Lung Ca (OPO)

7/27/2019 Lung Ca (OPO)

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Patient Summary

Patient RAB, 49 y/o male, diagnosed with Non-Small Cell Lung Cancer. Medical History shows

that he had wedge resection last November 2010 and Lobectomy last June 2011 because of Right

Adenocarcinoma. He also had a Segmentectomy due to Left Adenocarcinoma last December 2011. PET

scan performed last August 2012 reveals hypermetabolic pleural nodules at the Right Lower Lobe. Basedon his physical examination done last September 2012, he is negative EGFR (Epidermal Growth Factor

Receptor), Vital Signs Stable, Decreased Breath Sounds and NRRR. His initial recommendations are

Pemetrexed (Alimta) and Zoledronic Acid (Zometa). Patient undergone 2 cycles of Pemetrexed and

shifted to Gemcitabine HCL (Gemzar) last December 3, 2012.

Lung Cancer Overview

Lung Cancer is a disease characterized by uncontrolled cell growth in tissues of the lung, also

known as bronchogenic carcinomas.

There are two main types of lung cancer:

Non-small Cell Lung Cancer (NSCLC) is the most common type of lung cancer, accounts for

80%.

Squamous Cell Carcinoma (Epidermoid Carcinoma) – it is the most common type of

NSCLC and the most common type of lung cancer in men. This forms in the lining of the

bronchial tubes.

Adenocarcinoma - the most common type of lung cancer in women and in non-

smokers. It forms in the mucus-producing glands of the lungs.

Bronchioalveolar Carcinoma - this type of lung cancer is a rare type of

adenocarcinoma that forms near the lungs' air sacs.

Large-cell Undifferentiated Carcinoma - a rapidly growing cancer which form near the

outer edges or surface of the lungs. This is the least common type of NSCLC.

Small Cell Lung Cancer (SCLC) comprises about 20% of lung cancers. This is the most

aggressive and rapidly growing of all lung cancers. This is mostly related to cigarette smoking,

with only 1% of these tumors occurring in non-smokers.

If the lung cancer is made up of both types, it is called mixed small cell/large cell cancer.

If the cancer started somewhere else in the body and spread to the lungs, it is called metastatic cancer

to the lung.

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CAUSE SIGNS AND SYMPTOMS INCIDENCE PROGNOSIS

Smoking

Passive Smoking

Asbestos Fibers

Radon Gas

Familial

Predisposition

Lung Disease

(COPD)

Air Pollution

Persistent or intense coughing

Pain in the chest shoulder, or

back from coughing

Changes in color of the mucus

that is coughed up from the

lower airways (sputum)

Difficulty breathing and

swallowing

Hoarseness of the voice

Harsh sounds while breathing

(stridor)

Chronic bronchitis or

pneumonia

Coughing up blood, or blood in

the sputum

Lung cancer is the

deadliest type of

cancer for both men

and women. Each

year, more people

die of lung cancer

than of breast, colon,

and prostate cancers

combined. In 2008,

there were 1.61

million new cases,

and 1.38 million

deaths due to lung

cancer.

The overall prognosis

for lung cancer is poor

when compared with

some other cancers.

Survival rates for lung

cancer are generally

lower than those for

most cancers, with an

overall five-year

survival rate for lung

cancer of about 16%

Diagnosing Lung Cancer

Medical History and Physical Examination

Chest X-ray

CT Scan (Computerized Tomography)

MRI (Magnetic Resonance Imaging)

PET Scan (Positron Emission Tomography)

Bone Scan

Sputum Cytology

Bronchoscopy

Needle Biospy

Thoracentesis

Blood Tests

Staging Lung Cancer

The most common cancer staging method is called the TNM system.

T (1-4) indicates the size and direct extent of the primary tumor

N (0-3) indicates the degree to which the cancer has spread to nearby lymph nodes

M (0-1) indicates whether the cancer has metastasized to other organs in the body.

