OROPHARYNGEA

L CANCER
Oropharyngeal cancer is a disease in which
cancer cells are found within the anatomical
borders of the oropharynx.
Sometimes this is called throat cancer
The majority of oropharyngeal cancers are
squamous cell carcinomas.
Several types of cancers
can start in the mouth or
throat .
 A. Squamous Cell Carcinomas
 flat, scale-like cells that normally form the lining of the mouth
and throat
 B. Verrucous Carcinoma
 makes up less than 5% of all oral cavity tumors. It is a low-
grade cancer that rarely spreads to other parts of the body
but can deeply spread into surrounding tissue.
 C. Minor Salivary Gland Carcinomas
 Minor salivary gland cancers can develop in the glands that
are found throughout the lining of the mouth and throat
 D. Lymphomas
 tonsils and base of the tongue contain immune system
(lymphoid) tissue that can develop into a cancer
 Symptoms of Oropharyngeal
Cancer :
 A sore throat that persists
 Pain or difficulty with swallowing
 Unexplained weight loss
 Voice changes
 Ear pain
 A lump in the back of the throat or mouth
 A lump in the neck
Risk factors for Oropharyngeal
Cancer :
 Use of alcohol
 Use of tobacco
 Being infected with the human papilloma virus
(HPV), especially HPV-type-16 (HPV-16)
Stages of Oropharyngeal Cancer :
 Stage I
The cancer is 2 centimeters or smaller and has not spread
outside the oropharynx.
 Stage II
The cancer is larger than 2 centimeters, but not larger
than 4 centimeters and has not spread outside the
oropharynx.
 Stage III
In this stage, cancer is larger than 4 centimeters and has
not spread outside the oropharynx. An alternate form of
this stage is that cancer is any size and has spread to
only one lymph node on the same side of the neck as the
cancer. The lymph node that contains cancer is 3
centimeters or smaller.
 Stage IV
This stage contains the sub-stages of IVA, IVB and IVC.
 Stage IVA
In Stage IVA, one of the following is the case:
 The cancer has spread to tissues near the oropharynx, including the voice
box, roof of the mouth, jaw, muscle of the tongue, or central muscles of the
jaw. The cancer might have spread to one or more nearby lymph nodes,
which are still not larger than 6 centimeters.
 The cancer is any size, is only in the oropharynx, and has spread to one
lymph node that is larger than 3 centimeters but no larger than 6
centimeters, or to more than one lymph node, none larger than 6
centimeters.
 Stage IVB
In Stage IVB, one of the following is true:
 The cancer appears in a lymph node that is larger than 6 centimeters and
might have spread to other tissues around the oropharynx.
 The cancer surrounds the main artery in the neck or has spread to bones in
the jaw or skull, to muscle in the side of the jaw, or to the upper part of the
throat behind the nose. The cancer might have spread to nearby lymph
nodes.
 Stage IVC
In Stage IVC, the cancer has spread to other parts of the body. The tumor
might be any size and might have spread to lymph nodes.
Treatment by stage:
 Stage I - Treatment might be radiation therapy or surgery.
 Stage II - Treatment involves surgery to remove the cancer or
radiation therapy.
 Stage III - Treatment for this stage of oropharyngeal cancer might
include surgery to remove the cancer, followed by radiation therapy.
 Other treatments might include:
 Radiation therapy alone
 A clinical trial of chemotherapy that is followed by surgery or
radiation therapy
 A clinical trial of chemotherapy combined with radiation therapy
 A clinical trial of new ways to provide radiation therapy
