1. Adenocarcinoma
of the lung
Niccole Couse
University of South Florida
College of Nursing

2. Introduction
(Eldridge, 2010a)
• Adenocarcinoma refers to a cancer that
originates in glandular tissue of the
epithelium.
• It is a non-small cell cancer
– These are the most common types of lung cancer
• It is the most common cancer effecting non-
smokers and women.
– 2nd most common overall

3. Pathopysiology
(Eldridge, 2010a)
• Adenocarcinoma progresses in 4 stages
1. Cancer is confined in the lung with no spread
2. Cancer has spread within the lung and may be
affecting lymphnodes.
3. Cancer has spread to nearby tissues or the other
lung.
4. Cancer has spread to another part of the body.

4. Diagnosis
(Eldridge, 2010a)
• Determined by biopsy
• Detected on
– X-ray
– Chest CT scan
– Bronchoscopy
– PET scan
– Sputum cytology

5. Risk Factors
• Smoking (tobacco and marijuana) (Fayed, 2006)
– 15% of smokers develop lung cancer
– 80% of lung cancer cases are smokers
• Female
– Females are about 3X more likely (Gaspirino,2010)
• Radon Exposure (Fayed, 2006)
• Family History (Fayed, 2006)
• Inflammatory lung diseases (Fayed, 2006)
– Tuberculosis and pneumonia

6. Signs and Symptoms
(Spiro, S. G., Gould, M. K., & Colice, G. L., 2010)
• Early
– Fatigue
– Shortness of Breath
– Back/chest ache
• Late
– Chronic cough****
– Fatigue
– Dyspnea
– Back/chest pain
– Hemoptosis
– Weight loss

7. Assessment
(Spiro et al., 2010)
• History:
– Persistant cough, hemoptosis, dyspnea, chest pain, anorexia,
weight loss
• Oxygenation:
– Nail angle – clubbing
– Wheezing
• Assess for metastasis:
– Lymph nodes: Supraclavicular node
• enlarged in 20% of metastasis
– Liver – common site
• LFT – often not effected until late, jaundice, weakness, weight loss
– Intracranial – 10%
• Headaches, nausea, vomiting, seizures, confusion, personality changes

8. Treatments
• Surgery – lobectomy, pneumonectomy
• Chemotherapy ( Einhorn, 2008)
– Carboplatin & Paclitaxel
• inhibits DNA synthesis causing death of rapidly dividing
sells (Deglin, Vallerand, & Sanoski , 2012)
– Bevacizumab
• Inhibits new blood vessel growth causing decreased
metastasis (Deglin, Vallerand, & Sanoski , 2012)
• Radiation (Eldridge, 2012b)

9. Treatments – nursing considerations
(Van Leeuwen, Poelhuis-Leth, & Bladh, 2012)
• Surgery –
– HOB at 30-45degrees
– Increase fluid intake
– Monitor Airway
– Suction airway as needed
– Cough and deep breathing
– Monitor oxygen saturation
– Pain management
– Chest tube monitoring
– Early ambulation

10. Treatments – nursing considerations
(Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, & Loscalzo, 2012)
• Chemotherapy
– Hair loss
– Healthy tissue necrosis
– Immunodepression
– Anemia

11. Treatments – nursing considerations
(Edlridge, 2012b)
• Radiation
– Skin irritation
– Hair loss
– Dry cough/shortness of breath
• Lowered surfactant – steroids may be given
– Fatigue
– Esophagitis
• Dysphagia, heartburn
– Radiation pneumonitis
• Inflammation – 5-15% - treated with steroids

12. Treatments – nursing considerations
(Eldridge, 2012b)
• Radiation
– Pulmonary fibrosis
• Scar tissue formation
– Cardiac toxicity
– Secondary cancers
• Appear 5-10 years after treatment
– Leukemia, breast, and lung cancers most common

13. Prognosis
(Bianchi, Nuciforo, Vecchi, Bernard, Tizzoni, Marchette, Buttitta, Felicioni, Nicassio, & Di Fiore, 2007)
• Overall: 15% survive 5 years
– Often due to late diagnosis
– Inoperable
• Stage 1 detection: 30-60% survive 5 years

14. Nursing Diagnosis
(Ackley & Ladwig, 2011)
• Ineffective gas exchange
• Activity Intolerance
• Fear
• Disturbed body image

15. Clinical Example
80 year old Female. Lifetime never smoker.
HPI: In 2007 she had a chest X-ray and her Dr. noticed a
“nodule” in her right lower lobe. He decided to monitor it
for any changes before attempting any surgical
procedures. At a recent check-up, her Dr. noticed changes
in the nodule and decided to biopsy the node and some
surrounding lymph nodes. When a few biopsy results
came back positive for cancer, her Dr. referred her to a
specialist who operates out of Sarasota Memorial
Hospital for the removal of her right lower lobe of the
lung.