For example, a small tumor that has not spread to lymph nodes or distant organs may be staged as (T1,

N0, M0).

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For non-small cell lung cancer, TNM descriptions lead to a simpler categorization of stages. These stages

are labeled from I to IV, where lower numbers indicate earlier stages where the cancer has spread less.

More specifically:

Stage I is when the tumor is found only in one lung and in no lymph nodes.

Stage II is when the cancer has spread to the lymph nodes surrounding the infected lung.

Stage III A is when the cancer has spread to lymph nodes around the trachea, chest wall, and

diaphragm, on the same side as the infected lung.

Stage III B is when the cancer has spread to lymph nodes on the other lung or in the neck.

Stage IV is when the cancer has spread throughout the rest of the body and other parts of the

lungs.

Small cell lung cancer has two stages: limited or extensive. In the limited stage, the tumor exists in one

lung and in nearby lymph nodes. In the extensive stage, the tumor has infected the other lung as well as

other organs in the body.

Treatment

Surgery

Wedge Resection (Segmentectomy) - is a surgical operation where a part of a lung is

removed. It is done to remove a localized portion of diseased lung, such as

early stage lung cancer.

Lobectomy - is a type of lung cancer surgery in which one lobe of a lung is removed.

(The right lung has 3 lobes, and the left lung has 2 lobes.) A lobectomy of the lung is

performed in early stage non-small cell lung cancer patients. It is not performed on

patients that have lung cancer that has spread to other parts of the body. Pneumonectomy - is a type of lung cancer surgery in which an entire lung is removed as

a treatment for lung cancer.

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Radiation

Chemotherapy

Chemotherapy utilizes strong chemicals that interfere with the cell division process -

damaging proteins or DNA - so that cancer cells will commit suicide. These treatments

target any rapidly dividing cells (not just cancer cells), but normal cells usually can

recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is

considered systemic because its medicines travel throughout the entire body, killing the

original tumor cells as well as cancer cells that have spread throughout the body.

Combination therapies often include multiple types of chemotherapy, and

chemotherapy is also given as adjuvant therapy as a complement to surgery and

radiation. Adjuvant therapy is designed to reduce the risk of cancer recurrence after

surgery and killing any cancer cells that exist after surgery. Chemotherapy can be given

before surgery, called neo-adjuvant therapy, to shrink tumors and to make surgery

more successful.

DRUG STUDY

Pre-Medications

RAMOSETRON (Nasea)

CLASSIFICATION DOSAGE INDICATIONSADVERSE

EFFECTS

NURSING

RESPONSIBILITIES

Antiemetic 5 –

HT3 Antagonist

Adult Dosage is

300 mcg once a

day. If a

sufficient

response is not

achieved, an

additional 300

mcg dose may

be given.

However, the

daily dosage

should not

exceed 600

mcg.

Prevention

of

gastrointesti

nal

symptoms

(nausea and

vomiting)

associated

with anti-

cancer drug

therapy.

Shock or

anaphylactoid

symptoms (ill

feeling, feeling

of chest

distress,

dyspnea,

wheezing, hot

facial flushes,

redness,

itching,

cyanosis and

hypotension)

Epileptiform

attacks

Monitor BP carefully

during IV

administration

Monitor for

extrapyramidal

reactions, and consult

physician if they occur.

Instruct patient that

alcohol, sleep

remedies, or sedatives ;

serious sedation could

occur.

METOCLOPROMIDE

CLASSIFICATION DOSAGE INDICATIONS ADVERSE EFFECTSNURSING

RESPONSIBILITIES

Antiemetic 10mg given

30 minutes

Prevention of

nausea and

Restlessness,

drowsiness,

Monitor BP carefully

during IV

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before

chemother

apy.

vomiting

associated with

emetogenic

cancer

chemotherapy.

fatigue,

insomnia,

extrapyramidal

reactions

administration

Monitor for

extrapyramidal

reactions, and consult

physician if they occur.

