Screening and early detection of lung cancer

1. Screening And Early Detection
Of Lung Cancer
By
Mahmoud .E Abou Elmagd
Assistant Lecturer of pulmonary and
critical care medicine
Mansoura university

2. INTRODUCTION

3. Screening
• Screening means testing for a disease when
there are no symptoms or history of that disease
give a screening test to find disease early on,
when treatment may work better.
• Screening is tool for early detection.
• Methods of early detection should have the
highest yields among those at greatest risk for
lung cancer.

4. Importance of screening and early
detection
• Have major importance in survival of patients
with lung cancer.
• The stage at diagnosis is the primary
determinant of prognosis.
• Prognosis is better and treatment more
successful if disease is detected while still
localized.

5. Chest X-ray
PA and lateral view
The sensitivity is dependent on:
The size and location of the lesion
The quality factors related to image
Skill of the interpreting physician
Obscured lesion by the mediastinum, heart
or diaphragm

6. Low-Dose Helical CT
• Allows entire chest to be surveyed in a single
breathhold
– Time: approximately 7 - 15 seconds
– Reduces motion artifact
– Eliminates respiratory misregistration
• Narrower slice thickness
• Hourly throughput - 4 patients per hour
• Radiation dose one tenth of diagnostic CT

7. Low-Dose Helical CT
• Chest CT is more sensitive than chest
radiography for the detection of early lung
cancers presenting as small, non-calcified,
solitary pulmonary nodules (SPNs).
• most of these lesions were detected in an
early and thus resectable stage (stages IA to
IB) .

8. What do we see on CT?
Definition of terms
• GGO (non-solid): Nodule with hazy
increased lung attenuation which does
not obscure underlying bronchovascular
markings.
• Mixed (part-solid): Nodules containing
both ground glass and solid components
• Solid (soft tissue): Nodules with
attenuation obscuring the
bronchovascular structures

9. Downstream Effects of CT Screening
• Radiation carcinogenesis
– screening & consequent diagnostic tests: CT, PET
• Additional minimally invasive procedures
– Percutaneous Lung FNA
– Bronchoscopy
– VATS
• Thoracotomy for benign disease
– Is there an acceptable percentage?
– Potential post-operative morbidity & mortality
– Treatment for disease without biopsy?
• Evaluation for other observations: cardiac, renal, liver,
adrenal disease

10. Sputum cytometry
• The diagnostic yield of sputum cytology is known
to vary in relation to tumour location.
• It has greatest use in the identification of central
tumours and is of little or no value in the
identification of peripheral cancers.
• there is now evidence to suggest that its
sensitivity can be much improved through the
use of molecular genetic and
immunocytochemical markers of malignancy.

11. Autofluorescence bronchoscopy
• This technique exploits the differences in the fluorescence
properties of bronchial mucosa compared to mucosa of
pre-invasive and invasive disease.
• The LIFE (Lung Imaging Fluorescence Endoscopy)system,is
the best known instrument.
• This uses a blue helium cadmium laser to illuminate the
bronchial mucosa, and the resulting fluorescence is then
digitised into a real-time video image.
• Other devices, such as the D-light auto-fluorescence
system.

12. biomarkers
• A large number of biomarkers have been
studied for the early detection of lung cancer,
including DNA, promoter hypermethylation,
microsatellite instability, loss of
heterozygosity, chromosomal aneusomy,
tumour-associated antibodies, tumour-
associated antigens, proteomic profiles,
messenger RNA (mRNA), micro-RNA (miRNA)
and volatile organic compounds (VOCs).

13. biomarkers
• These biomarkers have in turn been investigated in
different specimens obtained by more or less invasive
procedures: bronchial biopsies or bronchioloalveolar
lavagefluid, induced sputum, buccal/nasal swabs, blood (
plasma, serum, circulating tumour cells and peripheral
blood mononuclear cells) and exhaled breath .
• An ideal early detection biomarker for large-scale screening
should be applicable on easily accessible specimens
through non-invasive procedures, have an easy and
reproducible quantification, a high sensitivity and
specificity and a low cost.

14. Molecular markers
• Changes in genes, gene products and
chromosomal abnormalities can be used as
biomarkers of premalignant conditions.
• Genes of ras family
• Genes of Her-2/neu is over expressed in non-
small cell lung cancer.
• P53 and rb are good candidate genes for detection
by antisera or PCR
• Chromosomal abnormalities have been reported
in chromosome numbers 3,11,13,17.

15. Endobronchial ultrasonography
It allows a view beyond the airway wall so
adding endobronchial ultrasonography to whit
light or florescent bronchoscope can
significantly help in :
Staging of lung cancer
Early detection of mucosal changes
and early invasion to submucosa.

16. Summery
• A chest X-ray should be ordered when lung
cancer is a possibility, particularly when patients
present with the following important “early”
symptoms:
• Haemoptysis
• Unexplained or persistent (>3 weeks):
- cough
- chest / shoulder pain
- dyspnoea