2. Epidemiology
Most common form of malignant
diseases
40,000 new patients per year
8% male deaths and 4% of all
female deaths
Men > women, middle age
3. Etiological factors
Tobacco smoking
Cigarette smokers are 8-20
times more likely to develop
lung cancer than life long non
smokers.
Squamous and small cell
carcinoma have clear
association with smoking.
Adenocarcinoma is commonest
histological type in a non
smoker
5. Occupational factors
Asbestos – mining, processing,
usage.
Radioactivity – metal ore mining,
uranium mining.
Nickel – refining.
Chromium salt – extraction,
production, usage.
Arsenic – metal refining, chemical
industry, insecticides.
6. Pulmonary scarring
Localised areas of pulmonary scarring
Diffuse pulmonary fibrosis
Cryptogenic fibrosing alveolitis is
associated with adenocarcinoma
Tuberculosis – scar carcinoma,
adenocarcinoma
Bronchioloalveolar carcinoma also occur
in areas of scarring
8. Histological classification
1. Squamous cell carcinoma
(epidermoid carcinoma)
2. Small cell carcinoma
a. oat cell carcinoma
b. intermediate cell type
c. combined oat cell
carcinoma
9. 3. Adenocarcinoma
a. acinar
b. papillary adenocarcinoma
c. bronchioloalveolar
d. solid carcinoma with mucous
4. Large cell carcinoma
5. Adenosquamous carcinoma
10. 6. Carcinoid tumours
7. Bronchial gland carcinoma
a. adenoid cystic carcinoma
b. mucoepidermoid carcinoma
c. others
11. Growth factors
Polypeptides that take part in the
control of cell differentiation and
proliferation
Bombesin/gastrin releasing peptide
– growth factor for small cell
carcinoma
Non small cell carcinoma – few
growth factors are recognized, EGF,
TGF
12. Genetic abnormalities
Loss of short arm of
chromosome in small cell
carcinoma (p14, p23)
CDKN2 gene on chromosome 9
– Non small cell lung carcinoma
14. Tumour markers
Substances produced by
tumour cells that are released
in to blood stream.
Neuron specific enolase,
creatinine phophokinase BB,
CEA
15. Modes of presentation
Worsening of preexisting respiratory
state.
No symptoms, detected by the chance
of finding an opacity.
Nonspecific symptoms of malignancy
like malaise, anorexia, and weight loss
Metastatic disease
16. Central tumours
Cough – most common symptom
New cough that persists longer than 2
weeks in a patient of 40 years who is a
smoker.
Hemoptysis – usually streaky
Breathlessness – due to central airway
narrowing, partial or total collapse of a
distal segment
Chest pain – deep chest discomfort,
due to peribronchial and perivascular
nerve involvement.
31. Treatment
Non small cell lung carcinoma
Surgery – best result, but only a small
minority
Types of surgery
Pneumonectomy
Lobectomy
VATS – segmentectomy
5 year survival rate overall 35%
32. Radiotherapy
Stage I&II – inoperable due to
medical contraindications
Indications
Hemoptysis, pain, cough, dyspnoea
due to large bronchus obstruction,
mediastinal compression, symptoms
due to intracranial metastasis,
symptoms due to spinal cord
compression.
34. Small cell carcinoma
At presentation 70% have extensive
disease
Chemotherapy
More sensitive to chemotherapy
Combined therapy preferred than
monotherapy
37. Gynaecomastia – large cell and
adeno carcinoma
Eaton-Lambert syndrome,
polymyositis/dermatomyositis
Peripheral neuropathy
Cerebellar ataxia
38. Superior venacava obstruction
Small cell carcinoma
Diagnosis – swelling of face and upper
torso and distension of veins across the
chest, upper arms and neck.
Treatment – chemotherapy,
radiotherapy and stenting
39. Superior sulcus tumour
Pancoast
Pain in lower part of shoulder and
inner aspect of the arm (C8, T1
and T2)
Sympathetic ganglion
involvement – stellate
Diagnosis
Treatment - radiotherapy and
surgery
41. Mediastinum lies centrally
within the chest and spans the
region vertically from the
thoracic inlet to the
diaphragmatic hiatus,
transversally between the
parietal pleura, and coronally
between the sternum and
vertebral column.
47. Hemoptysis Bronchogenic
carcinoma, airway
invasion, pulmonary
stenosis, heart failure
Dysphagia Oesophageal
narrowing/obstructio
n, oesophageal
motor dysfunction
Hoarseness Vocal cord paralysis
Facial swelling Superior vena cava
syndrome
48. Incidence
Adults
65% in Anterosuperior, 10% in the
middle and 25% in the posterior
compartments
Children
28% Anterosuperior, 10% in middle,
62% in the posterior compartment
55. Thymoma is the most common
primary neoplasm of the mediastinum
15% of Thymic lesions
Equal frequency in male and female
40-60 years
75% in anterior mediastinum
More than 90% are visible on chest
radiograph
57. Tumours of lymph nodes
Lymphomas
10-14% of mediastinal tumours
Rare in posterior mediastinum
Hodgkin’s and Non Hodgkin’s
20-30% asymptomatic
60-70% symptoms of local
invasion
30-35% systemic symptoms
58. Non-Hodgkin’s lymphoma
5% with mediastinal involvement
Large irregular anterior and
superior mediastinal involvement
Radiation therapy effective in low
grade lymphoma
chemotherapy
60. Benign germ cell tumours
(Teratoma)
Constitute 70% of the lesions in
children and 60% in adults.
Contain multiple tissues that
are foreign to the part of the
body in which they develop.
Symptomatic only when
infected
64. • Neurogenic tumours
• Most common malignancy in
children
• In children 50% malignant,
adults 10%
• Dumbbell tumours – intraspinal
extension
• CT, MRI, myelography
Posterior mediastinal tumours
65. Tumours of nerve sheath origin
Benign – neurilemoma or
neurofibroma
Malignant tumours-incidence
of malignancy more in von
Recklinghausen’s disease
Poor prognosis
66. Tumours of autonomic nervous
system
Neuroblatoma,
ganglioneuroblastoma rare in
adults