LUNG CANCER

1. Faculty of Medicine
Department of Internal Medicine
Semester XI
Dr. , Ahmed By
Main Doctor of the Subject Ahmed foljawe”

2. LUNG CANCER

3. Bronchogenic Carcinoma
 Definition:
- Bronchogenic carcinoma is a malignant neoplasm of the lung
arising from the epithelium of the bronchus or bronchiole.
- Is the most common malignant disease.
- Lung cancer is the most common cause of cancer deaths
worldwide.
 Incidence:
- male > female
Age: >50 years of old
 Aetiology:
- Unknown.
- No definite etiology

4.  Risk factors:
1. Cigarette smoking [Most Important]
- ↑ risk 10-15 times
- Passive smokers: ↑ risk 2 times
2. Air Pollution
- Motor vehicles, - Coal Burning
3. Industrial Carcinogens:
Arsenic – glass workers
Asbestos – mining, insulation
Coal dust – road work, Oven workers
4. Genetic factors
5. Existing lung damage – COPD, Lung fibrosis
6. Diet

14. Pathology
 Broadly classified into 2 types:
- Small cell lung carcinoma ~10-15%
- Non small cell lung carcinoma ~85%
 Classification according to the cell types:
- Squamous cell carcinoma 30%
- Adenocarcinoma 35-40% NSCLCs
- Large cell carcinoma 15%
- Small cell carcinoma 10-15% SCLCs
 Classification according to the location:
A- Centrally located:
- Squamous cell carcinoma
- Small cell carcinoma
B- Peripherally located:
- Adenocarcinoma
- Large cell carcinoma

15. Classification Site Incidence %
Squamous cell carcinoma Central 30%
Small cell carcinoma Central 10%
Adenocarcinoma Peripheral 40%
Large cell carcinoma Peripheral 15%
Others: Carcinoid, Lymphoma Central or Peripheral 5%
→ Centrally located tumors that obstruct segmental, lobar or
main stem bronchi may cause lung collapse as compared
to peripherally located tumors that are diagnosed late.

18.  Spread:
1- Local spread:
- to pleura [Peripheral type]
- to Mediastinum [Central type]
2- Blood spread:
- Bone
- Brain
- Liver
- Kidney
3- Lymphatic spread:
-Hilar -Axillary -Mediastinal -Cervical lymph nodes

19. Clinical Features
 Clinical manifestations of bronchogenic carcinoma are as
a result of:
- Effects of tumor it self
- Features of local spread of tumor
- Features of metastasis
- Features of paraneoplastic syndromes
 Clinical manifestation
- Intrathoracic
- Extrathoracic

20. Intrathoracic
1- Symptoms due to tumor in the bronchus:
A. Bronchial Manifestations
- Cough with purulent sputum
- Hemoptysis
- Chest pain
- Breathlessness
- Asymptomatic 25%
2- Symptoms due to local spread:
A. Pleural Manifestions
- Pleurisy
- Pleural effusion
- chylous, -hemorrhagic, -exudate, -Empyema
B. Mediastinal manifestations
- Dyspnea
- Dysphagia
- Hoarseness

21. Extrathoracic
3- Metastasis:
A. Liver
- Jaundice
- Palpable tender liver
B. Bone
- Severe bone pain
- Pathological fracture
C. CNS
- Fits
- Personality changes
- Paralysis
- ↑ Intracranial pressure

22. 4- Paraneoplastic syndrome:
A. Endocrine abnormalities
- Hyperparathyroidism
- Cushing syndrome
- Acromegaly
- Gynecomastia
B. Cachexia
C. Neurological abnormalities
- peripheral neuropathy
D. Hematological & cutaneous abnormalities
E. Clubbing of the fingers.

24. Investigations
 CXR:
- mediastinal mass
- coin shadow
- Pleural effusion or elevated diaphragm
 CT & MRI:
- Particularly useful
 Cytology:
- Sputum & pleural fluid to detect malignant cells.
 Fibreoptic Bronchoscopy:
- to get biopsy of the tumor
 Lab
 Metastatic Assessment:
- Abdominal U/S
- Brain CT
- Bone survey & scan.

