lung cancer - pneumologie.usmf.md
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Lung Cancer
Bronchial carcinoma
most common fatal lung malignancy account for 95% of lung cancer
leading cause of cancer death.
peak incidence occur between ages 55-65 years .
there is a 3:1 male : female ratio.
Epidemiology
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• Lung cancer is now the leading cause of cancer deaths worldwide in both men and women.
• 90% related to cigarette smoking (since 1876).
• Smokers have a 10 times higher risk than nonsmokers
http://www.lung.org/
Risc Factors
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• Tobacco, hookah smoke • Secondhand smoke• Asbestos• Radon• Diesel exhaust• Family history• Others
http://www.lung.org/
Types of Bronchogenic Cancer
• Non-small-cell lung cancer (NSCLC)
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• Adenocarcinoma(~40%)
• Squamous-cellcarcinoma (~30%)
• Large-cell carcinoma (~10%)
Hermes School 2014 Lung cancer
Types of Bronchogenic Cancer
• Small-cell lung cancer (SCLC) (~20% in Germany, ~13-20% in USA)
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SCLC
Hermes School 2014 Lung cancer
Genetic abnormalities
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Hermes School 2014 Lung cancer
TNM and Staging
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Hermes School 2014 Lung cancer
When a lung cancer should be
suspected ?Lung Tissues Invasion Tumor Compression Symptoms
Cough 40 –75 %
Haemoptysis 15–35 %
Dyspnoea 30 –40%
Chest Pain 5%
Post obstructive
Pneumonia- 25%
Clubbing 20%
Pleural Effusion
Horner’s Syndrome
Shoulder and Arm Pain
Hoarseness
Dysphagia 2%
Stridor 2%
Superior vena cava syndrome
NICE Clinical Guidelines, No. 27
Non-specific SymptomsWeight loss 8%
Generalized Weakness 10%
When a lung cancer should be
suspected ?
Systemic Paraneoplastic Syndromes
Endocrine Hematologic Neurologic
Hypercalcemia of malignancy
Hyponatriemia of malignancy
Ectopic ACTH production
Ectopic production of growth
hormone-releasing hormone
Granulocytosis
25%
Trombocytosis
40%
Thrombembolism
20%
Subacute Sensory
Neuropathy
Encephalomyelitis
Paraneoplastic cerebellar
Degeneration
Lambert-Eaton Syndrome
Fishman, Fisman’s Pulm Deas and Disordes, 2008
Lung Cancer Metastasis
Brain 50% Bone 30-40 Liver 30% Adrenal Gland 30%
Movsas et al: Cancer Management , May 01, 2014
Lung 50%
Radiological signs suggestive for LC
Solitary Pulmonary
noduleLung Mass Pancoast Tumor
Parker et al Thoracic Imaging , 2014
Radiological signs suggestive for LC
Golden S SignMass lesion
with Cavitation
Central Mass
with Atelectasis
Chest CT
◼Best to define the primary
tumor
◼Chest wall, mediastinal or
vertebral invasion
◼Mediastinal lymph node
detection
◼Hilar node disease◼
Parker et al Thoracic Imaging , 2014
Bronchoscopy as the most important
method of confirming the diagnosisCentral lesions
◼washing - 48%
◼brushing - 59%
◼BAL 35%- 69%
◼flexible bronchoscopy, 3 direct forceps biopsies 74 %
!!! overall Sn for flexible bronchoscopy 88%.
Peripheral lesionsBronchoscopy <2 cm- Sn 33%
>2 cm- Sn 62%
BAL : 11%
◼EBUS/+EUS provides access to all
mediastinal lymph node stations
!!! diagnostic accuracy similar to mediastinoscopySemenzato G,Respiration. 1992;59 Suppl 1:44-6
De Gracia et al. Amer Review of Resp Dis, Vol. 147, No. 3 (1993), pp. 649-652
Movsas et al: Cancer Management , May 01, 2014
Methods for lung sampling in patient with
peripheral or small lesions
◼Transthoracic Needle Aspiration (TTNA)- under fluoroscopic, ultrasound or CT guidance
- as the initial procedure in peripheral lesions
- in lesions < 2 cm in diameter
Sensitivity- 90%
◼!!! high rate of pneumothorax (10–35%)
◼Video-assisted thoracic surgery (VATS)
Sensitivity and Specificity 100%
- minimal morbidity and mortality
◼Surgical biopsyMortality - 3 to 7 percent
Fishman, Fisman’s Pulm Deas and Disordes, 2008
Hirai S, Ann Thorac Cardiovasc Surg .2006 Dec;12(6):388-92.
Diagnostic performances of
sputum cytology
3 daily sputum cytologies
Overall Sensibility - 52%
central lesions 71%
peripheral lesions 5%
induced sputum
Movsas et al: Cancer Management , May 01, 2014
Khajotia RR, Lancet.1991 Oct 19;338(8773):976-7
PET/CT
Solitary Pulmonary NoduleSensitivity- 97%
Specificity-78%
PET negative LCNodule size <1 cm
Nodule attenuation (sub solid)
Nodal (N) diseaseSensitivity- 85%
Specificity- 90%
Metastatic (M) diseasePleural Sn-100% Sp-78 %
Bone Sn-91% Sp-96 %
Adrenal Sn-98% Sp-92 %Gould Ann Int Med 2003; 139, 879-892
Types ot treatment
SCLC
1. Chemotherapy in most cases the initial response is good
2. Radiotherapy for limited cases and prophylactics
NSCLC
1. Surgery is most effective (I-III stage)
2. Chemotherapy after
3. Radiotherapy is not very effective
Aupe.rin A, et al. (2010). J Clin Oncol; 28: 2181–2190.
International Association for the Study of Lung Cancer. www.iaslc.org
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Target therapy NSCLC
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