A fully detailed presentation about lung cancers

1. LUNG CANCER
-SITHARA (MPT CARDIO)

2. • REFERS TO TUMORS ORIGINATING IN THE LUNG PARENCHYMA OR WITHIN BRONCHI
• MAINLY LINKED WITH INHALED CARCINOGENS
• CIGARETTE SMOKE- KEY CULPRIT
• MOST COMMON CANCER(LEADING TYPE)
• LEADING CAUSE OF CANCER MORTALITY WORLDWIDE

3. ETIOLOGY
• SMOCKING (MOST COMMON CAUSE- 90%)

4. RISK FACTORS
TOBACCO SMOKE EXPOSURE
ACTIVE (MAINSTREAM)—CIGARETTE, CIGAR
PASSIVE (SIDE STREAM)
OCCUPATIONAL AND ENVIRONMENTAL EXPOSURES
• ARSENIC
• CHROMIUM
• ASBESTOS
• NICKEL
• BERYLLIUM

5. • POLYCYCLIC AROMATIC HYDROCARBONS
• BIS(CHLOROMETHYL)ETHER
• RADON
• CADMIUM
• VINYL CHLORIDE
GENETIC PREDISPOSITION
GENDER
DIETARY FACTORS
COPD
AIR POLLUTION

6. PATHOPHYSIOLOGY
• REPEATED EXPOSURE TO CARCINOGENS – CIGARETTE SMOCK IN PARTICULAR
LEADS TO DYSPLASIA OF LUNG EPITHELIUM
• IF THE EXPOSURE CONTINUES IT LEADS TO GENETIC MUTATIONS AND AFFECTS
PROTEIN SYNTHESIS
• IT DISRUPTS THE CELL CYCLE AND PROMOTES CARCINOGENESIS

8. CLASSIFICATION
• SMALL-CELL LUNG CANCERS (SCLC) – ALMOST ALL OF THEM HAVE
METASTASIZED BY DIAGNOSIS
• NON SMALL-CELL LUNG CANCERS (NSCLC)
SQUAMOUS CELL CARCINOMA
ADENOCARCINOMA
LARGE CELL CARCINOMA

9. SMALL CELL LUNG CANCER
• 20-25%
• CHARACTERIZED BY SMALL CELLS WITH SCANT CYTOPLASM AND NO DISTINCT
NUCLEOLI
• CENTRALLY LOCATED - USUALLY ARISE IN CENTRAL BRONCHI
• HAS HIGHER DOUBLING TIME AND METASTASIZE EARLY
• GROW RAPIDLY AND METASTASIZE EARLY AND WIDELY, SO THAT DISEASE IS RARELY
LIMITED TO THE CHEST AT NECROPSY
• ALWAYS CONSIDERED A SYSTEMIC DISEASE AT DIAGNOSIS
• CNS, LIVER, BONE – MOST COMMON SITES

11. NON SMALL CELL LUNG CANCER
• SUB TYPES
1. SQUAMOUS CELL CARCINOMA
2. ADENOCARCINOMA
3. LARGE CELL CARCINOMA

12. SQUAMOUS CELL CARCINOMA
• MOST COMMON TYPE OF LUNG CANCER
• START IN SQUAMOUS CELLS, WHICH ARE FLAT CELLS THAT LINE THE INSIDE OF
THE AIRWAYS IN THE LUNGS
• SHOWS HISTOLOGICAL EVIDENCE OF SQUAMOUS DIFFERENTIATION, WITH
STRATIFICATION
THE FORMATION OF INTERCELLULAR BRIDGES AND
INTRACELLULAR KERATINIZATION

13. • CENTRALLY SITUATED – NEAR BRONCHUS
• MORE DIFFERENTIATED SCC GROW MORE SLOWLYAND ARE LESS LIKELY TO
GIVE RISE TO EXTRATHORACIC METASTASES.
• THOSE SQUAMOUS CELL CARCINOMAS THAT ARE MORE POORLY
DIFFERENTIATED TEND TO BEHAVE AGGRESSIVELY, EXTRATHORACIC
METASTASES BEING MORE FREQUENT.
• PRESENT AS PANCOAST TUMOR AND HYPERCALCEMIA (TUMOR IN THE SUPERIOR
SULCUS OF THE LUNG)

15. ADENOCARCINOMA
• ABOUT 5% OF ALL LUNG CANCERS
• MOST COMMON CANCER IN WOMEN AND NON- SMOKERS (LESS RELATED TO
CIGARETTE SMOKING)
• PERIPHERALLY LOCATED (ARE UN-RELATED TO BRONCHI OTHER THAN BY SPREAD)
• FURTHER DIVIDED INTO ACINAR, AND PAPILLARY – BOTH TEND TO PRODUCE
MUCIN
• START IN THE CELLS THAT WOULD NORMALLY SECRETE SUBSTANCES SUCH AS
MUCUS
• FOUND IN THE OUTER PARTS OF THE LUNG

