Lung Cancer:Diagnosis, Staging, and      Treatment  Edward Omron MD, MPH, FCCP       Pulmonary Medicine   Saint Louise Reg...
What is the Function of the Lungs?                 •   The lungs consist of five lobes, three                     in the r...
What is Lung Cancer?• The leading cause of cancer death among men  and women• Begins when cells in the lung grow out of  c...
Epidemiology• Lung Cancer is the most common cancer  – In 2008, 1.4 million deaths worldwide  – 1.61 million new cases  – ...
What Are the Risk Factors             for Lung Cancer?•   Tobacco and second-hand smoke•   Asbestos•   Radon, Radiation, G...
20 Year Lag Time between Smoking and Lung                  Cancer
Types of Lung Cancer• The types of lung cancer are treated differently. The  most common types are named for how the lung ...
Lung Cancer
Lung Cancer
Pulmonary Nodule
Pulmonary Nodule
Squamous Cell Carcinoma Lungs
Small Cell Carcinoma Lungs
What Are the Symptoms of Lung                 Cancer?•   Fatigue (tiredness)•   Cough•   Shortness of breath•   Chest pain...
Diagnosis•   Physical Exam•   Sputum Cytology•   CXR•   CT CHEST•   Bronchoscopy
How is Lung Cancer Evaluated?• The diagnosis must be confirmed with a biopsy and infectious or  autoimmune causes need to ...
Finding Lung Cancer Cells•   Thoracentesis•   Bronchoscopy•   Endobronchial Ultrasound•   Mediastinoscopy•   Thoracoscopy•...
PET Scan of Lung Cancer
Bronchoscopy
Endobronchial Tumor By Bronchoscopy
Endobronchial Ultrasound Biopsy of Lymph                 Nodes
Mediastinoscopy For Lymph Node Biopsy
Thoracentesis
VATS vs Thoracotomy
Lung Cancer and Early Detection• A low-dose helical computerized tomography  (CT or CAT) scan is currently recommended for...
How is Lung Cancer Treated?• Treatment depends on the stage and type of lung cancer• Surgery• Radiation therapy• Chemother...
Cancer Treatment: Surgery• The tumor and the nearby lymph nodes in the  chest are typically removed to offer the best  cha...
Cancer Treatment: Chemotherapy• Drugs used to kill cancer cells• EGFR genotyping for Adenocarcinoma• A combination of medi...
Cancer Treatment: Radiation Therapy• The use of high-energy x-rays or other particles to  destroy cancer cells• Side effec...
Lung Cancer Staging• Staging is a way of describing a cancer, such as  the size of the tumor and where it has spread• Stag...
Staging•   CT scan•   Bone Scan•   PET scan•   Bronchoscopy
Stage I Non-Small Cell Lung Cancer                  • Cancer is found only in                    the lung                 ...
Stage II Non-Small Cell Lung Cancer                    • The cancer has spread to                      lymph nodes in the ...
Stage III Non-Small Cell Lung Cancer                 •   The cancer has spread to the lymph nodes                     loca...
Stage IV Non-Small Cell Lung Cancer                  • The cancer has spread to                    different lobes of the ...
Small Cell Lung Cancer–All Stages• Patients with limited stage (confined to one area of the chest) small  cell lung cancer...
Five Year Survival Lung CancerClinical Stage       Non Small Cell Cancer   Small Cell Cancer1A                   50%      ...
Living With Lung Cancer• Patients with lung cancer face the risk of cancer growing back or the  development of a new lung ...
Resources• http://www.cancer.gov/  – NIH National Cancer Institute• http://www.lungcanceralliance.org/get-help-  and-suppo...
Lung Cancer Diagnosis, Symptoms, and Treatment Edward Omron MD, MPH, FCCP
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Lung Cancer Diagnosis, Symptoms, and Treatment Edward Omron MD, MPH, FCCP

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Community presentation regarding lung cancer.
