2. Introduction to Lung Cancer
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Lung cancer is the uncontrolled growth of
abnormal cells in one or both lungs.
As they grow, the abnormal cells can form
tumors and interfere with the functioning
of the lung, which provides oxygen to the
body via the blood.
They arise from epithelial cells
3. Epidemiology
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Worldwide, lung cancer is the most common
cancer in terms of both incidence and
mortality.
The highest rates are in Europe and North
America
Higher chances of lung cancer in people aged
over 50 and who have a history of smoking.
There was higher mortality in men, but now
women’s mortality rate is increasing.
4. Risk factors/ Causes
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the most common cause is
long-term exposure to tobacco
smoke
attributed to a combination of genetic
factors (gene mutations), and exposure to;
radon gas, asbestos, and air pollution
including second-hand smoking.
Family
history
5. Classification of Lung Cancer
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There are two major subdivisions of
lung cancer
NSCLC- Non Small Cell Lung
Carcinoma (85%)
Squamous Cell Carcinoma-
25-30%
Adenocarcinoma- 40%
Large Cell Carcinoma- 10-15%
SCLC- Small Cell Lung Carcinoma-
15%
6. Squamous Cell Carcinoma
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More in Males and
smokers
central (hilar) location
They typically occur
close to large airways.
forms in the lining of the
bronchial tubes.
accounts for about 30%
P53 mutation is common
in SCC
7. Adenocarcinoma
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Nearly 40% of lung cancers are adenocarcinoma,
which usually originates in peripheral lung tissue
Affects women, non smokers and
smokers also (most common)
Occurs at a younger age (<40yrs)
See Kras mutation (mainly in smokers)
EGFR-3 mutations in non smokers and
women
Slow growing and discovered on the outer area of
lung
Types: acinar, solid, papillary, broncho-alveolar,
mucin forming, mixed
Mucinous
Adenocarcinoma
8. Large Cell Carcinoma
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Called so because the cancer cells are
large, with excess cytoplasm and large
nuclei
Poor prognosis and early metastasis
Large cell Carcinoma
9. SCLC- Small Cell Lung Carcinoma
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See mainly in males
Related to smoking
Grows more rapidly
More responsive to chemo
Cells resemble lymphocytes
Inconspicuous nucleoli
Vascular invasion
Infiltrate and metastasize widely
Neuro endocrine orgins (paraneolastic syndromes)-
cells contain dense neurosecretory granules
See p53 and RB1 mutations
SCLC
10. Signs and Symptoms
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may not appear until the disease is advanced.
respiratory symptoms: coughing, coughing up
blood, wheezing, shortness of breath, change in
color or sputum, recurrent lung problems
systemic symptoms: weight loss, fever, clubbing
of the fingernails, fatigue, neurological
symptoms
symptoms due to local compression: chest pain,
bone pain, superior vena cava obstruction,
difficulty swallowing
Common sites of spread include the brain, bone,
adrenal glands, opposite lung, liver, pericardium,
and kidneys.
11. Diagnosis
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Performing an x-ray is one of the first steps
that may suggest lung cancer. This may
reveal mass, atelectasis (collapse),
consolidation (pneumonia), or pleural
effusion.
Sputum cytology- reveal the presence of lung
cancer cells.
CT imaging is typically used to provide more
information about the type and extent of
disease.
Bronchoscopy or CT-guided biopsy is often
used to sample the tumor for histopathology.
12. Staging of Lung Cancer
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Stage I: The cancer is located only in the lungs and has
not spread to any lymph nodes.
Stage II: The cancer is in the lung and nearby lymph
nodes.
Stage III: Cancer is found in the lung and in the lymph
nodes in the middle of the chest, also described as
locally advanced disease. Stage III has two subtypes:
If the cancer has spread only to lymph nodes on the same
side of the chest where the cancer started, it is called
stage IIIA.
If the cancer has spread to the lymph nodes on the
opposite side of the chest, or above the collar bone, it is
called stage IIIB.
Stage IV: This is the most advanced stage of lung
cancer, and is also described as advanced disease.
Cancer has spread to both lungs, to fluid in the area
around the lungs, or to another part of the body.
13. Management of NSCLC
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Treatment depends on the cancer's specific cell type, how far
it has spread, and the person's performance status.
Surgery
Most stage I and stage II. Surgeon removes the lobe, or
section, of the lung containing the tumor.
Some surgeons use video-assisted thoracoscopic surgery
(VATS)
https://www.youtube.com/watch?v=KoBw_-xj68E
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Chemotherapy and Radiation
Evidence suggests that chemotherapy after surgery
may help prevent the cancer from returning.
For people with stage III and IV lung cancer that
cannot be removed surgically, chemotherapy in
combination with definitive (high-dose) radiation
treatments. In stage IV patients, radiation is used
only for palliation of symptoms.
consists of a combination of drugs such as cisplatin
(Platinol) or carboplatin (Paraplatin) plus docetaxel
(Taxotere), gemcitabine (Gemzar), paclitaxel (Taxol
and others), vinorelbine (Navelbine and others), or
pemetrexed (Alimta).
the lung cancer may come back. Doctors will
prescribe a second course of drug treatment
referred to as second-line chemotherapy.
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Targeted Treatments
Targeted therapies are designed specifically to attack
cancer cells by attaching to or blocking targets that appear
on the surfaces of those cells.
People who have advanced lung cancer with certain
molecular biomarkers may receive treatment with a
targeted drug alone or in combination with chemotherapy.
These treatments for lung cancer include:
Erlotinib (Tarceva) –blocks the epidermal growth factor
receptor (EGFR). EGFR allowing substances in that encourage
a cancer cell to grow and spread.
Bevacizumab (Avastin)- blocks vascular endothelial growth
factor-VEGF so new blood vessels can’t grow
16. Management: SCLC
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Chemotherapy and Radiation Therapy
chemotherapy is an essential part of treatment.
Radiation treatment may be used as well
depending on the stage of cancer.
Preventive Radiation Therapy to the Brain
helps prevent the cancer from spreading to the
brain. This procedure is known as prophylactic
cranial irradiation (PCI).
Surgery- rarely used because it is fast
growing
17. Complications
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Shortness of breath
Coughing up blood.
Fluid in the chest (pleural effusion)- Lung
cancer can cause fluid to accumulate in the
space that surrounds the affected lung in
the chest cavity (pleural space).
Cancer that spreads to other parts of the
body (metastasis) can cause pain, nausea,
headaches, or other signs and symptoms
depending on what organ is affected.
18. Prognosis
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1-yr relative survival rate 41%
According to the American Cancer Society,
patients diagnosed with stage I or stage II
NSCLC have a 30-49 percent five-year
survival rate
SCLC is far more aggressive. If not treated,
the median survival rate is two to four
months, according to The National Cancer
Institute.
19. Case Study
• A 20-year-old man with
no history of tobacco use
presented with a several-
months’ history of cough
and lower back pain, and
an 11.3-kg weight loss.
Because of the
persistent cough and
development of
hemoptysis, further
imaging studies were
obtained. A chest
radiograph revealed total
opacification of the right
lung
Posteroanterior view of the chest
demonstrates complete opacification of
the right hemithorax.
20. Case Study, cont.
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Computed tomography imaging of the thorax
revealed a 7×7×8- cm mass in the superior right
hilum.
Further imaging revealed retroperitoneal
lymphadenopathy, renal and pancreatic masses,
skeletal metastases.
These findings confirmed a primary lung
adenocarcinoma.
https://www.youtube.com/watch?v=hy3lxAtyD_M
