2. Lung Cancer: Defined
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• Uncontrolled growth of malignant cells in
one or both lungs and tracheo-bronchial
tree
• A result of repeated carcinogenic irritation
causing increased rates of cell replication
• Proliferation of abnormal cells leads to
hyperplasia, dysplasia or carcinoma in situ
4. 2009 Estimated US Cancer Deaths*
Men
292,540
Women
269,800
ONS=Other nervous system.
Source: American Cancer Society, 2009.
26% Lung & bronchus
15% Breast
9% Colon & rectum
6% Pancreas
5% Ovary
4% Non-Hodgkin
lymphoma
3% Leukemia
3% Uterine corpus
2% Liver & intrahepatic
bile duct
2% Brain/ONS
25% All other sites
30%
9%
9%
6%
4%
4%
4%
3%
3%
Lung & bronchus
Prostate
Colon & rectum
Pancreas
Leukemia
Liver & intrahepatic
bile duct
Esophagus
Urinary bladder
Non-Hodgkin
lymphoma
Kidney & renal pelvis 3%
All other sites 25%
5. US Mortality, 2006
• 1. Heart Diseases
•
• 2. Cancer 559,888 23.1
137,119 5.7
124,583 5.1
Rank Cause of Death
No. of
deaths
631,636
% of all
deaths
26.0
Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention,
2009.
5. Accidents (unintentional injuries) 121,599 5.0
6. Diabetes mellitus 72,449 3.0
7. Alzheimer disease 72,432 3.0
8. Influenza & pneumonia 56,326 2.3
• 3. Cerebrovascular diseases
•
• 4. Chronic lower respiratory diseases
•
•
•
•
•
•
•
•
•
9. Nephritis* 45,344 1.9
• 10. Septicemia 34,234
*Includes nephrotic syndrome and nephrosis.
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1.4
5
6. Women & Lung Cancer
• Women are more prone to tobacco effects -
1.5 times more likely to develop lung cancer
than men with same smoking habits
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7. Where Does it Come From?
• Radiation Exposure
• Smoking
• Environmental/ Occupational
Exposure
OAsbestos
ORadon
OPassive smoke
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8. Smoking Facts
• Tobacco use is the
leading cause of lung
cancer
• 87% of lung cancers are
related to smoking
• Risk related to:
O age of smoking onset
O amount smoked (pack yrs)
O gender
O product smoked
O depth of inhalation
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10. It is preventable!
Lung cancer is the most
preventable form of cancer
death in our society.
By quitting tobacco use you
significantly reduce your risk
of all cancers.
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16. Pancoast's syndrome
• Superior pulmonary sulcus
• a constellation of symptoms referred to as
pancoast's syndrome:
Oshoulder and arm pain (in the distribution of
the C8, T1, and T2 dermatomes)
OHorner's syndrome
Oweakness and atrophy of the muscles of the
hand.
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17. Two Lung Cancer Cells, Classified
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Small Cell Lung
Cancer (SCLC)
• Oat Cell
Non Small Cell Lung
Cancer (NSCLC)
• Adenocarcinoma
• Squamous Cell Carcinoma
• Large Cell Carcinoma
• Intermediate
• Combined
18. Treatment and Staging
NSCLC
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Stage Description Treatment Options
Stage I a/b Tumor of any size is found only in the
lung
Surgery
Stage II a/b Tumor has spread to lymph nodes
associated with the lung
Surgery
Stage III a Tumor has spread to the lymph nodes
in the tracheal area, including chest
wall and diaphragm
Chemotherapy followed
by radiation or surgery
Stage III b Tumor has spread to the lymph nodes
on the opposite lung or in the neck
Combination of
chemotherapy and
radiation
Stage IV Tumor has spread beyond the chest Chemotherapy and/or
palliative (maintenance)
care
19. SCLC
• Limited Stage
Defined as tumor involvement of one lung, the
mediastinum and ipsilateral and/or contralateral
supraclavicular lymph nodes or disease that can
be encompassed in a single radiotherapy port.
• Extensive Stage
Defined as tumor that has spread beyond one
lung, mediastinum, and supraclavicular lymph
nodes. Common distant sites of metastases are
the adrenals, bone, liver, bone marrow, and
brain.
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20. Treatment Options
• Thoracotomy with resection is the only curative
treatment available
• Surgical options available if NOT a small cell ca
• Chemotherapy (platinum based, topoisomerase
and mitotic inhibitors), radiation and adjuvant
debulking surgery (usually only palliative unless
used in conjunction with curative resection)
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21. Contraindications for Surgery
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• MI within past 3 months, within 6 months only
relative
• Major arrhythmias
• Severe pulmonary HTN
• Pre-op hypoxia
• Pre-op FEV1/FVC < 80%
• Pre-op FEV1 < 1L
• Predictive post-op FEV1 /FVC < 40% OR
FEV1 <1L
22. Complications of Lung Ca
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• Obstruction – emphysema vs. atelectasis
• Abscess formation
• SVC syndrome
• Pericarditis
• Pleuritis
• Neuroendocrine abnormalities
• Paraneoplastic syndrome
• Hypercoagulable states
23. Paraneoplastic phenomena
• Remote effects that are not related to the direct invasion,
obstruction, or metastasis.
O Hypercalcemia- tumor secretion of a parathyroid hormone-
related protein (PTHrP)
O SIADH secretion- is frequently caused by SCLC and results in
hyponatremia. (10% of SCLC & 75 % all malignancy related
SIADHS)
O Dermatomyositis and polymyositis
O Hypertrophic osteoarthropathy -clubbing and periosteal
proliferation of the tubular bones
O Hematologic manifestations O
Hypercoagulable disorders O
Cushing's syndrome
O Neurologic- Lambert-Eaton myasthenic syndrome (LEMS),
cerebellar ataxia, sensory neuropathy, limbic encephalitis,
encephalomyelitis, autonomic neuropathy, retinopathy,
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25. Conclusion
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• Smoking cessation is essential for
prevention of lung cancer.
• New screening tools under way.
• Clinical trials under way.
• New treatments under way.
• Treatment can palliate symptoms and
improve quality of life.
