lung cancer

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Lung Cancer
P r e p a r e d b y : K r a t o s

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Topics :
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• Epidemiology
• Etiology
• Classification of lung cancers
• Clinical features
• Lung cancer screening

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Epidemiology
• Incidence
• Second most common cancer
• Leading cause of cancer death worldwide
• Age: peak incidence at 65–75 years
• Sex : ♂ > ♀
• Except for adenocarcinoma, which is more common
in women
• Mortality rates for men and women are converging
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Etiology
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• Tobacco smoking :
• Associated with the development of approx.
90% of lung cancers
• Weaker association with lung adenocarcinoma
• Occupational and environmental exposure to carcinogens :
• Passive smoking
• Radon (2nd leading cause of lung cancer) and uranium
(radioactively decays into radon)
• Asbestos
• Occupational carcinogens (e.g., arsenic, chromium, nickel, beryll
lium, silica)
• Environmental air pollution

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• Family history : genetic predisposition
• Other risk factors: pulmonary scarring, previous
radiation, pulmonary fibrosis, chronic infections
(e.g., tuberculosis, HIV)
• Smokers exposed to asbestos have a significantly higher risk
of developing lung cancer compared to smokers that are not.

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Classification of lung cancers
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• Non-small cell lung cancer :
• Adenocarcinoma
• Squamous cell carcinoma (SCC)
• Large cell carcinoma
• Small cell lung cancer (SCLC)

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Small cell lung cancer (SCLC)
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• Centrally located
• Strong association with smoking (extremely rare in
nonsmokers)
• Associated with several paraneoplastic syndromes
• Undifferentiated and very aggressive with early metastases
• Associated mutations: L-myc oncogene

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Histological findings:
• Neuroendocrine Kulchitsky cells
• Rapid growth pattern
• Expressed tumor markers
• Chromogranin A
• Synaptophysin
• Neuron-specific enolase

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Adenocarcinoma
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• Peripheral location
• Most common type of primary lung cancer
• More common in women and nonsmokers
• Associated with mutations in:
• EGFR gene
• ALK gene
• KRAS gene
• Common finding: hypertrophic osteoarthropathy (digital clubbing)
• Most common type of lung cancer that originates in pulmonary
scars
• Prognosis is usually better than in other types of lung cancer

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Histological findings:
• Glandular tumor
• Mucin-producing cells (positive mucin staining)
• Lepidic adenocarcinoma: growth along alveolar walls (alveolar
thickening)

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Squamous cell carcinoma (SCC)
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• Centrally located
• Strong association with smoking
• Cavitary lesions arising from a hilar bronchus
• PTHrP: hypercalcemia
Histological findings:
• Solid, epithelial tumor
• Intercellular bridges (desmosomes)
• Keratin pearls

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Large cell carcinoma
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• Peripherally located
• Strong association with smoking
• Poor response to chemotherapy
• Early metastases
• Poor prognosis
Histological findings:
• Undifferentiated
• Large tumor cells

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Clinical features
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• Symptoms of lung cancer may be related to the local effects of
the tumor in the lung or spread of disease beyond the
chest. Lung cancer often only becomes symptomatic in late stages,
generally affecting prognosis negatively.
Pulmonary symptoms:
• Cough, hemoptysis
• Progressive dyspnea
• Wheezing
• Chest pain

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• Extrapulmonary symptoms :
• Constitutional symptoms (weight loss, fever, weakness)
• Signs and symptoms of tumor infiltration and/or compression of neighboring

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Lung cancer screening
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• Annual screening with low-dose CT imaging is associated with a
decrease in lung cancer-specific mortality.
• The U.S. Preventive Services Task Force (USPSTF) recommendation
• Indicated in patients aged 50–80 years with a history of
smoking (≥ 20 pack-years) within the past 15 years
• Screening should be discontinued if the patient quit smoking
more than 15 years ago or has a health problem that lowers
the life expectancy or limits their ability or willingness to have
curative lung surgery.

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Thank You