 Stage IV - For cases in which oropharyngeal cancer can be removed
by surgery, treatment might be one of the following:
 Surgery to remove the cancer that is followed by radiation therapy
 Radiation therapy alone
 A clinical trial combining radiation therapy and chemotherapy
 A clinical trial of new ways to provide radiation therapy
For cases in which the cancer cannot be removed by
surgery, treatment might include one of the
following:
 Radiation therapy
 A clinical trial during which chemotherapy is
followed by surgery or radiation therapy
 A clinical trial of radiation therapy given with
chemotherapy or radiosensitizers (drugs to make
the cancer cells more sensitive to radiation therapy)
 A clinical trial of new ways of giving radiation
therapy
 A clinical trial of hyperthermia therapy plus radiation
therapy
Nursing Assessment
 Obtain complete history, noting risk factors such as
smoking and alcohol use.
 Question the patient regarding changes in
swallowing, smell or taste, salivation, discomfort
when eating, sore throat, foul breath odor.
 Note the quality of voice patterns and odor of breath.
 Inspect the oral cavity: erythema, red velvety areas;
white patches; bleeding; swelling; record the size,
location, and description.
 Palpate the cervical lymph nodes for size, firmness,
or tenderness.
Nursing Diagnoses:
 Pain related to malignant infiltration,
lesion(s), difficulty swallowing, surgery,
radiation therapy
 Altered Nutrition: Less Requirements
related to pain, difficulty in chewing or
swallowing, history of Alcohol abuse.
 Body Image Disturbance related to
changes in facial contour, cosmetic defect
from surgery.
 Nursing Interventions:
 A. Achieving an Acceptable Level of Comfort
 1. Provide systemic analgesics or analgesics gargles as prescribed.
 2. If the patient can tolerate it, provide mouth care with soft toothbrush and
flossing between teeth.
 3. If patient cannot tolerate brushing and flossing:
 a. Gently lavage oral cavity with a catheter inserted between the patient’s cheek
and gums with warm water and mouthwash.
 b.Use power water spray to clean inaccessible areas if patient’s comfort
allows.
 4. Encourage use of mouthwashes that do not contain alcohol, which may
irritate the gums.
 5. Provide management of decreased salivation, if necessary.
 a. Insert a gauze wick in corner of mouth; place basin conveniently to catch
drooling; replace frequently to absorb and direct excess saliva.
 b. Suction secretions with a soft rubber catheter as needed; instruct patient on
suctioning methods.
 6. Provide management of decreased salivation, if necessary
 a. Encourage intake of fluids, if not contraindicated.
 b. Instruct the patient to avoid dry, bulky, and irritating food
 c. Offer lemon lozenges or chewing gum to stimulate salivation.
 B. Improving Nutritional status
 A. Handle feeding problems in one or a combination of the
following ways, as ordered: Intravenously, Nasogastric Tube
Feedings or gastrostomy tube feedings, Orally
 B. Provide mouth care before and after eating
 C. Allow the patient to have meals in privacy, if desired.
 D. Offer easily chewed foods, mash or blenderize, if necessary.
 C. Strengthening Body Image
 1. Allow verbalization of fears, anger and distaste with
body changes in a non defensive manner.
 2. Communicate acceptance of appearance in an
honest manner.
 3. Encourage the family and friends to visit so patient is
aware that others care about him or her.
 4. Provide diversional activities.
LARYNGEAL CANCER

