This presentation is about lung cancer .every one can use it.if any mistakes are seen you may send me on siddiq.yusuf@gmail.com

2. LUNG CANCER
Prepared by M.Yusuf “Siddiq”
Medical student at K.M.U
2012

3. Defination:
 Uncontrolled growth of malignant cells in
one or both lungs and tracheo-bronchial
tree.
 A result of repeated carcinogenic irritation
causing increased rates of cell replication.
 Proliferation of abnormal cells leads to
hyperplasia, dysplasia or carcinoma in
situ.

4. Picture of the Lungs

5. Where Does it Come From?
(Risk factors)
Smoking
Radiation Exposure
Environmental/Occupational
Exposure
Asbestos
Radon
Passive smoke

6. Smoking Facts
 Tobacco use is the
leading cause of lung
cancer
 87% of lung cancers
are related to smoking
 Risk related to:
 age of smoking onset
 amount smoked
 gender
 product smoked
 depth of inhalation

7. Women & Lung Cancer
 Women are more prone to tobacco effects -
1.5 times more likely to develop lung cancer
than men with same smoking habits.

8. Where does it travel?
(Metastasis)
 Lymph Nodes, Brain, Liver, Adrenal
Gland, Bones
 40% of metastasis occurs in the
Adrenal Gland

9. Classification
According to the cell type
Squamous cell carcinoma 35%
Adenocarcinoma 30%
Small cell carcinoma 20%
Large cell carcinoma 15%

10. According to the location
1. Centrally located :
 Squamous cell carcinoma
 Small cell carcinoma
4. Peripherally located :
 Adenocarcinoma
 Large cell carcinoma
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.

11. Squamous cell carcinoma
Occurs most frequently in men and
old people.
Usually starts on one breathing tubes.
Tends to be localized in the chest
longer than other types of lung
cancer.
Does not tend to metastasize early.
It is strongly associated with smoking.

12. Adenocarcinoma
Most common cancer among women.
Usually started near the outer edges of
the lung.
Invasion of pleura and mediastinal
lymph node is common.
May spread to other parts of the body.
Can be seen in non smokers.

13. Large cell carcinoma
Less well – differentiated.
May occur at any part of the lung.
Tumors are large by the time they are
diagnosed.
Has greater possiblity of spreading to
brain and mediastinum.

14. Small cell lung cancer
Small cell lung cancer also called oat cell
because SCLC cells have oat grain
appearance.
It arises from endocrine cells [kulchitisky
cells] where many hormones are secreted.
Spreads to lymph nodes and other organs
more quickly than NSCLC.

15. Small cell lung cancer Cont…
Usually starts in one larger breathing tube.
Tends to grow rapidly .
Commonly has spread by the time and is
considered a systemic disease.
It is the only one of the bronchial
carcinomas that responds to
chemotherapy.

16. Clinical features
Clinical manifestations of lung cancer are
as a result of:
3. Effects of tumor it self.
4. Features of local spread of tumor.
5. Features of metastasis.
6. Features of paraneoplastic syndromes.

17. Symptoms due to tumor in the
bronchus
1. Cough (in 80% of cases)
It is the most common early symptom.
Sputum is purulent if there is
sec.infection.
A change in the character of the (regular
cough) associated with other new
respiratory symptoms increases the
possiblity of B.C.

18. 1. Hemoptysis (in 70% of cases)
Repeated episodes of scanty cough
hemoptysis or blood –streaking of
sputum in smokers are highly
suggestive of B.C and should be
always investigated .

19. 1. Dyspnea (in 60% of cases):
Reflects occlusion of a large
bronchus resulting collapse of a lobe of
the lung or development of pleural
effusion.
3. Pleural pain:
Reflects malignant invasion of the
pleura or reflects infection distal to a
tumor (which is recurrent and fail to
resolve).

20. Symptoms due to local spread
•Involvement of pleura and ribs.
Causing severe chest pain.
•Pancoast’s tumor:
Involvement of lower part of the brachial
plexus (C8,T1,T2) causing severe pain of
the shoulder and down inner surface of
the arm.
•Horner’s syndrome: Due to involvement
of the sympathetic ganglion.

21. •Recurrent laryngeal nerve palsy:
Causing unilateral vocal cord paresis with
hoarseness of voice and a bovine cough.
•Invasion of phrenic nerve:
Causing paralysis of the diaphragm.
•Involvement of esophagus:
Causing dysphagia.

22. •Cardiovascular:
Atrial fibrillation,Cardiac temponade
,pericarditis,pericardial effusion.
•Superior vena cava obstruction:
Causing early morning headache, facial
congestion and edema involving the upper
limbs, distention of jugular vein and veins
of the chest.

23. Nonmetastatic extrapulmonary
Manifestations
1. Anorexia and loss of weight.
2. Hypercalcemia due to release of PTH
related peptide.
3. Gynaecomastia due to release of HCG
hormone.
4. Cushing’s syndrome due to ectopic
ACTH secretion.
5. Acromegaly due to GHRH secretion.

