Lung cancer is a leading cause of cancer death worldwide. There are two main types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC accounts for around 85% of cases. The main risk factor is cigarette smoking, which causes over 70% of lung cancers. Symptoms may include cough, wheezing, shortness of breath, and chest pain. Diagnosis involves imaging tests and biopsy. Treatment options depend on the type and stage of cancer, and may include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Physiotherapy plays an important role in lung cancer management through techniques such as breathing exercises, postural drainage, chest percussion, and exercise training to

1. Lung cancer
Submitted by :- sharvari kulkarni

2. Agenda / Topics
• Anatomy of Respiratory system
• Definition
• Incidence of lung cancer
• Types of lung cancer
• etiology
• Pathology
• Clinical features
• Investigation
• Management

3. Anatomy
Respiratory system Basic structure of lung

4. Introduction
Lung cancer is associated with significant morbidity and mortality
and is a substantial burden to healthcare systems. Physiotherapists
play an important role in the management of people with lung
cancer. Advances in research over the past decade, particularly
supporting the use of exercise training, have rapidly progressed the
role of physiotherapy in lung cancer. This review summarises the
burden associated with lung cancer, the management of lung cancer
with a particular focus on physiotherapy interventions, and future
directions for research and clinical practice

5. Defination
Cancer is a generic term for a heterogeneous group of diseases that
occur when abnormal cells are not destroyed by normal metabolic
processes, but instead proliferate and metastasise out of control
• Lung cancer is the leading type of cancer diagnosed in males
worldwide.

6. Incidence
• More common in males than in females .
• More frequent in 50-70 years of age group.
• More in urban area than rural dwellers .
• More in smokers than non smokers .

7. Aetiology
• Cigarette smoking
• Most important cause .
• Atmospheric pollution .
• People who work in asbestos area .
• Occupational exposure .
• Radiation exposure .
• Household coal combustion .
• Familial predisposition
• Pre-existing non malignant lung disease such as COPD, idiopathic
pulmonary fibrosis ,and TB

8. Genetic mutation
• Mutation in epidermal growth factor receptor [EGFR] tyrosine
kinase domain .
• ALK mutation resulting in its fusion with echinoderm microtubule
associated with peotein like -4.

9. Types of lung cancer
Lung cancer
Small cell lung
cancer
{SCLS}
Large cell
carcinoma
Adenocarcinoma
Non small cell
lung cancer
{NSCLC}
Squamous cell
carcinoma

10. Pathology of lung cancer

11. Continuation
• Basal cell proliferation .
• Hyperplasia of goblet cell.
• Meta plastic stratification of squamous epithelium .
• Atypical metaplasia .
• Carcinoma in situ .
• Infiltration of cancer through basement membrane .
• Spread to regional lymph node .

12. Clinical features
• Cough with haemoptysis .
• Wheeze and stridor .
• Dyspnoea .
• Pneumonitis manifesting as fever and productive cough .
• Chest pain
• Dyspnoea
• Symptoms of lung abscess form tumour cavitation .

13. Con….

14. Investigation
• Pain radiograph • Peripheral pulmonary opacity with or
without cavitation .
• Unilateral enlargement at hilum
resulting from central tumour or hilar
glandular enlargement .
• Pleural effusion
• Collapse of whole lung ,lobe or
segment
• Rib destruction mainly 2nd and 1st
• Elevation of hemidiaphgram .

15. Con…
• Cytological examination
Of following are positive
1. Sputum .
2. Bronchial brushing .
3. Bronchial washing .
4. Percutaneous needle aspiration
biopsy from peripheral tumour .
• Bronchoscopy
• Computed tomography
• Scalene node biopsy
• Pleural aspiration
• Bariun swallow
• Endoscopic ultrasound –guided by
fine needle aspiration of mass of
lymph node

16. PET scan

17. Treatment
• Surgical treatment :-
• Surgery can have a role in treatment
1. If lymph nodes on the same side as the cancer have tumour cells in them, surgery will be
performed upfront or after receiving chemo radiation.
• Surgery has no role in treatment
1. If lymph nodes on the opposite side of the cancer have tumor cells in them, surgery does
not play a role

18. Surgical management
• Goals of Surgery
• Remove main tumour completely
• Remove all draining lymph nodes on the
side of the cancer
• Preserve lung function so that a patient
can maintain a good quality of life
Pre-operative considerations
Can an operation be tolerated - Are there other
significant medical problems
Is there sufficient pulmonary reserve
Can the tumor be completely removed (margins,
LN basins)

19. Types of surgery

20. Medical managment
• Chemotherapy
1. Cytotoxic druges are used with increase in regularity .
2. Results :- mixed but anaplastic tumours tend to respond to this type
treatment
• Radiotherapy
1. This is used symptomatically
2. Particularly to relive pain and obstruction
• Laser therapy
1. Used for persistent localised pain

21. Physical therapy management
•Short term goals
1. Education of patient
2. To relive any bronchospasm and facilitate the removal of secretion
3. To improve breathing pattern ,breathing control and control of dyspnoea
4. Maximize aerobic capacity and efficiency of oxygen transport
5. Optimize respiratory muscle strength and endurance
6. Optimize physical endurance and exercise capasity

22. Cont..
•Long term goals
1. Reduction and cessation of smoking
2. Continue with breathing exercise and relaxation tech.
3. Increase aerobic capasity
4. Self management in activits of daily living

23. Cont.
1. Removal of secretion
• Active cycle of breathing [ACBT]
oThoracic expansion exs
oForced expiratory technique
• Postural drainage
• Humidification
• Training with acepella

24. Cont..
2. Inspiratory resistant training
• Inspiratory spirometer
• Training with flutter
3.To improve breathing pattern
• Deep breathing exs
• Pursed lip breathing exs

26. 1.ACBT
2. thoracic expansion exs

27. Cont.
• Pre-operative and post –operative treatment
1. During radiotherapy
Positioning and ACBT should be used for sputum clearance .
Percussion and vigorous shaking should be avoided .(this may lead
to rid fracture )
Nor shaking them be used in presence of heampotasis .

28. Cont..
• During terminal stage of the disease ,where accumulation of
secretion is causing distress ,modified postural drainage and
vibration with breathing exs may help pt to be comfortable
• Suctioning can be given if effective coughing is not present

29. Cont…
• To improve aerobic capacity
1. Cycle hand ergometer can be given after complete recovery
patient
2. Walking

31. Thank you ….