Cancer of the larynx also may be

called laryngeal cancer. It can develop in
any part of the larynx. Most cancers of
the larynx begin in the glottis. The inner
walls of the larynx are lined with cells
called squamous cells. Almost all
laryngeal cancers begin in these cells.
These cancers are called squamous cell
carcinomas.
Symptoms
 Hoarseness or other voice changes
 A lump in the neck
 A sore throat or feeling that something is stuck
in your throat
 A cough that does not go away
 Problems breathing
 Bad breath
 An earache
 Weight loss
Diagnosis

 Indirect laryngoscopy
 Physical exam
 Direct laryngoscopy
 CT scan
 Biopsy
Treatment

 Radiation therapy
 Surgery
 Chemotherapy
STOMACH CANCER

Gastric cancer: Cancer of the

stomach, the major organ that holds food
for digestion. Most stomach cancers
begin in Inner layer or lining (mucosa).
Symptoms
 Symptoms of a more advanced stomach cancer can include:
 Loss of appetite
 Weight loss
 Fluid in the abdomen
 Blood in the stool
 Anaemia
 Early symptoms can include:
 Indigestion, acidity and burping
 Feeling full
 Pain or discomfort in the upper abdomen
 Feeling or being sick
 Difficulty in swallowing
 Bleeding or tiredness and breathlessness because you have lost blood
 Blood clots
diagnosis
 Upper endoscopy
 Stomach X-ray (barium upper GI series)
 Endoscopic ultrasound
 Computerized tomography (CT) scan
 Magnetic resonance imaging (MRI)
 Chest X-ray
 Laparoscopy
 Blood tests
Treatment

 Surgery
 Radiation therapy (also called
radiotherapy)
 Chemotherapy
 Drug therapy
 Clinical trials
 BREAST CANCER
Cancers occur when abnormal cells grow in
an uncontrolled way. Almost all breast cancers
occur in women - very few occur in men.
The cancer usually begins as a small lump in
a breast and then grows, either slowly or
quickly.
It can also spread to other parts of the body
after a period of time. Early diagnosis is the
key to survival.
Anatomy
 The female breast consists of a core made
up of lobules (milk glands) and ducts. This core
is surrounded by a layer of fat, and overlying this
is skin. Milk is produced on the lobules or milk
glands and collects in small ducts called terminal
ducts. These terminal duct join together to form
larger ducts, which drain, via the nipple.
Each female breast has about 12 to 15 breast
lobules. This understanding of breast anatomy is
important because breast lump including cancer
develop mostly within the milk ducts and glands.
Risk Factors
Age
Personal history of Breast cancer
Family history
Certain breast changes
Gene changes (BRCA1, BRCA2)
Reproductive and menstrual history
Race
Radiation therapy to the chest
Breast density
Taking DES (diethylstilbestrol)
Being overweight or obese after menopause
Lack of physical activity
Drinking alcohol
Clinical Manifestations
Common symptoms of breast cancer include:

A change in how the breast or nipple feels

A lump or thickening in or near the breast or in the
underarm area
(Nipple tenderness)
A change in how the breast or nipple looks
A change in the size or shape of the breast
A nipple turned inward into the breast
The skin of the breast, areola, or nipple may be scaly, red,
or swollen. It may have ridges or pitting so that it looks like
the skin of an orange.
Nipple discharge (fluid)
Early breast cancer usually does not cause pain.
Diagnosis
Clinical breast exam
Diagnostic mammogram
Ultrasound
Magnetic resonance imaging
Biopsy
Fine-needle aspiration
Core biopsy
Surgical biopsy
Staging
Stage 0 - Carcinoma in situ
Stage I - Tumor (T) does not involve axillary lymph nodes
(N).
Stage IIA – T 2-5 cm, N negative, or T <2 cm and N
positive.
Stage IIB – T > 5 cm, N negative, or T 2-5 cm and N
positive (< 4 axillary nodes).
Stage IIIA – T > 5 cm, N positive, or T 2-5 cm with 4 or
more axillary nodes
Stage IIIB – T has penetrated chest wall or skin, and may
have spread to < 10 axillary N
Stage IIIC – T has > 10 axillary N, 1 or more
supraclavicular or infraclavicular N, or internal mammary N.
Stage IV – Distant metastasis (M)
Treatment
Surgery: Removal of the lump (called a lumpectomy) is the preferred
technique. Removal of lymph nodes in the armpit may be undertaken as
well. Removal of the breast (called a mastectomy) is only performed if
absolutely necessary.

Chemotherapy: Medicines that interfere with cancer cell growth and

division are administered to reduce the size of tumours or kill them.

Hormonal therapy: Hormones are chemical signals which are released by

different parts of the body and can carried in the blood to some other area
to have an effect. Oestrogen is a sex hormone that promotes the growth of
some breast cancers. Hormonal treatments, such as anti-oestrogens,
aromatase inhibitors or LHRH analogues, are designed to block the effects
of oestrogen or its production, which stops or slows the growth of cancer
cells.