24. Para neoplastic syndrome Cont…
1. Clubbing of the fingers.
2. Inappropriate secretion of the ADH.
3. Hypertrophic pulmonary osteo
arthropathy and tenderness in the wrist
and ankle joints. X-ray of painful bones
shows subperiosteal new bone
formation.

25. Blood borne metastasis
Bony metastasis giving severe bony pain
and pathological fractures.
Liver metastasis (Jaundice).
Brain metastasis (change in personality,
epilepsy, focal neurological symptoms).

26. Physical signs
Examination is usually normal unless
there is significant bronchial obstruction
or tumor has spread to pleura or
mediastinum.
2.Physical signs of collapse (in large
obstructing tumor) which may rise to
pneumonia.
3.Monophonic or unilateral wheeze
(fixed bronchial obstruction).

27. Physical signs Cont...
1. Stridor (obstruction at or above the
level of carina).
2. Hoarseness of voice associated with
bovine cough (recurrent laryngeal
nerve palsy).
3. Dullness percussion and absent breath
sounds at the lung base
(unilateral diaphragmatic palsy
due to involvement of phrenic nerve).

28. Physical signs Cont...
1. Physical signs of pleurisy or pleural
effusion (involvement of pleura).
2. Bilateral engorgement of the jugular
veins and later edema affecting face,
neck and arms.
3. Tenderness and pain of long bones
and joints (HPOA).

29. Investigations
Sputum cytology:
High yield for Endobronchial tumors such
as squamous cell and small cell
carcinoma.
Chest x-Ray:
Common radiological presentations of
bronchial carcinoma includes:
E.Unilateral hilar-enlagement.
F.Peripheral pulmonary opacity.

30. Chest X-ray Cont...
A. Lung, lobe or segmental collapse.
B. Pleural effusion.
C. Broadening of the mediastinum,
enlarged cardiac shadow, elevation
of hemi diaphragm.
F. Rib distraction.
G. Pleural fluid cytology in pleural
effusion.

31. Bronchoscopy :
Gives high yield in excess of 90% (allows
biopsy and bronchial brush samples)
if fails precautious fine needle
aspiration under CT.

32. Other diagnostic procedures:
CT thorax and upper abdomen.
Head CT scan.
Radio nuclide bone scanning.
Liver ultrasonography.
Bone marrow biopsy.

33. Staging and Treatment
NSCLC
Stage Description Treatment Options
Stage I a/b Tumor of any size is found only in the Surgery
lung .
Stage II a/b Tumor has spread to lymph nodes Surgery
associated with the lung.
Stage III a Tumor has spread to the lymph nodes Chemotherapy followed
in the tracheal area, including chest by radiation or surgery
wall and diaphragm.
Stage III b Tumor has spread to the lymph nodes Combination of
on the opposite lung or in the neck. chemotherapy and
radiation
Stage IV Tumor has spread beyond the chest Chemotherapy and/or
palliative (maintenance)
care

34. SCLC
 Limited Stage
Defined as tumor involvement of one lung, the
mediastinum and ipsilateral and/or contralateral
supraclavicular lymph nodes or disease that can
be encompassed in a single radiotherapy port.
 Extensive Stage
Defined as tumor that has spread beyond one
lung, mediastinum, and supraclavicular lymph
nodes. Common distant sites of metastasis are
the adrenals, bone, liver, bone marrow, and
brain.

35. Treatment
Curative treatment is surgical resection.
Unfortunately the majority of the patients
present with evidence of tumor spread at
the time of diagnosis and can only be
offered palliative therapy.
Surgical resection:
In patients with localized disease and non-
small cell lung cancer(NSCLC).

36. Treatment Cont…
Results of surgical resection are poor
in small cell carcinoma.
Few patients are suitable for surgery.
5-year survival rate after resection of
squamous cell carcinoma can be as high
as 75% in stage I and 55% in stage II

37. Contraindications to surgery:
1. Distant metastasis.
2. Mediastinal involvement.
o Esophageal involvement.
o Vocal cord paralysis.
o Vena cava syndrome.
o Involvement of trachea.
7. Advanced age.
8. Poor respiratory function.
9. Small cell carcinoma.

38. Radiotherapy
 Radiotherapy is of great value to relieve
distressing complications e.g. superior
venacaval obstruction.
 It is the treatment of choice, if the tumor
is inoperable.
 Small cell carcinoma is more
susceptible
to radiotherapy. Prophylactic
radiotherapy to brain is also given in
small cell carcinoma.

39. Chemotherapy
In small cell carcinoma chemotherapy is
combined with radiotherapy. Drugs used
are IV vincristine, cyclophosphamide,
doxorubicin or cisplatin and etoposide
given every 3 weeks for 3-6 cycles.
Chemotherapy in non small-cell
carcinoma is not much effective.

40. Laser therapy
This is good for destroying tumor tissue
occluding major airways to allow
reaction of collapsed lung.
Prognosis:
Very poor, less than 10% patients survive
5 years after diagnosis.

41. Conclusion
 Smoking cessation is essential for
prevention of lung cancer.
 New screening tools under way.
 Clinical trials under way.
 New treatments under way.
 Treatment can palliate symptoms and
improve quality of life.
 Read first bullet again!!!

42. THANK YOU