This paper provides a comprehensive overview of lung cancer, covering current epidemiological statistics, risk factors, and key definitions for small cell and non-small cell lung cancer. It examines the normal anatomy of the lungs, clinical presentation, disease progression, and staging systems. The paper also surveys current diagnostic technologies — including fluorescence endoscopy and monoclonal antibody imaging — and approved treatment options such as Photofrin, Taxol, and Gemzar. A final section applies culturally sensitive nursing care by presenting NANDA-based nursing diagnoses tailored to Mexican Latino and Chinese immigrant patients, addressing coping, family communication, and spiritual distress.
Lung cancer is the leading cause of cancer death for both men and women, and the statistics for women have been increasing steadily since 1987, surpassing breast cancer as the leading cause of cancer death (Brown, 1999, p. 7). According to the American Cancer Society, more people die of lung cancer than of breast, prostate, and colon cancer combined.
In 2008, there were approximately 215,020 new cases of lung cancer (both small cell and non-small cell) in the United States: 114,690 among men and 100,330 among women. About 161,840 people died of this disease in 2008: 90,810 men and 71,030 women (American Cancer Society, "How Many People Will Get Non-Small Cell Lung Cancer?"). The incidence is therefore considered relatively high, and the rate of diagnosis increases with age and with other factors associated with lifestyle and environment.
Risk factors for lung cancer include many environmental factors that increase risk but are not necessarily known to be independent causes of cancer. Smoking and secondhand smoke are the highest risk factors for lung cancer, but other environmental exposures also increase risk, including occupational exposure to inhaled carcinogens. Lung cancer does frequently occur among people with no known history of environmental exposure to carcinogens. Some occupational exposures, such as asbestos and coal dust, are associated with specific types of cancer that are diagnosed and treated differently.
Lung cancer is rare in people under the age of 45. The average lifetime chance that a man will develop lung cancer is about 1 in 13; for a woman, it is 1 in 16. These numbers include both smokers and non-smokers — for smokers the risk is much higher, while for non-smokers it is lower (American Cancer Society, "How Many People Will Get Non-Small Cell Lung Cancer?"). Lung cancer is a serious health threat in all nations but is more common in industrialized nations and in centers of industrial or agricultural activity.
Carcinoid Tumors: Tumors of the lungs that form masses but are usually well contained and can be cured by surgical intervention.
Lung Cancer: Any abnormally growing cells that occur primarily, or first, within the tissues of the lung and/or the lining of the lungs.
Non-Small Cell Lung Cancer: The most common form of lung cancer (approximately 75% of cases), in which cells form into larger tumors or masses during growth stages. These tumors can frequently be treated with surgery combined with drug and radiation therapy.
Small Cell Lung Cancer: A form of lung cancer in which cancer cells do not form discrete tumors or masses but instead spread across areas of the lung. This type is generally harder to detect and treat, as it has usually spread beyond the lungs and cannot be cured by surgery due to its diffuse nature.
There are two stages for small cell lung cancer. In the limited stage, the tumor is usually confined to one lung and the lymph nodes on the same side of the chest. In the extensive stage, the cancer has spread to the other lung, to lymph nodes on the other side of the chest, or to distant organs.
The stages of non-small cell lung cancer are as follows:
Occult Stage: Cancer can be detected in the patient's saliva, but tumors cannot be found in the lungs.
Stage 0: Cancer is localized in a few layers of cells and has not grown through the lung's top lining.
Stage I: The tumor is only in the lung and is surrounded by normal tissue.
Stage II: Cancer has spread to nearby lymph nodes.
Stage III: Cancer has spread to the chest wall or diaphragm near the lung, or to the lymph nodes in the mediastinum (the area that separates the two lungs), or to the lymph nodes on the other side of the chest or in the neck. This stage is divided into Stage IIIA, which can usually be operated on, and Stage IIIB, which usually cannot withstand surgery.
Stage IV: The cancer has spread to other parts of the body.
Recurrent: Cancer has returned after treatment (Brown, 1999, p. 7).
In basic terms, the lungs are two spongy organs in the center of the chest — the right lung has three lobes and the left has two — that facilitate the chemical exchange between blood and the air we breathe. The lungs replace carbon dioxide with oxygen from inhaled air and allow the body to expel carbon dioxide. Air passes from the mouth through the trachea into the bronchi and then into the bronchioles, which lead to clusters of small sacs called alveoli, where the actual gas exchange occurs (American Cancer Society, "Non-Small Cell Lung Cancer").
Lung cancer presents with symptoms such as a persistent cough, chest pain, weight loss and/or decreased appetite, bloody phlegm, shortness of breath, hoarseness, fever of unknown origin, and recurring infections such as bronchitis and pneumonia (Brown, 1999, p. 7).
Diagnosis of lung cancer is accomplished through several means, including blood tests, though it is most often detected by chest X-rays and other imaging tools. It is also well established that lung cancer can take many years to produce symptoms and may progress so slowly that early warning signs are ignored or attributed to other disease states or causes until the disease is quite advanced.
Most lung cancers begin in the lining of the bronchi, though cancer can also originate in other areas of the lung. The two major types — small cell and non-small cell — are treated in different ways. Lung cancer generally takes many years to develop to the point where it is symptomatic or detectable on X-rays and other diagnostic imaging.
Initially, there may be areas of pre-cancerous change in the lung. These changes do not form a mass or tumor, cannot be seen on an X-ray, and do not cause symptoms. Over time, these pre-cancerous areas may become true cancer and produce chemicals that cause new blood vessels to form nearby. These new blood vessels nourish the cancer cells and allow a tumor to develop. Eventually, the tumor becomes large enough to appear on an X-ray. At some point, cancer cells can break away and spread to other parts of the body in a process called metastasis. Lung cancer is a life-threatening disease in large part because it often spreads in this way before it is detected (American Cancer Society, "Non-Small Cell Lung Cancer").
Lung cancer often spreads through the lymphatic system; Stage IV cancer has reached this point and spread further to other cells in the body. It is frequently not detected until this metastasized state (American Cancer Society, "Non-Small Cell Lung Cancer"). Only about 15% of lung cancer diagnoses are made before metastasis occurs. The one-year survival rate has improved slowly over the years, rising to approximately 40% from 32% in the early 1970s, and the five-year survival rate has improved from 8% in the 1960s to 14%. "Improvement in survival rates can be attributed, at least partially, to diagnostics and new drugs that the Food and Drug Administration has approved" (Brown, 1999, p. 7).
"Imaging, bronchoscopy, fluorescence, and antibody diagnostics"
"Surgery, chemotherapy, radiation, and FDA-approved drugs"
"NANDA nursing diagnoses for immigrant patient populations"
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