Radiation therapy: X-rays or other high-energy rays are applied to the

tumour and surrounding areas to destroy cancer cells.
Prognosis
There are several prognostic factors associated with
breast cancer. Stage is the most important, as it takes into
consideration local involvement, lymph node status and
whether metastatic disease is present. The higher the stage at
diagnosis, the worse the prognosis. Breast cancer patients
whose lymph nodes are cancer-free have a much better
prognosis than those whose lymph nodes are positive for
cancer.
The presence of estrogen and progesterone receptors in
the cancer cell is another important prognostic factor which
may guide treatment. Hormone receptor positive breast cancer
is usually associated with much better prognosis compared to
hormone negative breast cancer.
HER2/neu status has also been described as a prognostic
factor. Patients whose cancer cells are positive for HER2/neu
have more aggressive disease and may be treated with
trastuzumab, a monoclonal antibody that targets this protein.
Management
Treatment methods

Local therapy: Surgery and radiation therapy are local treatments.

They remove or destroy cancer in the breast. When breast cancer
has spread to other parts of the body, local therapy may be used
to control the disease in those specific areas.

Systemic therapy: Chemotherapy, hormone therapy, and biological

therapy are systemic treatments. They enter the bloodstream and
destroy or control cancer throughout the body. Some women with
breast cancer have systemic therapy to shrink the tumor before
surgery or radiation. Others have systemic therapy after surgery
and/or radiation to prevent the cancer from coming back.
Systemic treatments also are used for cancer that has spread.
Surgery

Breast-sparing surgery: An operation to remove the cancer but not

the breast is breast-sparing surgery. It is also called breast-
conserving surgery, lumpectomy, segmental mastectomy, and
partial mastectomy. Sometimes an excisional biopsy serves as
a lumpectomy because the surgeon removes the whole lump.

Mastectomy: An operation to remove the breast (or as much of

the breast tissue as possible) is a mastectomy. In most cases,
the surgeon also removes lymph nodes under the arm. Some
women have radiation therapy after surgery.

Sentinel lymph node biopsy is a new method of checking for

cancer cells in the lymph nodes. A surgeon removes fewer
lymph nodes, which causes fewer side effects. (If the doctor
finds cancer cells in the axillary lymph nodes, an axillary lymph
node dissection usually is done.)
Radiation therapy

External radiation: The radiation comes from a large

machine outside the body. Most women go to a
hospital or clinic for treatment. Treatments are usually
5 days a week for several weeks.

Internal radiation (implant radiation): Thin plastic tubes

(implants) that hold a radioactive substance are put
directly in the breast. The implants stay in place for
several days. A woman stays in the hospital while she
has implants. Doctors remove the implants before she
goes home.
Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells.

Chemotherapy for breast cancer is usually a combination
of drugs. The drugs may be given as a pill or by injection
into a vein (IV). Either way, the drugs enter the
bloodstream and travel throughout the body.

Blood cells: These cells fight infection, help your blood to

clot, and carry oxygen to all parts of the body. When
drugs affect your blood cells, you are more likely to get
infections, bruise or bleed easily, and feel very weak and
tired. Years after chemotherapy, some women have
developed leukemia (cancer of the blood cells).
Hormone therapy

Drugs: Your doctor may suggest a drug that can block

the natural hormone. One drug is tamoxifen, which
blocks estrogen. Another type of drug prevents the
body from making the female hormone estradiol.
Estradiol is a form of estrogen. This type of drug is an
aromatase inhibitor. If you have not gone through
menopause, your doctor may give you a drug that
stops the ovaries from making estrogen.
Biological therapy

