This document discusses lung cancer, including risk factors, types, staging, diagnosis, and treatment options. It notes that smoking is the primary risk factor, greatly increasing lifetime risk. The two main types are non-small cell lung cancer (NSCLC) and small cell lung cancer. Staging involves determining the size and spread of the tumor using imaging and lymph node involvement. Treatment depends on stage but commonly includes surgery for early stages and chemotherapy with or without radiation for later stages. Outcomes remain poor, especially for metastatic disease, but improved understanding of lung cancer has led to personalized treatment approaches.
Lung cancer: a 2014 update with information about immunotherapiesZeena Nackerdien
In 2006, Dana Reeve – actress, activist, and non-smoker – died of lung cancer. In 2009, Valerie Harper – actress and “Dancing with the Stars” contestant – was diagnosed with lung cancer that has since metastasized to the brain. They are the famous faces of a disease that is the leading cause of cancer deaths. Five-year survival rates for lung cancer, the leading cause of cancer deaths, are very low. Please take a look at some of the ASCO 2014 lung cancer updates on my blog: http://norwalk.patch.com/groups/zeena-nackerdiens-blog/p/american-society-of-clinical-oncology-annual-meeting-2014-key-lung-cancer-abstracts.
Lung cancer: a 2014 update with information about immunotherapiesZeena Nackerdien
In 2006, Dana Reeve – actress, activist, and non-smoker – died of lung cancer. In 2009, Valerie Harper – actress and “Dancing with the Stars” contestant – was diagnosed with lung cancer that has since metastasized to the brain. They are the famous faces of a disease that is the leading cause of cancer deaths. Five-year survival rates for lung cancer, the leading cause of cancer deaths, are very low. Please take a look at some of the ASCO 2014 lung cancer updates on my blog: http://norwalk.patch.com/groups/zeena-nackerdiens-blog/p/american-society-of-clinical-oncology-annual-meeting-2014-key-lung-cancer-abstracts.
Presentation by Kenneth Neigut, MD at the Longboat Key Central FL Cancer Institute Annual Seminar. Overview: 1. Review lung cancer screening updates. 2. Management of smal lung nodules detected on CT. 3. The role and limitations of using PET/CT for staging. Key Stats: 160,000 lung cancer deaths occur in the USA every year. 85% of these deaths occur in those with a strong smoking history. Lung CA is the number one cancer killer. Insurance companies will be required to cover the $300-$400 screening under a mandate in the federal health law.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
Computed tomography ventilation imaging (CTVI) is an exciting new functional lung imaging modality enabling functionally adaptive lung cancer radiotherapy treatments. In 2015, this became clinical reality with the first patient treatment performed in the US. Unfortunately the development of new CTVI workflows in the clinic can be challenging, due to the requisite advanced four-dimensional (4D) image processing. To overcome this, we have developed VESPIR (VEntilation via Scripted Pulmonary Image Registration), a user-friendly software toolkit to help streamline the end-to-end validation of CTVI workflows in the clinic.
Lung cancer is an epidemical disease, annually there are 1.4 million deaths and about 1.6 million new cases.
More people die of lung cancer than of colon, breast, and prostate cancers combined.
Lung cancer mainly occurs in older people. About 2 out of 3 people diagnosed with lung cancer are older than 65.
Fewer than 3% of all cases are found in people under the age of 45. The average age at the time of diagnosis is about 71.
The chance that a man will develop lung cancer is about 1 in 13, for a woman, the risk is about 1 in 16, These numbers include both smokers and non-smokers. For smokers the risk is much higher, while for non-smokers the risk is lower.
Lung cancer incidence rates were around twice as high in more developed countries compared with less developed countries
Staging of any tumour is an important step prior to its therapy as the treatment plan usually depends on the extent of the tumour. While there are many noninvasive tools used for staging lung cancer; there is always a need to get a tissue diagnosis by some invasive procedure. Among many invasive techniques, mediastinoscopy and mediastinotomy are very important in the evaluation of mediastinal lymphadenopathy to accurately stage lung cancer.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. Lung Cancer
• Lifetime risk of being
diagnosed in men is 1 in 13 (7.77%)
and in women 1 in 16 (6.35%)
• Most lethal cancer
• Accounts for 14% of cancers in men
but 28% of cancer deaths, in
women also 14% of cases but 26%
of all cancer deaths
4. Age standardized lung cancer
mortality rate per 1000 men/year
Non Smoker 0.17
Former smoker 0.68
Current Smoker 2.49
1 – 14 cigarettes/day 1.31
15 – 24 2.33
> 24 4.17
The odds of dying of lung cancer goes up 24 X if compare heavy
smoker to a non smoker
BMJ 2004;328:1519 (26 June)
5.
6. Risk of Getting Lung Cancer
Smoking Men Women
Non-smoker 0.2% 0.4%
Quit 5.5% 2.6%
Current 15.9% 9.5%
Heavy 24.4% 18.5%
European study in 2006, defined heavy as > 5 cigarettes per day
7. Cumulative Risk of Lung Cancer in Men
at Age 75 by Smoking History
Non-smoker <30y 40 y 50y 60y current
Age when they stopped
8. Risk for long term
heavy smokers
relative risk of lung cancer in the long-term
smoker compared with the lifetime nonsmoker
vary from 10- to 30-fold.
