Lung Cancer


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Description of Lung Cancer with visual aids

Lung Cancer

  1. 1. Lung Cancer Dr. Suneet Khurana
  2. 2. Lung Cancer
  3. 3. Etiology of Lung Cancer  Tobacco Smoking x 13.3 times (10 – 20) (78-90%)  2nd hand smoke (15%)  Asbestos x 5 – 90 times  Radon (2-3%)  Arsenic  Ionizing radiation  Beryllium, Nickel, Copper  Chromium, Cadmium  Diesel Exhaust  Polycyclic aromatic hydrocarbons
  4. 4. Epidemiology of Lung Cancer
  5. 5. Epidemiology
  6. 6. Epidemiology
  7. 7. Symptoms - Signs of Lung Cancer Symptom / Signs Cough 74% Dyspnea 37% Hemoptysis 57% Recurrent Pneumonia Chest Pain, Wheezing 25% Dysphagia Laryngeal Nerve Paralysis 18% Horners Syndrome Pancoast Syndrome Superior Vena Cava Syndrome Atelectasis Pleural Effusion
  8. 8. Pathological ClassificationNon Small Cell Lung Cancer Small Cell Lung Cancer(NSCLC) (SCLC)Squamous Cell Carcinoma 25 – 30% Oat Cell CarcinomaAdenocarcinoma 35-40% Intermediate Cell CarcinomaLarge Cell Carcinoma 10-15% Combined Cell Carcinoma
  9. 9. TNM Staging (AJC CS ERR)Primary Tumor - TT1 Tumor <3cm without invasion more proximal than lobar bronchusT2 Tumor >3cm OR of any size with any of the following - Invades Visceral Pelura - Atelectasis of less than entire lung - Proximal extent of at least 2cm from carinaT3 Tumor of any size with any of the following - Invasion of Chest Wall - Invasion of Diaphragm, Mediastinal Pleura, Pericardium - Atelectasis involving entire lung - Proximal extent within 2cm of carinaT4 Tumor of any size with any of the following - Invasion of mediastinum - Invasion of heart or great vessels - Invasion of vertebral body - Presence of malignant pleural or pericardial effusion - Satellite tumor nodes within same lobe as primary tumor
  10. 10. TNM StagingNodal Involvement - NN0 No regional node involvementN1 Involvement of ipsilateral hilar or ipsilateral peribronchial nodesN2 Involvement of ipsilateral mediastinal or subcarinal nodesN3 Involvement of contralateral mediastinal or hilar nodes OR Ipsilateral or contralteral scalene or supraclavicular nodesMetastasis - MM0 Distant Metastasis absentM1 Distant Metastasis present
  11. 11. Stage IStage IA T1 N0 M0Stage IB T2 N0 M0
  12. 12. Stage IIStage IIA T1 N1 M0Stage IIB T2 N1 M0, T3 N0 M0
  13. 13. Stage IIIa Stage IIIA T3 N1 M0, T1-3 N2 M0
  14. 14. Stage IIIb Stage IIIB Any T N3 M0, T4 Any N M0
  15. 15. Stage IV Stage IV Any T Any N M1
  16. 16. Investigations for Lung Cancer
  17. 17. InvestigationsDiagnostic Tests Staging TestsChest X-Ray CT Scan - Chest, Brain, AbdomenBronchoscopy PET ScanUltrasound Guided Biopsy Bone ScintigraphyCT guided Biopsy Mediastinoscopy Bone Marrow Biopsy
  18. 18. Chest X-Ray – Diagnostic
  19. 19. Fiberoptic Bronchoscopy - Diagnostic Bronchoscopy Video
  20. 20. Ultrasound Guided Biopsy - Diagnostic
  21. 21. CT Guided Biopsy - Diagnostic
  22. 22. CT Scan - STAGING
  23. 23. PET Scan for STAGING
  24. 24. Fused PET and CT Scan
  25. 25. Mediastinoscopy for STAGING
  26. 26. Bone Scintigraphy for STAGING
  27. 27. Bone Marrow Aspiration - STAGING
  28. 28. Current Treatments for NSCLC
  30. 30. Treatment by Stages of CancerStage Description Treatment OptionsStage Ia – Ib Tumor localized in lung Surgical resectionStage IIa – IIb Tumor spread to local lymph nodes Surgical resectionStage IIIa Tumor spread to regional lymph Chemotherapy followed nodes in trachea, chest above by radiation or surgery diaphragmStage IIIb Tumor spread to contra lateral Combination of lymph nodes Chemotherapy and RadiationStage IV Tumor metastasis to organs outside Chemotherapy and or chest palliative care
  31. 31. Surgery – Wedge, Lobectomy, Pneumonectomy
  32. 32. Radiation Therapy  Treatment of stage I and stage II NSCLC, radiation therapy alone is considered when surgical resection is not possible.  Role of radiation therapy as surgical adjuvant therapy after resection of the primary tumor is controversial.  Radiation therapy reduces local failures in completely resected (stages II and IIIA) NSCLC but has not been shown to improve overall survival rates.  Radiation therapy alone used as local therapy has been associated with 5-year survival rates of 12-16% in early-stage NSCLC (ie, T1 and T2 disease).  No randomized trials have directly compared radiation therapy alone with surgery in the management of early- stage NSCLC
  33. 33. Chemotherapy Only 30% of patients with NSCLC become eligible for surgical resection 50% of patients who undergo resection experience either a local or systemic relapse of cancer 80% of patients with NSCLC end up taking some sort of chemotherapy Combination chemotherapy has better survival rates than single agent chemotherapy, which has potentially no role in curative therapy of NSCLC. Adjuvant chemotherapy (after surgery) has failed to elicit any benefits, however neoadjuvant chemotherapy (given prior to surgery) has improved survival in patients with Stage IIIa disease.
  34. 34. Chemotherapeutic AgentsDrug Mechanism of Action ToxicityCisplatin / Carboplatin Causes intrastrand and interstrand cross- Tinnitus, Hearing Loss, linking of DNA, - strand breakage Toxic Neuropathy, MyelotoxicVinorelbine It inhibits tubulin polymerization during G2 Granulocytopenia, phase of cell division Constipation, FatigueGemcitabine Antimetabolite that acts as inhibitor of DNA Myelosuppression, Flu synthesis like symptoms, Hemolytic Uremic Syndrome, Lung toxicityPaclitaxel Inhibits tubulin depolymerization in spindle Myelosuppression, during cell division neuropathy, hypersensitivityPemetrexed disodium Disrupts folate-dependent metabolic Fatigue, processes essential for cell replication. myelosuppression, Infection, GI toxicityDocetaxel Inhibits cancer cell growth by promoting Myelosuppression, fluid assembly and blocking disassembly of retention, HSN rxns microtubulesEtoposide Causes single strand breaks in DNA, inhibits Myelosuppression, repair of DNA Transient Hypotension
  35. 35. Targeted Therapy
  36. 36. What are “targeted therapies”? Cytotoxic vs. Cytostatic Primarily target malignant cells Target molecules involved in: ◦ cell growth signal transduction ◦ angiogenesis ◦ metastasis Generally less toxic at therapeutic doses Many are oral agents
  37. 37. Targeted Therapies Targets the HER2 receptor that is over-expressed in 25% of breast cancers
  38. 38. Targeted TherapiesTargets the VEGF and inhibits angiogenesis in NSCLC and colorectal cancer
  39. 39. Epidermal Growth Factor Receptor EGFREGFR is over-expressed in:• many tumour typesincluding NSCLC
  40. 40. Tyrosine Kinase Inhibitor