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Lung cancer .pptx
- 1. LUNG CANCER SEWAR KANAWAT 5THCOURSE -4TH GROUP
- 2. LUNGS ANATOMY ANDPHYSIOLOGY
- 3. LUNG CANCER EPIDEMIOLOGY •LUNG CANCER HAS BEEN THE MOST COMMON CANCER WORLDWIDE SINCE 1985, BOTH IN TERMS OF INCIDENCE AND MORTALITY. GLOBALLY, LUNG CANCER IS THE LARGEST CONTRIBUTOR TO NEW CANCER DIAGNOSES (1,350,000 NEW CASES AND 12.4% OF TOTAL NEW CANCER CASES) AND TO DEATH FROM CANCER (1,180,000 DEATHS AND 17.6% OF TOTAL CANCER DEATHS) • AGE: 65–75 YEARS • MORE OFTEN IN MEN THAN WOMEN EXCEPT FOR ADENOCARCINOMA WHICH IS MORE COMMON IN WOMEN . • MORTALITY RATES FOR MEN AND WOMEN ARE CONVERGING
- 5. ETIOLOGY – RISKFACTORS CHANGEABLE NON CHANGEABLE • TOBACCO SMOKE PREVIOUS RADIATION THERAPY TO THE LUNGS • SECONDHAND SMOKE AIR POLLUTION • EXPOSURE TO RADON PERSONAL OR FAMILY HISTORY OF LUNG CANCER • EXPOSURE TO ASBESTOS OTHER RISK FACTORS: PULMONARY SCARRING,, PULMONARY FIBROSIS, CHRONIC INFECTIONS (E.G., TUBERCULOSIS, HIV)
- 6. CLASSIFICATIONS • THERE ARETWO MAIN TYPES OF LUNG CANCER: SMALL CELL LUNG CANCER (SCLC) AND NON-SMALL CELL LUNG CANCER (NSCLC). A THIRD LESS COMMON TYPE OF LUNG CANCER IS CALLED CARCINOID.
- 7. NON-SMALL CELL LUNGCANCER (NSCLC) • NON-SMALL CELL LUNG CANCER IS MORE COMMON. IT MAKES UP ABOUT 80 %. THIS TYPE USUALLY GROWS AND SPREADS TO OTHER PARTS OF THE BODY MORE SLOWLY THAN SMALL CELL LUNG CANCER DOES. THERE ARE THREE DIFFERENT TYPES OF NON- SMALL CELL LUNG CANCER: • ADENOCARCINOMA: A FORM OF NON-SMALL CELL LUNG CANCER OFTEN FOUND IN AN OUTER AREA OF THE LUNG. IT DEVELOPS IN THE CELLS OF EPITHELIAL TISSUES, WHICH LINE THE CAVITIES AND SURFACES OF THE BODY AND FORM GLANDS. • SQUAMOUS CELL CARCINOMA:FOUND IN THE CENTER OF THE LUNG NEXT TO AIR TUBE (BRONCHUS). • LARGE CELL CARCINOMA: A FORM THAT CAN OCCUR IN ANY PART OF THE LUNG AND TENDS TO GROW AND SPREAD FASTER THAN ADENOCARCINOMA OR SQUAMOUS CELL CARCINOMA. • LESS COMMON TYPES INCLUDE: ADENOSQUAMOUS CARCINOMA SARCOMATOID CARCINOMA
- 9. SMALL CELL LUNGCANCER (SCLC) • AROUND 15 TO 20% DIAGNOSED ARE THIS TYPE. IT IS USUALLY CAUSED BY SMOKING. THESE CANCERS TEND TO SPREAD QUITE EARLY ON. MOST PATIENTS HAVE METASTATIC DISEASE AT DIAGNOSIS, • SMALL CELL LUNG CANCERS ARE ALSO CLASSED AS NEUROENDOCRINE TUMOURS. NEUROENDOCRINE TUMOURS ARE RARE TUMOURS THAT DEVELOP IN CELLS OF THE NEUROENDOCRINE SYSTEM. • PATIENTS WITH SCLC TYPICALLY PRESENT WITH RESPIRATORY SYMPTOMS, COUGH, DYSPNOEA OR HAEMOPTYSIS (COUGHIN BLOOD)
- 10. VARIANTS OF LUNGCANCER • PANCOAST TUMOR: AN APICAL LUNG CARCINOMA, LOCATED IN THE SUPERIOR SULCUS OF THE LUNG PREDOMINANTLY NSCLC *MAY LEAD TO THE DEVELOPMENT OF PANCOAST SYNDROME: A CONSTELLATION OF SYMPTOMS SECONDARY TO THE MASS EFFECT OF THE TUMOR ON SURROUNDING STRUCTURES *CERVICAL SYMPATHETIC GANGLION (STELLATE GANGLION): HORNER SYNDROME (IPSILATERAL MIOSIS, PTOSIS, AND ANHIDROSIS) * BRACHIAL PLEXUS *LOCALIZED PAIN IN THE AXILLA AND SHOULDER (PLEXUS NEURALGIA) *UPPER LIMB MOTOR AND SENSORY DEFICITS (E.G., HAND MUSCLE WEAKNESS AND ATROPHY) *RECURRENT LARYNGEAL NERVE: HOARSENESS *BRACHIOCEPHALIC VEIN :UNILATERAL EDEMA OF THE ARM , FACIAL SWELLING *PHRENIC NERVE: PARALYSIS OF THE HEMIDIAPHRAGM
