This document summarizes information about lung cancer and other lung diseases. It discusses the definition, risk factors, types, symptoms, investigations, treatment and prognosis of bronchogenic carcinoma (lung cancer). The main types of lung cancer - small cell carcinoma and non-small cell carcinoma - are described in more detail. Other topics covered include bronchial adenoma, carcinoid tumors, mesothelioma and their relationship to asbestos exposure. Throughout, smoking is identified as the leading risk factor for lung cancer development and progression.

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…