THIS PRESENTATIONS COVERS THE TOPIC ON LUNG CANCER and its epidemiology among different age groups, its incidence and fatality rate, types of lung cancer andpathogenesis of lung cancer, diagnosis, treatment, complication and prognosis of lung caner

1. LUNG CANCER
ALOK HRIDAY MISHRA
CHETNA NEIN
MD -7 A1

2. TABLE OF CONTENT
• INTRODUCTION
• EPIDEMIOLOGY
• TYPES
• CLINICAL FEATURES
• RISK FACTORS
• PATHOGENESIS
• SCREENING GUIDELINES
• PACK YEARS
• DIAGNOSIS
• TREATMENT
• COMPLICATIONS
• PROGNOSIS

3. WORD OF WISDOM
Smoking alone 10 fold increases the occurance of
lung cancer

4. INTRODUCTION
IT OCCUR WHEN ABNORMAL CELL, GROW OUT
OF CONTROL IN LUNG, WHICH CAN FURHTER
INVADE NEARBY TISSUE TO FORM TUMOR, AND
CAN METASTASIZE TO NEARBY LYMPH NODE
AND TO OTHER PARTS OF THE BODY.
THEREBY COMPRESSING STRUCTURE AND IF
LEFT UNTREATED CAN BE FATAL

5. EPIDEMIOLOGY
• SECOND MOST COMMON CANCER IN US IN BOTH SEXES
• AND IS THE MOST FATAL (#1) CANCER IN US IN BOTH SEXES
SECONDARY LUNG CANCER IS MUCH COMMON THAN PRIMARY LUNG
CANCER
AN DIS USUALLY METASTASIZE FROM EITHER BREAST, COLON, RENAL
CELL CARCINOMA AND THEY METASTASIZE TO MOSTLY LUNG
PARENCHYMA
DYSPNEA IS THE MOST COMMON SYMPTOM OF LUNG CANCER
IN PRIMARY LUNG CANCER:-
INCIDENCE IN MEN ARE DECREASING BUT INCREASING IN FEMALES BUT
STILL THE INCIDENCE IS STILL HIGHER IN MEN THAN IN WOMEN.

6. TYPES
• MAIN TWO TYPES
NON SMALL CELL LUNG CANCER (NSCLC):- MOST COMMON (80%)
1. ADENOCARCINOMA (MOST COMMON ADULTS)
2. SQUAMOUS
3. LARGE CELL
4. BRONCHIAL CARCINOID (MOST COMMON IN CHILDREN)
 SMALL CELL LUNG CANCER (SCLC) :- (20%)

7. CLINICAL FEATURES
• COUGH
• WEIGHT LOSS
• CHEST PAIN
• HEMOPTYSIS
• DYSPNEA
SYMPTOMS OF HYPERCALCEMIA (SQUAMOUS CELL
CARCINOMA) BCOZ IT RELEASES PARATHYROID HORMONE
RELATED PEPTIDE (PTHrP)
SO, CONSTIPATION
POLYURIA
KIDNEY STONES
PSYCHIATRIC ISSUES
ACUTE PANCREATITIS

8. • SIGN OF PRIMARY LUNG CANCER:-
• CLUBBING
• TACHYPNEA
• HORNER SYNDROME, UPPER EXTREMITIY WEAKNESS,
SHOULDER PAIN (CANCER COMPRESSING AUTONOUS CHAIN
GANGLION AND BRAHCIAL PLEXUS)

9. RISK FACTORS
• SMOKING CIGGARETE
• RADON GAS
• ASBESTOS
• COAL DUST
• RADIATION
• AIR POLLUTION
• URANIUM
• TB
• RHEUMATOID ARTHRITIS
• SILICA DUST
• METAL POISONING
• FREQUENT LUNG INFECTION

10. PATHOGENESIS
• ONCOGENE:- over expression of cancer gene
• KRAS gene
• Myc family gene
• BCL- 2
• HER 2
• EGFR
• TUMOR SUPPRESSOR GENE:- decreased expression of
these genes
• p53 gene
•RB-1 gene
•P16 gene

11. executors
Cycling dependent kinase
Cell devision
control

13. SCREENING
GUIDELINES
• GIVEN BY ACCP
(AMERICAN COLLEGE OF CHEST PHYSICIANS)-2013
We do low dose CT
And is performed annually that too with
age group 55-74 y/o that too
who smoked 30 pack year and still smoke
Or
have stopped smoking during last 15 years

14. PACK YEARS
20 represents number of
ciggarete in one packet,
so if a patient smoked 20
ciggarete per day for 30
years then his pack years will
be 30

15. DIAGNOSIS
• Detailed history + Medical exam
• LAB :- CBC, CMP, LFT, ALP, SPUTUM CYTOLOGY
• RADIOLOGY:-
CONTRAST CT
oCHEST
oABDOMEN (LIVER, ADRENAL) could be the
source
oPELVIS (COLON)
IF WE SUSPECT LUNG CANCER, THEN GO WITH MORE TEST
PERIPHERAL MASS = ADENOCARCINOMA OR LARGE CELL CANCER
CENTRAL MASS = SQUAMOUS OR SMALL CELL

16. PET SCAN
Patient is injected with 18F-
fluorodeoxyglucose
Cancer cell upatke it bcoz of their high
metabolic rate and is visible as bright area
in PET scan
MRI / CT:- to find their metastasized areas
• TISSUE BIOPSY
• MOLECULAR MARKERS FOR SPUTUM
(BAL(bronchio alveolar lavage))
If effusion is also present, after thoracocentesis use fluid for
cytology

19. COMPLICATIONS
PARANEOPLASTIC SYNDROME
METASTASES
oHILAR LYMPH NODES
oADRENAL
oLIVER
oBRAIN
oBONE
CACHEXIA
o CACHEXIN
o INF –GAMMA
o IL-6
ANEMIA
COMPLICATIONS DUE TO TREATMENT
DEATH

20. PROGNOSIS
• Prognosis of non small cell lung cancer(NSCLC) is better than
that of small cell lung cancer (SCLC)
• NSCLC :- 5 year survival rate
10-15%
• SCLC:- 5 year survival rate
10% in limited disease
1-2% in extensive disease
AND ABOUT 98% OF POPULATION WON’T
EVEN SURVIVE FOR 5 YEAR

21. FOR SMALL CELL LUNG CANCER:-
ONLY CHEMO AND RADIATION BCOZ CANCER IS TOO SMALL TO BE
OPERATED ON