The cumulative lung cancer risk among heavy
smokers may be as high as 30 percent,
compared with a lifetime risk of lung cancer of
1 percent or less in nonsmokers
9. Effect of Smoking Reduction on Lung Cancer Risk
Nina S. Godtfredsen; Eva Prescott; Merete Osler JAMA. 2005;294:1505-1510.
10. Lung Cancer
• 5 year survival rate for all
• cancers from 1975 to 2008 has gone
from 49 to 68%
• 5 year survival for lung cancer during this
period has gone from 12 to 17%
• Most people are diagnosed in advance
stages: Local (15%), Regional (22%),
Distant (56%)
• Cure rate stage is poor: Local (52%),
Regional (25%), Distant (4%)
12. Symptoms of Lung Cancer
Symptoms Percent of Patients
Cough 45 – 74%
Weight Loss 46 – 68%
Dyspnea 37 – 58%
Chest Pain 27 – 49%
Hemoptysis 27 – 29%
Bone Pain 20 – 21%
Hoarseness 8 – 18%
13. Age and Lung Cancer
• Median age at diagnosis is 65y and median age at
death is 72y
Decade Non Small Small Cell
Cell
40‟s 5.9% 5.6%
50‟s 16% 19%
60‟s 30% 33%
70‟s 33% 31%
80‟s 15% 11%
14. Types of Lung Cancer
Non-small cell carcinoma (NSCC) (87%)
◦ Adenocarcinoma (38%)
◦ Squamous cell (20%)
◦ Large cell (5%)
Small cell carcinoma (13%)
15. Biopsy - confirm the cancer and
determine the type
Bronchoscopy CT directed biopsy
16. Histology (NCDB 2000-2010)
Non Small Cell 85%
Adenocarcinoma 37%
Squamous 25%
NSCL 19%
Other 12%
Large Cell 4%
Bronchoalveolar 3%
Small Cell 15%
17. Pathology Report
• Pathological review: histology type and
extent of the growth and size of the cancer
• Immunohistochemical stains (“special
stains”) to better clarify the true source and
type of cancer
• Molecular diagnostic studies to look for
evidence of genetic mutations that would
impact on the use of targeted therapies
18. Pathology and the use of
targeted therapy
• Erlotinib (Tarceva) or Cetuximab (Erbitux) for
EGFR mutations
• Crizotinib (Xalkori) with ALK gen mutation
• Bevacizumab (Avastin) anti angiogenesis but
not for squamous cancers
• KRAS mutation they would not respond to TKI
29. Importance of the Lymph
Nodes
Spread to the Nodes
on the side (hilar
or N1 or Stage II )
is not as serious as
if nodes in the
middle or higher up
are involved (N2 or
mediastinal nodes
or Stage III)
30. Superior Mediastinal Nodes (1-4)
1. Highest Mediastinal: 2. Upper Paratracheal: 3. Pre-vascular or Pre-vertebral4. Lower
Paratracheal
Aortic Nodes (5-6)
5. Subaortic (A-P window): 6. Para-aortic
Inferior Mediastinal Nodes (7-9)
7. Subcarinal. 8. Paraesophageal 9. Pulmonary Ligament
Hilar, Interlobar, Lobar, Segmental and Subsegmental Nodes (10-14)
10-14: these are located outside of the mediastinum. They are all N1-nodes.
42. Same side (N1), nodes in the
middle (N2) and the opposite side
(N3)
43. PET Scan will help separate the
active cancer from areas of
collapse or fluid
Squamous cancer left upper lobe bronchus ,
obstructing the left upper lobe
44. Stages of Lung Cancer
Stage I – small spot no nodes
Stage II – larger or nodes on the
side of the lung (hilar or N1 nodes)
Stage III – very large tumor or
lymph nodes in the middles of the
chest (mediastinum or N2 nodes)
Stage IV – metastases to other
organs
50. Lung Cancer Stages
Stage TNM
IA T1a or T1b N0
IB T2a N0
IIA T2bN0 or
T1a or T1b or T2a N1
IIB T2bN1 or
T3N0
IIIA T1 or T2 N2 or
T3 N1 or T3 N2 or
T4 N0 or N1
IIIB Any N3 or
T4N2
IV Any M1a or M1b
51. Small Cell Carcinoma of the Lung usually
presents with a large central tumor (hilar/mediastinal lymph
node mass) and are usually classified as either Limited Stage
(LS) or Extensive Stage (ES)
52. Small Cell Lung Cancer
PET scan showing a
typical small cell
cancer with a large
mediastinal mass
making it hard to even
see the heart on the
left side
57. Treatment of Lung Cancer
Stage I and II – surgery (if possible)
and sometime postOp chemo or
radiation (virtually all small cell
cancer patients receive
chemotherapy)
Stage III – usually chemo plus
radiation, sometime followed by
surgery
Stage IV – chemo or radiation,
58. Lung Cancer
Robert Miller MD
www.aboutcancer.com