Edward Omron MD, MPH, FCCP
Pulmonary Medicine
Morgan Hill, CA 95037
www.docomron.com

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Lung Cancer Diagnosis, Symptoms, and Treatment Edward Omron MD, MPH, FCCP

  1. 1. Lung Cancer:Diagnosis, Staging, and Treatment Edward Omron MD, MPH, FCCP Pulmonary Medicine Saint Louise Regional Hospital Gilroy, CA
  2. 2. What is the Function of the Lungs? • The lungs consist of five lobes, three in the right lung and two in the left lung • Most cells in the lung are epithelial cells, which line the breathing passages and produce mucus, which lubricates and protects the lungs • The main function of the lungs is to allow oxygen from the air to enter the bloodstream for delivery to the rest of the body
  3. 3. What is Lung Cancer?• The leading cause of cancer death among men and women• Begins when cells in the lung grow out of control and form a tumor• There are two main types of lung cancer: non- small cell and small cell
  4. 4. Epidemiology• Lung Cancer is the most common cancer – In 2008, 1.4 million deaths worldwide – 1.61 million new cases – In the USA, lifetime risk for men is 8% and women is 6%• Lung Cancer was rare before the advent of cigarette smoking, first recognized in 1761.• For every 3.5 million cigarettes smoked, 1 lung cancer death
  5. 5. What Are the Risk Factors for Lung Cancer?• Tobacco and second-hand smoke• Asbestos• Radon, Radiation, Genetics, Chemicals• Most people who develop lung cancer today have either stopped smoking years earlier or have never smoked
  6. 6. 20 Year Lag Time between Smoking and Lung Cancer
  7. 7. Types of Lung Cancer• The types of lung cancer are treated differently. The most common types are named for how the lung cancer cells look under a microscope.• Most lung cancers (about 85 percent) are non-small cell lung cancers. This type spreads more slowly than small cell lung cancer.• About 13 percent of lung cancers are small cell lung cancers. This type tends to spread quickly.
  8. 8. Lung Cancer
  9. 9. Lung Cancer
  10. 10. Pulmonary Nodule
  11. 11. Pulmonary Nodule
  12. 12. Squamous Cell Carcinoma Lungs
  13. 13. Small Cell Carcinoma Lungs
  14. 14. What Are the Symptoms of Lung Cancer?• Fatigue (tiredness)• Cough• Shortness of breath• Chest pain• Loss of appetite• Coughing up phlegm• Hemoptysis (coughing up blood)• If cancer has spread, symptoms include bone pain, difficulty breathing, abdominal pain, headache, weakness, and confusion
  15. 15. Diagnosis• Physical Exam• Sputum Cytology• CXR• CT CHEST• Bronchoscopy
  16. 16. How is Lung Cancer Evaluated?• The diagnosis must be confirmed with a biopsy and infectious or autoimmune causes need to be excluded• The location(s) of all sites of cancer is determined by additional CT scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging)• It is important to find out if cancer started in the lung or somewhere else in the body. Cancer arising in other parts of the body can spread to the lung as well
  17. 17. Finding Lung Cancer Cells• Thoracentesis• Bronchoscopy• Endobronchial Ultrasound• Mediastinoscopy• Thoracoscopy• CT Guided Biopsy
  18. 18. PET Scan of Lung Cancer
  19. 19. Bronchoscopy
  20. 20. Endobronchial Tumor By Bronchoscopy
  21. 21. Endobronchial Ultrasound Biopsy of Lymph Nodes
  22. 22. Mediastinoscopy For Lymph Node Biopsy
  23. 23. Thoracentesis
  24. 24. VATS vs Thoracotomy
  25. 25. Lung Cancer and Early Detection• A low-dose helical computerized tomography (CT or CAT) scan is currently recommended for high risk individuals.• Any person who is at increased risk due to smoking or asbestos exposure should discuss the benefits and limitations of a screening CT scan with his or her doctor
  26. 26. How is Lung Cancer Treated?• Treatment depends on the stage and type of lung cancer• Surgery• Radiation therapy• Chemotherapy (options include a combination of drugs)• Targeted therapy• Lung cancer is usually treated with a combination of therapies
  27. 27. Cancer Treatment: Surgery• The tumor and the nearby lymph nodes in the chest are typically removed to offer the best chance for cure• For non-small cell lung cancer, a lobectomy (removal of the entire lobe where the tumor is located), has shown to be most effective• Surgery may not be possible in some patients
