005) with new cases of lung
and bronchus cancer estimated at 172,570 for 2005
(Jemal et al, 2005).
b. Mortality: Number one cause of death in cancer patients;
in 2004, death rates for men and women were 89,575 and
68,431, respectively; results in more deaths than breast
cancer, prostate cancer, and colon cancer combined
(U.S. Cancer Statistics Worling Group, 2007).
c. Cost: $9.6 billion was spent for treatment in 2004.
VI. Treatment Options
a. Depends upon staging—generally the lower the stage, the
more favorable the prognosis
i. Surgery is primary treatment for NSCLC stage I and
stage II tumors.
ii. Selected stage III carcinomas may be operable if the
tumor is resectable.
b. Surgical procedures for operable tumors of the lung
i. Pneumonectomy—performed for lesions originating in
the main stem bronchus or lobar bronchus
ii. Lobectomy—preferred for peripheral carcinoma localized
in a lobe
iii.Wedge or segmental resection—performed for lesions
that are small and well contained within one segment
iv. Endoscopic laser resection—may be done on peripheral
tumors to reduce the necessity of cutting through ribs
v. Photodynamic therapy—reduces symptoms such as
bleeding or may be used to treat very small tumors
Client is treated in inpatient surgical and possibly subacute
Psychosocial aspects of care
Radical neck surgery: laryngectomy (postoperative care)
1. Maintain or improve respiratory function.
2. Control or alleviate pain.
3. Support efforts to cope with diagnosis and situation.
4. Provide information about disease process, prognosis,
and therapeutic regimen.
1. Oxygenation and ventilation adequate to meet individual
2. Pain controlled.
3. Anxiety and fear decreased to manageable level.
4. Free of preventable complications.
5. Disease process, prognosis, and planned therapies
6. Plan in place to meet needs after discharge.