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Lung Cancer

4 min read

Lung Cancer

Key Points

  • Lung cancer includes non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), with NSCLC as the most common type.
  • Smoking is the highest-risk exposure, but secondhand smoke, radon, occupational toxins, and family history also increase risk.
  • Common early manifestations include persistent or worsening cough, dyspnea, pleuritic chest pain, hemoptysis, hoarseness, fatigue, and weight loss.
  • Diagnosis and staging use multimodal testing including imaging and tissue biopsy.
  • Nursing care prioritizes respiratory support, symptom control, psychosocial support, and ongoing evaluation of measurable outcomes.

Pathophysiology

Lung cancer develops from uncontrolled cellular growth in lung tissue and may also involve metastatic disease from another primary site. NSCLC includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. SCLC is typically more aggressive and is often associated with earlier metastatic spread.

Staging determines tumor size and location, nodal involvement, and distant spread. Stage is a major driver of prognosis and treatment selection.

Classification

  • NSCLC: About 85% of lung-cancer cases; includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.
  • SCLC: Less common but generally faster-growing and more likely to metastasize early.
  • Risk profile domains: Tobacco smoke exposure, secondhand smoke, family history, HIV infection, radon, radiation, air pollution, and workplace carcinogens such as asbestos, arsenic, and chromium.
  • Screening-eligibility pattern: Annual low-dose CT is used for high-risk adults (typically age 50-80 with 20 pack-year or greater history who currently smoke or quit within 15 years), with shared decisions about potential harms.

Nursing Assessment

NCLEX Focus

Prioritize cue recognition for worsening oxygenation, metastatic progression, and treatment-related complications.

  • Assess persistent or worsening cough, dyspnea, pleuritic chest pain, hemoptysis, hoarseness, malaise, fatigue, appetite loss, and unexplained weight loss.
  • Screen by body-system findings: superior vena cava syndrome; neurologic changes such as severe headache or seizures; bone pain or pathologic fracture; jaundice; and hydronephrosis-related findings.
  • Trend respiratory effort and oxygenation status, not single-point values alone.
  • Assess accurate smoking history in pack-years and quit timeline to determine screening eligibility.
  • Review diagnostic and staging progression to identify delays in care.

Diagnostic Testing and Staging

  • Chest x-ray: Common initial imaging for suspected masses or other pulmonary abnormalities.
  • CT scan: Defines tumor size, location, and extent.
  • PET scan: Evaluates likely metastatic spread using tracer uptake in high-metabolic tissue.
  • MRI: Adds detail when nearby structure involvement is suspected.
  • Sputum cytology: Screens sputum for malignant cells.
  • Bronchoscopy and EBUS: Enables airway and mediastinal tissue sampling.
  • Biopsy: Definitive diagnosis via needle, bronchoscopic, or surgical approach.

Nursing Diagnoses and Outcomes

Common diagnosis patterns include impaired gas exchange, decreased activity tolerance, disturbed body image, fear, imbalanced nutrition less than body requirements, powerlessness, and risk for spiritual distress.

Sample measurable outcomes:

  • Oxygen saturation remains within ordered target range.
  • Pain is maintained at or below the patient-defined acceptable level.
  • Respiratory rate remains below 20 breaths per minute with effective pattern.
  • Patient verbalizes at least three coping strategies before discharge.

Interventions

Medical Interventions

  • Surgery: Lobectomy, pneumonectomy, segmentectomy or wedge resection, VATS, and chest-wall resection when indicated.
  • Radiation therapy: External beam, brachytherapy, and stereotactic radiosurgery in selected cases.
  • Chemotherapy: Systemic and adjuvant pathways based on disease burden and treatment goals.
  • Immunotherapy: Checkpoint inhibitor strategies such as PD-1 or PD-L1 pathways.
  • Palliative and hospice care: Symptom-focused care at any stage; hospice for terminal disease with limited life expectancy.

Nursing Interventions

  • Provide medication management and monitor side effects from symptom-control and antineoplastic therapies.
  • Manage pain using pharmacologic and nonpharmacologic methods tailored to patient preference.
  • Implement dyspnea strategies: positioning, breathing and coughing techniques, and oxygen support as ordered.
  • Teach energy-conservation techniques for fatigue management.
  • Deliver psychosocial support with active listening, anxiety and depression screening, and counseling referral when needed.
  • Initiate advance-care planning and end-of-life preference discussions when clinically appropriate.

Evaluation

Evaluate outcomes continuously after interventions, diagnostic updates, and interprofessional plan changes. Mark outcomes as met, partially met, or unmet; revise the care plan when progression or symptom burden indicates a new priority.

Self-Check

  1. Which findings should trigger urgent escalation in a patient with suspected or known lung cancer?
  2. How do NSCLC and SCLC differences influence staging urgency and treatment planning?
  3. Which nursing interventions best improve dyspnea and quality of life in advanced disease?

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