  28. 28. Cancer Treatment: Chemotherapy• Drugs used to kill cancer cells• EGFR genotyping for Adenocarcinoma• A combination of medications is often used• May be prescribed before or after surgery, or before, during, or after radiation therapy• Can improve survival and lessen lung cancer symptoms in all patients, even those with widespread lung cancer
  29. 29. Cancer Treatment: Radiation Therapy• The use of high-energy x-rays or other particles to destroy cancer cells• Side effects include fatigue, malaise (feeling unwell), loss of appetite, and skin irritation at the treatment site• Radiation pneumonitis is the irritation and inflammation of the lung; occurs in 15% of patients• It is important that the radiation treatments avoid the healthy parts of the lung
  30. 30. Lung Cancer Staging• Staging is a way of describing a cancer, such as the size of the tumor and where it has spread• Staging is the most important tool doctors have to determine a patient’s prognosis• The type of treatment a person receives depends on the stage of the cancer• Staging is different for non-small cell lung cancer and small cell lung cancer
  31. 31. Staging• CT scan• Bone Scan• PET scan• Bronchoscopy
  32. 32. Stage I Non-Small Cell Lung Cancer • Cancer is found only in the lung • Surgical removal recommended • Radiation therapy and/or chemotherapy may also be used
  33. 33. Stage II Non-Small Cell Lung Cancer • The cancer has spread to lymph nodes in the lung • Treatment is surgery to remove the tumor and nearby lymph nodes • Chemotherapy recommended; radiation therapy sometimes given after chemotherapy
  34. 34. Stage III Non-Small Cell Lung Cancer • The cancer has spread to the lymph nodes located in the center of the chest, outside the lung • Stage IIIA cancer has spread to lymph nodes in the chest, on the same side where the cancer originated • Stage IIIB cancer has spread to lymph nodes on the opposite side of the chest, under the collarbone, or the pleura (lining of the chest cavity) • Surgery or radiation therapy with chemotherapy recommended for stage IIIA • Chemotherapy and sometimes radiation therapy recommended for stage IIIB
  35. 35. Stage IV Non-Small Cell Lung Cancer • The cancer has spread to different lobes of the lung or to other organs, such as the brain, bones, and liver • Stage IV non-small cell lung cancer is treated with chemotherapy
  36. 36. Small Cell Lung Cancer–All Stages• Patients with limited stage (confined to one area of the chest) small cell lung cancer are treated with simultaneous radiation therapy and chemotherapy• Patients with extensive stage (not confined to one area of the chest) small cell lung cancer are treated with chemotherapy only• Because small cell lung cancer can spread to the brain, preventative radiation therapy to the brain is routinely recommended to all patients whose tumors disappear following chemotherapy and radiation therapy
  37. 37. Five Year Survival Lung CancerClinical Stage Non Small Cell Cancer Small Cell Cancer1A 50% 38%1B 47 212A 36 382B 26 183A 19 133B 7 94 2 1
  38. 38. Living With Lung Cancer• Patients with lung cancer face the risk of cancer growing back or the development of a new lung cancer. All patients must follow up with their doctors for regular x-rays, scans, and check-ups• Many people with lung cancer feel that they will not receive as much support or help from people around them because they believe others will think that their behavior caused the disease• Doctors and other members of the health-care team can help patients and families cope with a diagnosis of lung cancer• Patients can take comfort knowing that the advances being made in the diagnosis and treatment of lung cancer will provide more and more patients with a chance for cure
  39. 39. Resources• http://www.cancer.gov/ – NIH National Cancer Institute• http://www.lungcanceralliance.org/get-help- and-support/practical-resources/ – Lung Cancer Alliance• http://www.cancer.org/ – American Cancer Society

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