carcinoma bronchus

Dr shaista khan

AETIOLOGYTobacco:Latent period of 10-30 yearsThe primary determinants are:Number of cigarettes consumedAge of onset of smoking (those under 16 years of age

at start have irreversible damage to their bronchial genetic makeup

Length of time of smokingType of tobacco (cigarettes or pipe, filter or non-filter)Passive exposure to tobacco smokeAsbestos exposure Irradiation Toxic metals Certain chemicals

Types of bronchial carcinoma:

Squamous cell carcinoma (SCC) Adenocarcinoma Small cell carcinoma (oat cell carcinoma) Alveolar cell or bronchoalveolar carcinoma

Squamous cell carcinoma:60% of all lung tumors Associated with smoking and is rare in non-

smokers Squamous metaplasia -> carcinoma in situ ->

invasive carcinoma

Adenocarcinoma:15% of lung tumours Has a tendency to be more peripheral,

arising in the small bronchial glands Most common in women Is the type seen in non-smokers

Small cell (oat cell) carcinoma:20% of lung tumours Arises from the chromaffin cells Highly malignant Hormone production by the tumour is

common A benign form of a small cell carcinoma is a

carcinoid tumour

Alveolar cell carcinoma:5% of lung tumours Arises in the distal airways Often diffuse, multifocal and bilateral Resistant to radio-/chemotherapy Very poor prognosis

TNM STAGING (T)T1 - tumorDiameter of 3 cm or smaller and surrounded

by lung or visceral pleura or endobronchial tumor distal to the lobar

bronchus

T2 - tumorGreater than 3 and smaller than 7 cm Invasion of the visceral pleura Atelectasis or obstructive pneumopathy

involving less than the whole lung Tumor involving the main bronchus 2 cm or

more distal to the carina.

T3 - tumorTumor with atelectasis or obstructive

pneumonitis of the entire lung Tumor in the main bronchus within 2 cm of the

carina but not invading it Tumor of any size with invasion of non-vital

structures such as the chest wall, mediastinal pleura, diaphragm, pericardium.

Separate tumour nodules in the same lobe as the primary tumor.

T4 - tumorInvasion of vital mediastinal structures: fat,

heart, trachea, esophagus, great vessels, recurrent laryngeal nerve, carina.

Invasion of vertebral body. Malignant pleural or pericardial effusion

(cytologically proven). Separate tumour nodule(s) in a different

ipsilateral lobe to that of the primary tumor.

Lymph nodes (N)

N1 - NodesN1-nodes are ipsilateral nodes within the

lung up to hilar nodes.N1 alters the prognosis but not the management.

N 2 NODES.Nodes in the ipsilateral mediastinum

N3 - NodesN3-nodes are clearly unresectable.

These are contralateral mediastinal or contralateral hilar nodes or any scalene or supraclavicular nodes.

CALCIFICATION

FDG UPTAKE

STAGE ??

STAGE ??

PANCOAST TUMOR

OPERABLE OR NOT?

THANKS