Instruct patient that

alcohol, sleep

remedies, or sedatives ;

serious sedation could

occur.

DEXAMETHASONE


EFFECTS

NURSING

RESPONSIBILITIES

Corticosteroid 20mg Short term

management of various

inflammatory

and allergic

disorders.

Seizures,

vertigo,headaches,

hypertension

and peptic or

esophageal

ulcer.

Avoid exposure to

infection Report unusual weight

gain, swelling of the

extremities, muscle

weakness, black tarry

stools, fever ,

prolonged sore throat,

colds or other

infections.

RANITIDINE


EFFECTS

NURSING

RESPONSIBILITIES

Histamine2 (H2)

Antagonist

50mg Inhibiting gastric

acid secretion

that it is

stimulated by

food, histamine

and cholinergic

agonists.

Headache,

tachycardia,

bradycardia,

constipation,

diarrhea,

nausea,

vomiting and

abdominal

pain.

Check allergy to

ranitidine, impaired

renal or hepatic

function.

Report sore throat,

unusual bruising or

bleeding, tarry stools,

dizziness and severe

headache.

ZOLEDRONIC ACID (Zometa)


EFFECTS

NURSING

RESPONSIBILITIES

Biphosphonate 4mg / Prevention of Bone pain, Check allergy to

7/27/2019 Lung Ca (OPO)


100ml D5W

for 15

minutes

skeletal related

events

To reduce and

delay bone

complications

due to multiple

myeloma and

bone

metastases from

solid tumors.

nausea,

fatigue,

anemia, fever,

vomiting,

constipation,

shortness of

breath,

diarrhea,

weakness and

muscle pain.

Zometa.

Monitor patient with

mild to moderate renal

impairment. It should

be assessed prior

Zometa administration.

Protocol of Lung Cancer

Pemetrexed (Alimta) – is antifolate antineoplastic agents which works by blocking the action of

a certain substance in the body that may help cancer cells multiply.

o In patients treated for non-small cell lung cancer, the recommended dose of ALIMTA is

500 mg / m2 BSA administered as intravenous infusion over 10 minutes on the first day

each of each 21-day cycle.

o To reduce the incidence and severity of skin reactions, a corticosteroid should be given

the day prior to, on the day of, and the day after pemetrexed administration.

o This drug can suppress bone marrow function as manifested by neutropenia,

thrombocytopenia and anemia. Myelosuppression is usually the dose limiting toxicity.

Patients should be monitored for myelosuppression during therapy and Alimta should

not be given to patients until absolute neutrophil count (ANC) returns to > 1500

cells/mm3 and platelets returns to > 100,000 cells/mm3.

Gemcitabine HCl (Gemzar) – is a nucleoside analogue that exhibits antitumor activity.

o This medication is given by injection into a vein (intravenous) usually over 30 minutes. It

should not be given for longer than 60 minutes or more than once a week because of

the risk to increase side effects or toxicity.

o Combination Therapy with Gemzar plus Cisplatin in NSCLC

28 day schedule – Gemzar 1000 mg/m2

on days 1 , 8 and 15 cisplatin 100 mg

/m2

day 1 every 28 days.

21 day schedule – Gemzar plus cisplatin: Gemzar 1250 mg/m2

on days 1, and 8

cisplatin 100 mg / m2 on day 1 every 21 days.

Currently patient RAB, received Gemzar 1600mg in 250ml PNSS for 30minutes as ordered by his physician (1

stcycle).

o The most common side effects are low blood cell counts (red blood cells, white blood

cells, and platelets); fever; infection; hair loss; tiredness; nausea; vomiting; constipation;

diarrhea; rash; shortness of breath; muscle aches; blood in urine; hearing changes and

numbness or tingling in your toes or fingers

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Lung Cancer

(Out Patient Oncology)

Submitted by:

Krizelle C. Natividad

ANSET II – Cluster C

7/27/2019 Lung Ca (OPO)


Cheats

history and physical examination may reveal the

presence of symptoms or signs that are suspicious

for lung cancer. In addition to asking about

symptoms and risk factors for cancer development

such as smoking, doctors may detect signs of

breathing difficulties, airway obstruction, or

infections in the lungs.Cyanosis, a bluish color of the

skin and the mucous membranes due to insufficient

oxygen in the blood, suggests compromised function

due to chronic disease of the lung. Likewise, changes

in the tissue of the nail beds, known as clubbing, also

may indicate chronic lung disease.

chest X-ray is the most common first diagnostic step

when any new symptoms of lung cancer are present.