Biological therapy helps the immune system fight

cancer. The immune system is the body's natural
defense against disease.
Some women with breast cancer that has spread
receive a biological therapy called Herceptin®
(trastuzumab). It is a monoclonal antibody. It is made
in the laboratory and binds to cancer cells.
Herceptin is given to women whose lab tests show
that a breast tumor has too much of a specific protein
known as HER2. By blocking HER2, it can slow or
stop the growth of the cancer cells.
Radiological Investigations

MRI of Breast Ultrasound Mammotome

Ultrasonography Digital Mammography

Lung Cancer
 Lung cancer is leading cancer killer
among men and women in the United
StAtes.In 2005, there were an estimated
172,500 new case of the lung and
bronchus (93,000 men and 79,500
women).
Pathophysiology
 Between 80% and 90% of lung cancers are caused by
inhaled carcinogens, most commonly cigarette smokers
 other carcinogens include radon gas and occupational
and environmental agents.
 Lung cancers arise from a single transformed epithelial
cell in the tracheobronchial airways, in which the
carcinogen binds to and damages the cell’s DNA.this
damage results in cellular changes, abnormal cell growth,
and eventually a malignant cell. As the damaged DNA is
passed on to daughter cells, the DNA undergoes further
changes and becomes unstable. With the accumulation of
genetic changes, the pulmonary epithelium undergoes
malignant transformation from normal epithelium
undergoes malignant transformation from normal
epithelium eventually to invasive carcinoma. Evidence
indicates that carcinoma tends to arise at of sites of
previous scarring (TB, fibrosis) in the lung.
 Risk
Factors
 Tobacco Smoke

Tobacco use is responsible for more than one of every six

deaths in the United States from pulmonary and cardiovascular
diseases. Smoking is the most important single preventable cause
of death and disease in this country .lung cancer is 10 times more
common in cigarette smokers than nonsmokers. Risk is
determined by the pack- year history (number of packs of
cigarette used each day, multiplied by the number of years
smoked), the age of initiation of smoking, the depth of inhalation,
and the tar and nicotine levels in the cigarettes smoked. The
younger a person is when he or she starts smoking, the greater
the risk of developing lung cancer. The risk of cancer is always
higher for former smokers than for people who have never
smoked. However, the risk decreases beginning at approximately
5 years after smoking cessation occurs and continues to decrease
over time.
 Secondhand
Passive smoking has been identified as
a possible cause of lung cancer in
nonsmokers. It is estimated that
secondhand smoke causes about 3000
deaths per year (Baldwin, 2003). When
compared with unexposed to tobacco
smoke in a closed environment ( house,
automobile,buiding) have an increased risk
of lung cancer.
 Environmental and Occupational Exposure
Various carcinogens have been identified in
the atmosphere,including mototr vehicle
emissions and pollutants from refineries and
manufacturing plants.Evidence suggests that the
incidence of lung cancer is greater in urban areas
as a result of the buildup of pollutants and motor
vehicle emissions
Radon is colors, odorless gas found in soil
and rocks. For many years it has been associated
with the development of lung cancer, especially
when combined with cigarette smoking.
Homeowners are advised to have radon levels
checked in their houses and to arrange for
special venting if the levels are high.
 Genetics

 Some familial predisposition to lung cancer seems apparent, because
the incidence of lung cancer in close relatives of patients with lung
cancer appears to be two to three times that in the general population
regardless of smoking status.

