lung carcinoma


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lung carcinoma

  1. 1. Lung Carcinoma6
  2. 2. Carcinoma of the Lung• In United States:-• 6.5 % of all deaths & 29% of cancer -relateddeath.• #1 cause of cancer deaths in males & females– 31% of male cancer deaths in 2008– 26% of female cancer deaths
  3. 3. Annual Age-adjusted Cancer Death Rates for SelectedCancers, United States, 1930-2004MalesFemalesCA Cancer J Clin 2008;58:81-82
  4. 4. Smoking-related diseases
  5. 5. Causes of Lung Cancer• 85-90% smoking• Industrial hazards :- Asbestos , UraniumRare arsenic, chromium, mustard gas, nickel,vinyl chloride .• Air pollution :- Radon• Molecular genetics:- KRAS, c-MYC,EGFR,p53
  6. 6. Classification of Lung Carcinoma(Major Types)Non-Small Cell Carcinoma:- Adenocarcinoma 42%- Squamous cell carcinoma 28%- Large cell carcinoma 14%Small cell carcinoma 16%
  7. 7. Precursor lesions:-(1)Squamous dysplasia & Ca.insitu.(2)Atypical adenomatoushyperplasia.(3)Diffuse idiopathic pulmonaryneuroendocrine hyperplasia.
  8. 8. Adenocarcinoma• Frequency: 42%• Smoking: X 3 (increased risk)• Males < females• Survival (5 years): 15 - 20%• Peripheral
  9. 9. Adenocarcinoma• Malignant epithelial tumors with tubular, acinar, orpapillary growth patterns, and/or mucus productionby the tumor cells.• Adenocarcinoma is the predominant histological subtype oflung carcinoma in most countries (40-50% of all cases).• Most prevalent form of lung cancer in younger males (<50 yr)and in women of all ages, in never smokers, and in formersmokers• Adenocarcinoma has flipped with squamous tumors as mostcommon over the past 20 years. Why? Thought that smokingwith filters, light tobacco, profound inhalation favor thedevelopment of distal bronchiolar and alveolaradenocarcinomas
  10. 10. AdenocarcinomaBronchioloalveolar type• Frequency: 2 %• Smoking: yes• Males = females• Survival (5 years): 25 a 40 %.• Presentation:– Single or multiple tumor nodules– Miliary tumor– “Pneumonic form”
  11. 11. Bronchioalveolar carcinoma – Mucinous typePneumonic presentation (40%) – Poor prognosis
  12. 12. 1. Definition: noninvasive tumors with bland cytology and lepidicspread (line alveolar surfaces)2. New proposal to classify these as “adenocarcinoma in situ”or atypical adenomatous hyperplasiaAdenocarcinomaBronchioloalveolar type
  13. 13. Squamous cell carcinoma• Frequency: 28%• Smoking: X 25 (increased risk)• Males > females• Survival (5 years): 15 - 20%• Arises in bronchial squamousmetaplasia• Centrally located• May cavitate
  14. 14. Squamous cell carcinoma• Malignant epithelial tumor with morphologicevidence of keratinization, intercellular bridgesor both.• Second most common type of lung cancer.• 2/3 central 1/3 peripheral.
  15. 15. Squamous cell carcinoma
  16. 16. Squamous cell carcinoma
  17. 17. Large Cell Carcinoma• Frequency: 14%• Gross– Peripheral lesion• Microscopic– group of tumors that do not fit the criteria of asquamous cell carcinoma, adenocarcinoma, orsmall cell carcinoma• Prognosis– Similar to adenocarcinoma
  18. 18. Small cell carcinoma• Frequency: 16%• Smoking: 95% of patients• Survival (5 years): 1 - 5 %
  19. 19. • Malignant epithelial tumor consisting of small cellswith minimal/scant cytoplasm, finely granularnuclear chromatin, absent or inconspicuousnucleoli, displaying prominent nuclear molding,high mitotic/apoptotic activity and extensivenecrosis• Highly associated with cigarette smoking, centrallocation, early spread, common paraneoplasticsyndromesSmall cell carcinoma
  20. 20. Small cell carcinoma• Still a dismal lesion: over 75% of casespresent with stage III or IV disease• In many series long term survival is lessthan 5%• Takes one importance because it essentiallyremoves a patient from consideration ofresection in most cases
  21. 21. Presenting Symptoms of LungCancer• Potentially curable– asymptomatic– cough– hemoptysis• Usually incurable– dyspnea & chest pain– anorexia & weight loss– hoarseness– bone pain– Horner’s syndrome (Pancoast tumor)
  22. 22. Bronchogenic carcinoma+ bronchectasis.
  23. 23. Mesothelioma• Mesothelioma:– Malignant tumor ofmesothelial cells– Highly malignantneoplasm with shortsurvival– Most patients (70%)have an asbestosexposure history• Asbestos exposurealso increases the riskof pulmonary cancer• Smoking is not relatedto mesothelioma