1. Dr shaista khan

2. AETIOLOGY
Tobacco:
Latent period of 10-30 years
The primary determinants are:
Number of cigarettes consumed
Age of onset of smoking (those under 16 years of age at start
have irreversible damage to their bronchial genetic
makeup
Length of time of smoking
Type of tobacco (cigarettes or pipe, filter or non-filter)
Passive exposure to tobacco smoke
Asbestos exposure
Irradiation
Toxic metals
Certain chemicals

3. Types of bronchial carcinoma:
Squamous cell carcinoma (SCC)
Adenocarcinoma
Small cell carcinoma (oat cell carcinoma)
Alveolar cell or bronchoalveolar carcinoma

4. Squamous cell carcinoma:
60% of all lung tumors
Associated with smoking and is rare in non-smokers
Squamous metaplasia -> carcinoma in situ -> invasive
carcinoma

5. Adenocarcinoma:
15% of lung tumours
Has a tendency to be more peripheral, arising in the
small bronchial glands
Most common in women
Is the type seen in non-smokers

6. Small cell (oat cell) carcinoma:
20% of lung tumours
Arises from the chromaffin cells
Highly malignant
Hormone production by the tumour is common
A benign form of a small cell carcinoma is a carcinoid
tumour

7. Alveolar cell carcinoma:
5% of lung tumours
Arises in the distal airways
Often diffuse, multifocal and bilateral
Resistant to radio-/chemotherapy
Very poor prognosis

10. TNM STAGING
(T)
T1 - tumor
Diameter of 3 cm or smaller and surrounded by lung
or visceral pleura or
endobronchial tumor distal to the lobar bronchus

13. T2 - tumor
Greater than 3 and smaller than 7 cm
Invasion of the visceral pleura
Atelectasis or obstructive pneumopathy involving less
than the whole lung
Tumor involving the main bronchus 2 cm or more
distal to the carina.

16. T3 - tumor
Tumor with atelectasis or obstructive pneumonitis of the
entire lung
Tumor in the main bronchus within 2 cm of the carina but
not invading it
Tumor of any size with invasion of non-vital structures
such as the chest wall, mediastinal pleura, diaphragm,
pericardium.
Separate tumour nodules in the same lobe as the primary
tumor.

19. T4 - tumor
Invasion of vital mediastinal structures: fat, heart, trachea,
esophagus, great vessels, recurrent laryngeal nerve, carina.
Invasion of vertebral body.
Malignant pleural or pericardial effusion (cytologically
proven).
Separate tumour nodule(s) in a different ipsilateral lobe to
that of the primary tumor.

23. Lymph nodes (N)

24. N1 - Nodes
N1-nodes are ipsilateral nodes within the lung up to
hilar nodes.
N1 alters the prognosis but not the management.

26. N 2 NODES.
Nodes in the ipsilateral mediastinum

28. N3 - Nodes
N3-nodes are clearly unresectable.
These are contralateral mediastinal or contralateral
hilar nodes or any scalene or supraclavicular nodes.

39. CALCIFICATION

45. FDG UPTAKE

50. STAGE ??

51. STAGE ??

54. PANCOAST TUMOR

57. OPERABLE OR NOT?

59. THANKS