Bronchogenic Carcinoma

  1. General information
    1. The majority of primary pulmonary tumors arise from the bronchial epithelium and are therefore referred to as bronchogenic carcinomas.
    2. Characteristic pathologic changes include nonspecific inflammation with hypersecretion of mucus, desquamation of cells, hyperplasia, and obstruction.
    3. Metastasis occurs primarily by direct extension and via the circulatory or lymphatic system.
    4. Men over age 40 affected most often; 1 out of every 10 heavy smokers; affects right lung more often than left.
    5. Caused by inhaled carcinogens (primarily cigarette smoke but also asbestos, nickel, iron oxides, air silicone pollution; preexisting pulmonary disorders [TB, COPD])
  2. Medical management: depends on cell type, stage of disease, and condition of client; may include
    1. Radiation therapy
    2. Chemotherapy: usually includes cyclophosphamide, methotrexate, vincristine, doxorubicin, and procarbazine; concurrently in some combination
    3. Surgery: when entire tumor can be removed
  3. Assessment findings
    1. Persistent cough (may be productive or blood tinged), chest pain, dyspnea, unilateral wheezing, friction rub, possible unilateral paralysis of the diaphragm
    2. Fatigue, anorexia, nausea, vomiting, pallor
    3. Diagnostic tests
      1. Chest x-ray may show presence of tumor or evidence of metastasis to surrounding structures
      2. Sputum for cytology reveals malignant cells
      3. Bronchoscopy: biopsy reveals malignancy
      4. Thoracentesis: pleural fluid contains malignant cells
      5. Biopsy of scalene lymph nodes may reveal metastasis
  4. Nursing interventions
    1. Provide support and guidance to client as needed.
    2. Provide relief/control of pain.
    3. Administer medications as ordered and monitor effects/side effects.
    4. Control nausea: administer medications as ordered, provide good oral hygiene, provide small and more frequent feedings.
    5. Provide nursing care for a client with a thoracotomy.
    6. Provide client teaching and discharge planning concerning
      1. Disease process, diagnostic and therapeutic interventions
      2. Side effects of radiation and chemotherapy
      3. Realistic information about prognosis