 Dietary Factors
 Smokers who eat a diet low in fruits and vegetables have an
increased brisk of developing lung cancer. the actual active agents in
a diet rich in fruits and vegetables
 Have yet to be determined. It has been hypothesized that carotenoids,
particularly
 Carotene or vitamin A may be important. Several ongoing trials may
help determine whether carotene supplementation has anticancer
properties. Other nutrients, including vitamin E, selenium, vitamin C
fat, and retinoids are alsobeing evaluated regarding their protective
role against lung cancer.
CLINICAL
MANIFESTATIONS
 Often lung cancer develops insidiously and is asymptomatic until late in its
course. the signs and symptoms depend on the location and size of the
tumor, the degree of obstruction, and the existence of metastases to regional
or distant sites. The most frequent symptom of lung cancer is cough, without
sputum production. When obstruction of airways occurs, the cough may
become productive due to infection. Dyspnea occurs in 35% to 50% of
patients (Baldwin, 2003). Hemoptysis or blood tinged sputum may be
expectorated. Chest or shoulder pain may indicate
 Chest wall or pleural involvement by a tumor. Pain also is a late manifestation
and may be related to metastasis to the bone. In some patient, a recurring
fever is an early symptom in response to a persistent infection in an area of
pneumonitis distal to the tumor. In fact,cancer of the lung should be
suspected in people with repeated unresolved upper respiratory tract
infections.if the tumor spreads to adjacent structures and regional lymph
nodes,the patient may present with chest pain and tightness,
hoarseness(involving the recurrent laryngeal nerve).dysphagia, head and
neck edema, and symptoms of pleural or pericardial effusion. The most
common sites of metastases are lymph nodes, bone, brain,contralateral lung,
adrenal glands,and liver.Nonspecific symptoms of weakness,anorexia,and
weight loss also may be present.
Assessment and
Diagnostic Findings
 If pulmonary symptoms occur in heavy smokers, cancer
of the lung should always be considered chest x-ray is
performed to search for pulmonary density, a solitary
pulmonary nodule (coin lesion), atelectasis, and infection.
CT scans of the chest are used x-ray and also to serially
examine areas for lymphadenopathy.sputum cytology is
rarely used to make a diagnosis of lung cancer.Fiberoptic
bronchoscopy is more commonly used; it provides a
detailed study of the tracheobronchial tree and allow for
brushings, washings, and amenable to bronchoscopic
biopsy, a transthoracic fine- needle aspiration may be
performed under CT guidance to aspirate cells from a
suspicious area. In some circumstances, an endoscopy
with esophageal ultrasound may be used to obtain a
transesophageal biopsy of enlarged subcarinal lymph
nodes that are not easily accessible by others means.
Medical Management
 The objective of management is to provide a
cure, if possible. Treatment depends on the cell
type, the stage of the disease, and the patient’s
physiologic status (particularly cardiac and
pulmonary status).In general,treatment m may
involve surgery,radiation therapy, or
chemotherapy—or a combination of
these.Newer and more specific therapies to
modulate the immune system(gene therapy,
therapy wiyh defined tumor antigens) are under
study and show promise.
Surgical Management
 Surgical resection is the preferred method of treating
patients with localized non-small cell tumors, no evidence of
metastatic spread, and adequate cardiopulmonary function.
If the patient’s cardiovascular status are safisfactory,
surgery is generally well tolerated. However, coronary artery
disease, pulmonary insufficiency, and other comorbidities
may contraindicate surgical intervention. The cure rate of
surgical resection depends on the type and stage of the
cancer surgery is primarily used for NSCLCs, because
small cell cancer of the lung grow rapidly and metastasizes
early and extensively. Lesons of many patients with
bronchogenic cancer are inoperable at the of diagnosis.