16. Clinical Example
• Positive Diagnosis: via biopsy after abnormal
Xray
• Positive Risk Factors: Non smoker, female,
family history, inflammatory lung disease
(asthma and tuberculosis)
• Positive Symptoms: none
• Treatment: lobectomy possible chemotherapy
• Prognosis: Good

17. NCLEX style question
• A female client is newly diagnosed with
adenocarcinoma of the lung. She asks “How
can I have lung cancer? I never smoked!”
What is an appropriate response to the
patients concerns?
a) You must have been exposed to cigarette smoke
at some point.
b) You don’t have to lie about smoking.
c) Adenocarcinoma is the most common lung
cancer in non-smoking persons.
d) It’s O.K. Everything will be fine!

18. NCLEX style question
• A female client is newly diagnosed with
adenocarcinoma of the lung. She asks “How
can I have lung cancer? I never smoked!”
What is an appropriate response to the
patients concerns?
a) You must have been exposed to cigarette smoke
at some point.
b) You don’t have to lie about smoking.
c) Adenocarcinoma is the most common lung
cancer in non-smoking persons.
d) It’s O.K. Everything will be fine!

19. NCLEX style question
• Which of the following indicate stage 4
metastasis
1. Jaundiced skin
2. Seizures
3. Palpable supraclavicular lymph nodes
4. Chronic cough
a) 1,2,3
b) 2,3
c) 1,4
d) 1,2

20. NCLEX style question
• Which of the following indicate stage 4
metastasis
1. Jaundiced skin
2. Seizures
3. Palpable supraclavicular lymph nodes
4. Chronic cough
a) 1,2,3
b) 2,3
c) 1,4
d) 1,2

21. References
Ackley, B. J., & Ladwig, G. B., (2011) Nursing Diagnosis Handbook: An Evidence-Based
Guide to Planning Care ( 9th edition). St. Louis, MO: Mosby Inc.
Bianchi, F., Nuciforo, P., Vecchi, M., Bernard, L., Tizzoni, L., Marchette, A., Buttitta, F.,
Felicioni, L., Nicassio, F., & Di Fiore, P. P., (2007) Survival Prediction of Stage 1
Lung Adenocarcinomas by expression of 10 genes. The Journal of Clinical
Investigation, 117(11).
Doi: 10.1172/JCI32007
Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2030461/
Deglin, J.D., Vallerand, A. H., & Sanoski, C. A., (2012) Davis Drug Guide.. Nursing Central.
Einhorn, L. H., (2008) First-Line Chemotherapy for Non–Small-Cell Lung Cancer: Is There a
Superior Regimen Based on Histology? Journal of Clinical Oncology, 26(21).
Doi: 10.1200/JCO.2008.17.2056
Retrieved from: http://jco.ascopubs.org/content/26/21/3485.full

22. References
Eldridge, L., (2012a) Lung Adenocarcinoma: symptoms, treatments, and prognosis.
About.com Guide. Retrieved from:
http://lungcancer.about.com/od/typesoflungcancer/a/Lung- Adenocarcnoma.htm
Eldridge, L., (2012b) Side Effects of Radiation Therapy for Lung Cancer. About.com
Guide. Retrieved from:
http://lungcancer.about.com/od/treatmentoflungcancer/a/radsideeffects.ht m
Fauci, A., Braunwald, E., Kasper, D., Hauser, S., Longo, D., Jameson, L., & Loscalzo, J.,
(2012) Harrison’s Manual of Medicine, Nursing Central
Fayed, L., (2006) Causes and Risk Factors for Lung Cancer. About.com Guide. Retrieved
from: http://cancer.about.com/od/lungcancer/p/lungcancercause.htm
Gasperino, J., (2010) Gender is a Risk Factor for Lung Cancer. Medical Hypothesis,
76(3). Retrieved from:
http://www.sciencedirect.com.ezproxy.lib.usf.edu/science/article/pii/S0306 987710004433

23. References
Spiro, S. G., Gould, M. K., & Colice, G. L., (2010) Initial Evaluation of the Patient With
Lung Cancer: Symptoms, Signs, Laboratory Tests, and Paraneoplastic
Syndromes. CHEST Journal, 132(3).
Doi: 10.1378/chest.07-1358
Retrieved from:
http://chestjournal.chestpubs.org/content/132/3_suppl/149S.full
Van Leeuwen, A. M., Poelhuis-Leth, D. J., & Bladh, M. L., (2012) Diseases and
Disorders. Nursing Central

24. Questions?