16. • THESE TUMOURS ARE A HETEROGENEOUS GROUP OF PERIPHERAL LUNG
TUMOURS THAT ARISE FROM ANY EPITHELIAL CELL WITHIN OR DISTAL TO THE
TERMINAL BRONCHIOLES
• OFTEN APPEARING AS MULTIPLE PULMONARY NODULES OR AN AREA OF
PERIPHERAL ‘PNEUMONIC CONSOLIDATION
• COMMON SITES OF METASTASIS ARE PANCREAS, COLON, BREAST, STOMACH AND
KIDNEY

18. LARGE CELL CARCINOMA
• ABOUT 15% OF ALL LUNG CANCERS
• PERIPHERALLY LOCATED
• BULKY
• LIGHT MICROSCOPY SHOWING -
 NO FEATURES OF MATURATION AND
 THE PRESENCE OF LARGE, LESS WELL-DIFFERENTIATED, POLYGONAL, SPINDLE-
SHAPED OR OVAL CELLS WITH ABUNDANT CYTOPLASM
• HIGHLY ANAPLASTIC TUMOR

20. CLINICAL FEATURES
• ASYMPTOMATIC UP TO 50% OF CASES
• COUGH AND DYSPNEA
• HEMOPTYSIS( CENTRAL TUMOR)
• PLEURITIC CHEST PAIN
• PNEUMONIA
• WHEEZE
• PLEURAL EFFUSION
• LYMPHADENOPATHY

21. CLINICAL FEATURES WITH RESPECT TO REGIONAL
GROWTH OR SPREAD

22. INVESTIGATION
• A CHEST RADIOGRAPH AND CT SCAN OF THE CHEST SHOWS
 A SMALL SPOT (<3 CM IN DIAMETER) TERMED A NODULE
 A LARGER SPOT (>3 CM IN DIAMETER) TERMED A MASS
 ENLARGED LYMPHNODES IN THE HILA
 PLEURAL EFFUSION
• MRI
• BRONCHOSCOPY
• LUNG BIOPSY – CELLS ENLARGED AND UNDIFFERENTIATED

23. • POSITRON EMISSION TOMOGRAPHY (PET) WITH FLUORODEOXYGLUCOSE (FDG-
PET).
MALIGNANT CELLS ARE METABOLICALLY VERY ACTIVE, THEY TAKE UP THE GLU
COSE ANALOGUE MORE AVIDLY THAN NON MALIGNANT CELLS.
THE ATTACHED RADIOACTIVE TRACER BECOMES TRAPPED IN THE CELLS,
ALLOWING IT TO BE IMAGED
WHEN THIS TEST IS USED TO HELP PREDICT THE PRESENCE OF LUNG CANCER, IT
HAS A SENSITIVITY OF 97% AND A SPECIFICITY OF 78%

24. STAGING
• THE CLINICAL STAGING OF LUNG CANCER IS AN ATTEMPT TO DEFINE THE
ANATOMICAL EXTENT OF THE TUMOUR
• SEPARATE SYSTEMS HAVE EVOLVED FOR NON-SMALL-CELLAND SMALL-CELL
TUMOURS

25. NSCLC- STAGING
• TNM STAGING
• T’ - PRIMARY TUMOUR
• ‘N’-REGIONAL LYMPH NODES AND
• ‘M’ -DISTANT METASTASES.

29. SCLC- STAGING
• SMALL-CELL LUNG CANCERS GROW MORE AGGRESSIVELY AND OFTEN METASTASIZE
EARLIER FROM A MUCH SMALLER PRIMARY THAN OTHER CELL TYPES; BECAUSE OF
THIS, THE TNM SYSTEM OF STAGING IS IRRELEVANT FOR SMALL-CELL TUMOURS.
• CLINICIANS HAVE ADOPTED A SIMPLE STAGING SYSTEM USING THE TERMS ‘LIMITED’
AND ‘EXTENSIVE’ DISEASE.
• LIMITED DISEASE REFERS TO A GROUP OF APPROXIMATELY 30% OF PATIENTS WHO AT
PRESENTATION APPEAR TO HAVE DISEASE CONFINED TO THE IPSILATERAL
HEMITHORAX (LUNG, PLEURA, AND HILAR, MEDIASTINAL AND SUPRACLAVICULAR
LYMPH NODES).
• EXTENSIVE DISEASE REFERS TO SPREAD BEYOND THESE CONFINE