25. Characteristics of different types of
Bronchogenic carcinoma
Squamous cell carcinoma:
- Mostly arise centrally from proximal tracheobronchial tree.
- Clinical features develop early due to proximal location
causing obstruction of bronchus.
- Metastasize to regional lymph nodes. Distant metastasis
occurs relatively late.
- Sputum cytology is diagnostic in most cases [40-60%]
- Treatment:
- Surgery & Radiotherapy
- Chemotherapy is far less effective.

26. Adenocarcinoma:
- Mostly arise in the periphery in the mucus glands of small
bronchi.
- Remain undetected until they have spread locally or distally.
- Metastasize to distant organs e.g. brain & bones.
- This is the commonest bronchial carcinoma associated with
asbestos, & relatively more common in non-smokers.
- CXR shows solitary peripheral nodule
- Response to radiation & chemotherapy is poor.

27. Small cell carcinoma:
- This centrally located tumor originates from
neuroendocrine cells [kulchitsky cells]
- a.k.a Oat cell carcinoma
- Risk factors are smoking & uranium mining.
- Associated with many paraneoplastic syndromes.
- It is rapidly growing & highly malignant
- CXR shows hilar or perihilar mass.
- Sputum cytology should be done.
- It is the only one of the bronchial carcinomas that
respond well to chemotherapy.

28. Large cell carcinoma:
- This peripheral located tumor is large & grows rapidly.
- Histologic examination shows large cells.
- Chest radiograph shows large masses.
- The response to radiation & chemotherapy is poor.
- Treatment is surgical.

29. Bronchoalveolar cell carcinoma:
- This arises from alveolar type ll pneumocytes.
- The tumor presents in two forms:
a. localized solitary nodular lesion
b. diffuse alveolar process
- This is not related to tobacco smoking
- CXR shows solitary nodule or pneumonic lesions.
- Response to radiotherapy & chemotherapy is poor.
- Treatment is surgery.

30. T.N.M Staging
 Staging:
Tx Cannot be assessed
T0 No evidence
T1 <3cm & not involving in main bronchus.
T2 >3cm & involving in main bronchus.
T3 Chest wall invasion or within 2 cm in carina.
T4 Mediastinum, great vessels, trachea
Nx Cannot be assessed
N0 No evidence
N1 Ipsilateral hilar L.N.
N2 Ipsilateral mediastinal L.N
Mx Cannot be assessed
M0 No evidence
M1 Metastasis.

31. Treatment
1. Surgical:
- Operable
- Inoperable
2. Radiotherapy
3. Chemotherapy:
- Vincristine
- Cyclophosphamide
- doxorubicin or Methotrexate
4. Laser therapy
5. Combination
6. Palliative:
- Stop smoking
- health education
- symptomatic relief: pain, paramalignant syndrome.

32. Prognosis
- Very poor, <10% patients survive 5 years after diagnosis.

33. Bronchial Adenoma
Bronchial adenoma is a rare type of benign neoplasm that arises
in the mucus glands & ducts of the lung airways [bronchi] or
trachea & in the salivary glands.
 Types:
- Carcinoid tumors
- Adenoid cystic carcinoma
- Mucoepidermoid carcinoma
 Etiology:
- Unknown
- Genetics may play a role in some forms of this cancer.

34.  Clinical Features:
- Hemoptysis
- wheezing
- chest pain
- Shortness of breath
 Investigations:
- CXR  coin shadow
- Bronchoscopy  biopsy
 Treatment:
- Surgery is the main treatment for bronchial adenomas.
- Chemotherapy & Radiotherapy.
 Prognosis:
- Surgery usually results in a complete cure.
- Most patients have a good prognosis when removed with
surgery.

35. Pleural Mesothelioma
- Pleural mesothelioma is a rare & malignant neoplasm caused by
asbestos inhalation [Exposure to Asbestos].
- Is the most common type of asbestos-related cancer.
- Malignant pleural mesothelioma accounts for ~80-90% of all
mesothelioma cases.
 Site: Pleura
 Common symptoms:
-Dyspnea, -Pleurisy, -Dry cough, -Pleural effusion
 Investigations: CXR & Pleural biopsy
 Treatment:
-Surgery [Standard treatment], Chemotherapy & Radiotherapy.
 Prognosis: 6-12 months
-The prognosis of Pleural mesothelioma is poor, with a median
survival time of about 1 year.

40. FIGHTING & UNITING
AGAINST LUNG CANCER

41. THANKS…