- 11. *CLINICAL FEATURES • PULMONARYSYMPTOMS *COUGH, HEMOPTYSIS* PROGRESSIVE DYSPNEA *WHEEZING *CHEST PAIN • EXTRAPULMONARY SYMPTOMS : • CONSTITUTIONAL SYMPTOMS (WEIGHT LOSS, FEVER, WEAKNESS) • SIGNS AND SYMPTOMS OF TUMOR INFILTRATION AND/OR COMPRESSION OF NEIGHBORING STRUCTURES • SUPERIOR VENA CAVA SYNDROME: COMPRESSION OF THE SUPERIOR VENA CAVA IMPAIRS THE VENOUS BACKFLOW TO THE RIGHT ATRIUM, RESULTING IN VENOUS CONGESTION IN THE HEAD, NECK, AND UPPER EXTREMITIES. • HOARSENESS: PARALYSIS OF THE RECURRENT LARYNGEAL NERVE • DYSPNEA AND DIAPHRAGMATIC ELEVATION: PARALYSIS OF THE PHRENIC NERVE • DULLNESS ON PERCUSSION, REDUCED BREATH SOUNDS: MALIGNANT PLEURAL EFFUSION ON THE AFFECTED SIDE • POSTOBSTRUCTIVE PNEUMONIA DYSPHAGIA: ESOPHAGEAL COMPRESSION
- 12. • SYMPTOMS OFMETASTATIC DISEASE • OVER HALF OF ALL PATIENTS DIAGNOSED WITH LUNG CANCER HAVE METASTATIC DISEASE . • THE SYMPTOMS OF METASTATIC DISEASE ARE SITE-SPECIFIC: • BRAIN: HEADACHES, SEIZURES, FOCAL MOTOR DEFICITS, BEHAVIORAL CHANGES • LIVER; : TYPICALLY ASYMPTOMATIC, BUT MAY MANIFEST WITH NAUSEA, JAUNDICE ASCITES • ADRENAL GLAND: TYPICALLY ASYMPTOMATIC • BONES: BONE PAIN, ELEVATED SERUM ALKALINE PHOSPHATASE AND CALCIUM
- 13. DIAGNOSIS • SCREENING: ANNUALLOW-DOSE CT SCAN IN HIGH-RISK PATIENTS • INITIAL DIAGNOSTIC STEPS: DEPEND ON CLINICAL PRESENTATION PULMONARY OR EXTRAPULMONARY SYMPTOMS: OBTAIN LABORATORY STUDIES AND CHEST IMAGING TO ASSESS FOR UNDERLYING DISEASE. • BLOOD :FBC, U&E, LFT, CA, CLOTTING • SPUTUM CYTOLOGY :GOOD FOR SCLC AND SQUAMOUS • CT SCANS, WHICH USE X-RAYS TO CREATE CROSS-SECTIONAL IMAGES OF THE CHEST. • MRI SCANS . • PET SCANS, WHICH USE FLUORODEOXYGLUCOSE (FDG) INJECTED INTO THE BODY TO ILLUMINATE CANCER CELLS. IT’S ALSO USEFUL IN DETERMINING IF CANCER HAS SPREAD BEYOND THE INITIAL SITE.
- 14. ONCE A DOCTORDETERMINES THAT THERE IS REASON TO SUSPECT THAT THERE MAY BE CANCER (OR SOME OTHER CONDITION), HE OR SHE WILL ORDER FURTHER TESTING, WHICH MAY INCLUDE ONE OR MORE OF THE FOLLOWING PROCEDURES • BIOPSIES • BRONCHOSCOPY • ENDOBRONCHIAL ULTRASOUND • MEDIASTINOSCOPY • VIDEO-ASSISTED THORACOSCOPY (VAT) • WEDGE RESECTION IS SURGERY IS USED TO REMOVE A TRIANGULAR SECTION OF TISSUE, INCLUDING A NODULE OR TUMOR. IT MAY BE USED AS A DIAGNOSTIC PROCEDURE TO DETERMINE IF A SUSPICIOUS NODULE IS CANCEROUS
- 15. STAGES • SMALL-CELL LUNGCANCER STAGES : • LIMITED STAGE. IT’S IN JUST ONE LUNG AND POSSIBLY NEARBY LYMPH NODES. IT HASN’T SPREAD TO BOTH LUNGS OR PAST LUNGS. • EXTENSIVE STAGE. TUMOR HAS SPREAD TO OTHER AREAS OF LUNGS AND CHEST. IT MAY HAVE SPREAD TO THE FLUID AROUND LUNGS (CALLED THE PLEURA) OR OTHER ORGANS LIKE BRAIN.