30. TREATMENT
SURGERY
WEDGE RESECTION
LOBECTOMY
PNEUMONECTOMY
VIDEO ASSISTED THORACOSCOPIC SURGERY (VATS)
• CHEMOTHERAPY
• RADIOTHERAPY
• IMMUNOTHERAPY

31. PHYSIOTHERAPY MANAGEMENT
• PTS CAN OFFER GUIDANCE ON THE PROPER USE OF INHALED MEDICATIONS, THE
USE OF SUPPLEMENTAL OXYGEN, AND THE ROLE OF PULMONARY
REHABILITATION BEFORE AND AFTER TREATMENT
• DEPENDING ON THE STAGE IN DISEASE
• AMERICAN CANCER SOCIETY RECOMMENDS THAT ADULTS WITH CANCER
ENGAGE IN ATLEAST
i. 150 MTS OF MODERATE INTENSITYAEROBIC EXERCISES
ii. 2 SESSIONS OF RESISTANCE EXERCISES/WK

32. EXERCISES
• AEROBIC EXERCISES AND RESISTANCE TRAINING – TO REDUCE AIRFLOW
OBSTRUCTION AND CLEARING OF AIRWAYS
• PULMONARY REHABILITATION PROGRAMME AFTER LUNG SURGERY- AIMS TO
OPTIMIZING RESPIRATORY FUNCTION AND QUALITY OF LIFE IMPROVEMENT
• EXERCISES FOLLOWING SURGERY/ TREATMENT AIMS TO
i. RESTORE PHYSICAL STATUS
ii. MAXIMUM FUNCTION IN PHYSICALACTIVITY, PSYCHOLOGICAL STATUS AND
HEALTH RELATED QOL IN LONG TERM

33. REVIEW OF LITERATURE
CATHERINE L GRANGER (2016)HAS DONE A STUDY ON PHYSIOTHERAPY
MANAGEMENT OF LUNG CANCER AND CONCLUDED THAT
THERE IS GROWING EVIDENCE FOR EXERCISE INTERVENTIONS TO REDUCE
CANCER MORBIDITY IN LUNG CANCER
THE ROLE OF EXERCISE IN THIS SITUATION IS TO PREVENT DETERIORATION AND
TO MAXIMISE OR RESTORE PHYSICAL STATUS PRIOR TO, DURING AND
FOLLOWING TREATMENT

34. • MARCUS JONSSON ET AL (2019) HAS DONE A STUDY ON IN-HOSPITAL
PHYSIOTHERAPY IMPROVES PHYSICAL ACTIVITY LEVEL AFTER LUNG CANCER
SURGERY: A RANDOMIZED CONTROLLED TRIAL AND CONCLUDED THAT PATIENTS
RECEIVING IN-HOSPITAL PHYSIOTHERAPY SHOWED INCREASED LEVEL OF
PHYSICAL ACTIVITY DURING THE FIRST DAYS AFTER LUNG CANCER SURGERY,
COMPARED TO AN UNTREATED CONTROL GROUP

35. • HÜSEYIN ULAŞ ÇINAR ET AL (2020) DONE A STUDY ON IS RESPIRATORY
PHYSIOTHERAPY EFFECTIVE ON PULMONARY COMPLICATIONS AFTER
LOBECTOMY FOR LUNG CANCER? AND CONCLUDED THAT AN INTENSIVE
PHYSIOTHERAPY PROGRAM FOCUSING ON RESPIRATORY EXERCISES IS A COST-
EFFECTIVE PRACTICE WHICH REDUCES THE RISK OF DEVELOPMENT OF
POSTOPERATIVE PULMONARY COMPLICATIONS IN PATIENTS UNDERGOING
LOBECTOMY FOR LUNG CANCER

36. REFERENCES
• TEXTBOOK OF CROFTON AND DOUGLAS'S RESPIRATORY DISEASES
• TEXTBOOK OF EGANS.FUNDAMENTALS.OF.RESPIRATORY.CARE.10°
• PHYSIOPEDIA
• IN-HOSPITAL PHYSIOTHERAPY IMPROVES PHYSICAL ACTIVITY LEVEL AFTER
LUNG CANCER SURGERY: A RANDOMIZED CONTROLLED TRIAL- MARCUS
JONSSON
• IS RESPIRATORY PHYSIOTHERAPY EFFECTIVE ON PULMONARY COMPLICATIONS
AFTER LOBECTOMY FOR LUNG CANCER?- HÜSEYIN ULAŞ ÇINAR,
• ON PHYSIOTHERAPY MANAGEMENT OF LUNG CANCER -CATHERINE L GRANGER