Chest X-rays may reveal suspicious areas in the lungs

but are unable to determine if these areas are

cancerous. In particular, calcified nodules in the lungs

or benign tumors called hamartomas may be

identified on a chest X-ray and mimic lung cancer.

CT scans - may be performed on the chest, abdomen,

and/or brain to examine for both metastatic and lung

tumors. A CT scan of the chest may be ordered when

X-rays do not show an abnormality or do not yield

sufficient information about the extent or location of

a tumor. One advantage of CT scans is that they are

more sensitive than standard chest X-rays in the

detection of lung nodules, that is, they will

demonstrate more nodules. MRI - scans may be appropriate when precise detail

about a tumor's location is required.

PET scanning is a specialized imaging technique that

uses short-lived radioactive drugs to produce three-

dimensional colored images of those substances in

the tissues within the body. While CT scans and MRI

scans look at anatomical structures, PET scans

measure metabolic activity and the function of

tissues. PET scans can determine whether a tumor

tissue is actively growing and can aid in determining

the type of cells within a particular tumor

Bone scans are used to create images of bones on a

computer screen or on film. Doctors may order a

bone scan to determine whether a lung cancer has

metastasized to the bones

Sputum cytology: The diagnosis of lung cancer

always requires confirmation of malignant cells by a

pathologist, even when symptoms and X-ray studies

are suspicious for lung cancer. The simplest method

to establish the diagnosis is the examination of

sputum under a microscope. If a tumor is centrally

located and has invaded the airways, this procedure,

known as a sputum cytology examination, may allow

visualization of tumor cells for diagnosis. This is the

most risk-free and inexpensive tissue diagnostic

procedure, but its value is limited since tumor cells

will not always be present in sputum even if a cancer

is present. Also, noncancerous cells may occasionally

undergo changes in reaction to inflammation or

injury that makes them look like cancer cells.

Bronchoscopy: Examination of the airways by

bronchoscopy (visualizing the airways through a thin,

fiberoptic probe inserted through the nose or mouth)

may reveal areas of tumor that can be sampled

(biopsied) for diagnosis by a pathologist

Needle biopsy: (FNA) through the skin, most

commonly performed with radiological imaging for

guidance, may be useful in retrieving cells for

diagnosis from tumor nodules in the lungs. Needle

biopsies are particularly useful when the lung tumor

is peripherally located in the lung and not accessible

to sampling by bronchoscopy

Thoracentesis: Sometimes lung cancers involve the

lining tissue of the lungs (pleura) and lead to an

accumulation of fluid in the space between the lungs

and chest wall (called a pleural effusion). Aspiration

of a sample of this fluid with a thin needle

(thoracentesis) may reveal the cancer cells andestablish the diagnosis. As with the needle biopsy, a

small risk of a pneumothorax is associated with this

procedure.

Blood tests: While routine blood tests alone cannot

diagnose lung cancer, they may reveal biochemical or

metabolic abnormalities in the body that accompany

cancer. For example, elevated levels of calcium or of

the enzyme alkaline phosphatase may accompany

cancer that is metastatic to the bones. Likewise,

elevated levels of certain enzymes normally present

within liver cells, including aspartate

aminotransferase(AST or SGOT) and alanine

aminotransferase (ALT or SGPT), signal liver damage,

possibly through the presence of tumor metastatic to

the liver.

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Lung Ca (OPO)