- 16. • NON-SMALL-CELL LUNGCANCER STAGES • OCCULT STAGE: CANCER CELLS CAN BE PICKED UP IN THE MUCUS COUGH UPTUMOR CAN’T BE SEEN ON IMAGING SCANS OR A BIOPSY. IT’S ALSO CALLED HIDDEN CANCER OR STAGE ZERO. • STAGE 0: TUMOR IS VERY SMALL. CANCER CELLS HAVEN’T SPREAD INTO DEEPER LUNG TISSUES OR OUTSIDE STAGE I CANCER IS IN LUNG TISSUES BUT NOT LYMPH NODES. • STAGE II : THE DISEASE MAY HAVE SPREAD TO LYMPH NODES NEAR LUNGS. • STAGE III IT HAS SPREAD FURTHER INTO LYMPH NODES AND THE MIDDLE OF CHEST. • STAGE IV ( CANCER HAS SPREAD WIDELY AROUND BODY. IT MAY HAVE SPREAD TO BRAIN, BONES, OR LIVER.
- 17. TREATMENT • SURGERY • MAINLYFOR NON-SMALL CELL LUNG CANCER • CURATIVE ONLY IN T1 NON-SMALL CELL DISEASE • ABOUT 5-10% OF CASES. • CONTRAINDICATIONS • SVC OBSTRUCTION • TUMOUR WITHIN 2CM OF EITHER MAIN BRONCHUS (AS NOT ENOUGH RESECTION MARGIN FOR PNEUMONECTOMY) • SURVIVAL IMPROVED WITH ADJUVANT CHEMO • FOR SCLC THE MEDIAN SURVIVAL IS 16 MONTHS. FULL RESPONSE RATE IN 40-50%, PARTIAL IN A FURTHER 40%.
- 18. • CHEMOTHERAPY :INDICATION: MOST LUNG CANCERS • COMMONLY USED AGENTS: CISPLATIN PLUS A SECOND AGENT • RADIOTHERAPY HIGH DOSE RADIOTHERAPY CAN BE CURATIVE IN PATIENTS WITH SLOW-GROWING SQUAMOUS CARCINOMA CAUSES SOME (OFTEN ASYMPTOMATIC) PULMONARY FIBROSIS TARGETED THERAPY INDICATION: ADVANCED OR METASTATIC NON-SMALL CELL LUNG CANCER WITH A DEMONSTRATED ONCOGENIC MUTATION . • MECHANISM OF ACTION: TARGET UP-REGULATED PATHWAYS THAT CAUSE EXPRESSION OF THE MALIGNANT PHENOTYPE • IMMUNOTHERAPY INDICATIONS • LOCALLY ADVANCED OR METASTATIC NSCLC
- 19. FOLLOW-UP OF LUNGCANCER PATIENTS • DOCTOR VISITS AND TESTS: IN PEOPLE WITH NO SIGNS OF CANCER REMAINING, MANY DOCTORS RECOMMEND FOLLOW-UP VISITS (WHICH MAY INCLUDE CT SCANS AND BLOOD TESTS) ABOUT EVERY 3 MONTHS FOR THE FIRST COUPLE OF YEARS AFTER TREATMENT, ABOUT EVERY 6 MONTHS FOR THE NEXT SEVERAL YEARS, THEN AT LEAST YEARLY AFTER 5 YEARS.
- 20. REFERENCES • MERICAN LUNGASSOCIATION: “LUNG CANCER STAGING.” • LUNGCANCER.ORG: “TYPES AND STAGING OF LUNG CANCER.” • AMERICAN CANCER SOCIETY: “NON-SMALL CELL LUNG CANCER STAGES.” • NATIONAL CANCER INSTITUTE DICTIONARY OF CANCER TERMS. • HTTPS://OXFORDMEDICALEDUCATION.COM/RESPIRATORY/LUNG-CANCER/ • HTTPS://WWW.PHYSIO-PEDIA.COM/LUNG_ANATOMY • HTTPS://WWW.CHESTMED.THECLINICS.COM/ARTICLE/S0272-5231(11)00094- 3/FULLTEXT • HTTPS://WWW.CANCER.ORG/CANCER/LUNG-CANCER/CAUSES-RISKS- PREVENTION/WHAT- CAUSES.HTML#:~:TEXT=SMOKING%20TOBACCO%20IS%20BY%20FAR,OFTEN%20I NTERACTS%20WITH%20OTHER%20FACTORS.