 Several different types of lung resection may be performed

(chart 23-9). The most common surgical procedure for a
small, apparently curable tumor of the lung is lobectomy
( removal of a lobe of the lung). In some cases, an entire
lung may be removed
Radiation Therapy
 Radiation therapy may offer cure in a small percentage of patients. It
is useful in controlling neoplasm that cannot be surgically resected
but are responsive to radiation. Irradiation also may be used to reduse
the size of a tumor,to make an inoperable, or to relieve the pressure of
the tumor on vital structures. It can reduce symptoms of spinal cord
metastasis and superior vena caval compression. Also, Prophylactic
brain irradiation is use in certain patients to treat microscopic
metastases to the brain. Radiation therapy may help relieve
cough,chest pain, dyspnea, hemoptysis ands bone and liver pain.
Relief of symptoms may last in improving the quality of the remaining
period of life. Radioatoin therapy usually is toxic to normal tissue
within the radiation field, and this may lead to complicationssuch as
esophaitis, pneumonitis, and radiation lung fibrosis. These may impair
ventilatory and diffusion cacacity and significantly redurce pulmonary
reserve. The patient’s nutritional status, psychological outlook, fatigue
level, and signs of anemia and infection are monitored throughout the
treatment. See chapter 16 for management of the patient receiving
radiation therapy.
Chemotherapy
 CHEMOTHERAPY is used to alter tumor growth
patterns, to treat distant metastases or small cell
cancer of the lung, and as an adjunct to surgery or
radiation therapy. Chemotherapy may provide
relief, especially of pain, but it does not usually
cure the disease or prolong life to any great
degree. Chemotherapy is also accompanied by
side effects. It is valuable in reducing pressure
symptoms of lung cancer and in treating brain
spinal cord and pericardial metastasis. See
chapter 16 for a discussion of chemotherapy for
the patients with cancer.
Palliative Therapy

 Palliative therapy may include radiation therapy

to shrink the tumor to provide pain relief, a
varierty of bronchoscopic interventions to open
a narrowed bronchus or airway, and pain
management and other comfort measures.
Evaluation and referral for hospice care are
important in planning for comfortable and
dignified end –of –life care for the patients and
family.
Nursing management

 Nursing care of patients with lung cancer

is similar to that for other patients with
cancer (see Chapter 16 ) and addresses
the physiology and psychological needs
of the respiratory manifestations of the
disease. Nursing care includes straregies
to ensure relief of pain and discomfort
and to prevent complications.
Managing Symptom

 The nurse instructs the patient and family

about the potential side effects of the
specific treatment and strategies to
manage them. Strategies for managing
such symptoms as dyspnea, fatigue,
nausea and vomiting, and anorexia help
the patient and family cope with
therapeutic measures.
Relieving Breathing Problems

 Airway clearance techniques are key maintaining airway patency

through the removal of excess secretion. This may be
accomplished through deep-breathing exercises, chest
physiotherapy, directed cough.sunctioning, and in some instance
bronchoscopy. Bronchodilator medications may be prescribed to
promote bronchial dilation. As the tumor enlarges or spreads,
 it may compress a bronchus or involve a large area of lung tissue,
resulting in an impaired breathing pattern and poor gas exchange.
At some stage of the disease, supplement oxygen will probably be
necessary.
 Nursing measures focus on decreasing dyspnea by encouraging
the patient to assume positions that promote lung expansion and
relaxation. Patient education about energy conservation and
airway clearance techniques is also necessary. Many of the
techniques used in pulmonary rehabilitation can be applied to
patients with lung cancer, Depending on the severity of disease
and the patient's wishes, a referral to a pulmonary rehabilitation
program may be helpful in managing respiratory symptoms.
Reducing Fatigue
 Fatigue is a devastating symptom that affect quality of life in
patients with cancer, it is commonly experienced by patients
cancer and may be related to the disease itsefl, the cancer
treatment and complication (eg, anemia), nutrition, or the
psychological ramifications of the disease (eg, anxiety,
depression). The nurse is pivotal in thoroughly assessing the
patient's level of fatigue, identifying potentially treatable causes,
and validating with the patient that fatigue is indeed an important
symptom. Educating the patient about energy conservation
techniques or referral to physical therapy, occupational therapy, or
pulmonary rehabilitation program may be helpful. In addition,
guided exercise has been recently identified as a potential
intervention for treating fatigue in cancer patients. This is an
important area for research, because few studies have been
conducted, and only in select populations of patients with cancer.
Providing Psychological
Support
 Another important part of the nursing care of patients
with lung cancer is provision of psychological support
and identification of potential resources for the patient
and family. Often, the nurse must help the patient and
family deal with the following:
 The poor prognosis and relatively rapid progression of
this disease
 Informed decision making regarding the possible
treatment options
 Method to maintain the patient’s quality of life during the
course of this disease
 End-of-life treatment option