lung cancer [autosaved].ppt

8/14/2019 Lung cancer [Autosaved].ppt

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Lung cancer

(types and presentation)

Presented byReem alssafar


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Bronchial carcinoma

.most common fatal lung malignancy account for 95% oflung cancer

.leading cause of cancer death.

.peak incidence occur between ages 55-65 years .

.there is a 3:1 male : female ratio.

.Aetiology :

- smoking is the most common aetiological factor. -others: passive smokers , exposure to asbestos,

chromium , iron oxide and products of coolcombustion


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Types:

There are 4 major types :

1- epidermiod [squamous] -35%2- adeno carinema -30%

3- large cell carcinoma -15%

4- small cell lung cancer -20%


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Epidermiod carcinoma -35% :

.occurs most frequently in men and old people

.usually starts on one breathing tubes.

.tend to be localized in the chest longer thanother types of lung cancer.

.does not tend to metastasize early.

.It is strongly associated with smoking.


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Adenocarcinnoma-30%:

.most common cancer among women.

.usually started near the outer edges of

the lung..Invasion of pleura and mediastinallymph node is common.

.may spread to other parts of the body.

.can be seen in non smoker.


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Small cell lung cancer:

.small cell lung cancer also called oatcellbecause SCLC cells have oat grain

appearance..It arises from endocrine cells [kulchitiskycells] where many hormones are secreted

.spread to lymph nodes and other organsmore quickly than NSCLC .


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.usually started in one larger breathing tube.

.Tend to grow rapidly .

.commonly has spread by the time and is

considered a systemic disease..It is the onlyone of the bronchialcarcinomas that respond to chemotherapy


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Local effects of tumor within the

bronchus :1- cough ( in 80% of cases ) :

- It is the most common early symptoms.

- sputum is purulant if there is sec. infection.

- A change in the character of the (regular cough)

associated with other new respiratorysymptoms increase the possibilityof B.C.


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2- Haemoptysis ( in 70% of cases) :

- Repeated episodes of scanty cough

hemoptysis or blood streaking ofsputum in smokers are highlysuggestive of B.C and should be

always investigated .


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3- Dyspnea ( 60% of cases ): - reflect occulusion of a large

bronchus resulting in collapse ofa lobe of the lung or developmentof plearal effusion.

4- Plearal pain : reflect malignant invasion of thepleura or reflect infection distal to atumuor (wich is recurrent and fail to

resolve).


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Direct spread:

.Involvement of pleuraand ribs .

.Pancoasts tumour:

-involvement of lower part of the brachial plexus( C8 , T1,T2) causing severe pain of theshoulder and down inner surface of the arm.

-Horner syndrom: due to involvement of thesympathetic ganglion.


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-recurrent laryngeal nerve palsy:causing unilateral vocal cord paresiswith hoarsness of voice and a bovine

cough.

.Invation of phrenic nerve , causingparalysis of the diaghragm.


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.Involvement of esophagus , causingdysphagia.

.Cardiovascular:atrial fibrillation,temponade ,pericarditis ,pericardialeffusion .


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.Superior vena cava obstructioncausing early morning headache,facial congestion and edemainvolving

the upper limb, distention of jugularvein and veins of the chest.


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Nonmetastatic extra pulmonary

manifistation:1- Endocrine manifestation:

12% of tumors ,in particular small celltumors present with SIADH, ACTHsecretion(SCLC),

hypercalcemia(sq.cell carcinoma),bone metastasisgynaecomastia(LCLC) .


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2- Neurological manifetation:

e.g: sensory polyneuropathy,myelopathy, cerebellardegeneration.


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3- Others:

Digital clubbing , hypertrophicpulmenaryosteo-arthropathy(sq.cell cancer),nephrotic syndrom, DIC,hypercoagulopathy(adenocarcinoma),

,thrombophelibitis migricans.


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Blood borne metastasis:

.Bony metastasis giving severe bony painand pathalogical fractures.

.liver metastasis (Jundice)

.Brain metastasis (change in personality,epilpsy,focalneurological symptoms).


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Physical signs:

Examination is usually normal unlessthere is significant bronchial

obstruction or tumor has spread topleura or mediastinum.


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1- physical signs of collapse (in largeobstructing tumor) which may rise to

pneumonia.2- monophonic or unilateral wheeze (fixed

bronchial obstruction).

3- stridor (obstruction at or above the leverof main carina.


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6- physical signs of pleursy or pleuraleffusion (involvement of pleura).

7- bilateral engorgement of the jangularvein and later edema affecting face,neck, arms.

8- tenderness and pain of long bone andjoints (HPOA).


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Management

Investigation:

. Sputum cytology: high yield for

endobronchial tumors such assquamous cell and small cellcarcinoma.


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4- pleural effusion .

5- broadening of the mediastinum,

enlarged cardiac shadow, elevation

of hemidiaphram.

6- rib distruction.


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.CT thorax and upper abdomen.

.Head CT scan.

.Radio nuclide bone scanning.

.liver US.

.bone marrow biobsy.


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Treatment:

1- surgery: in patient with localized diseaseand non-small cell cancer.

2- solitary pulmonary nodule ,resection if :

1- age 35 2-segarette smoking. 3- large (>2 cm) lesion. 4-lack of cacification.

5-chest symptoms.

6- growth of lesion compared old CXR.


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4- small cell lung cancer : combination

chemotherapyis standard mode of

therapy with long-term survival.

5- laser obliterationof tumor though

bronchoscopy in presence ofbronchial obstruction.


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6- Radio therapyfor brain metastasis,

spinal cord comprission, symptomatic

mass, bone lesion.

7- Encourage cessation of smoking.


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References:

-Parveen Kumar and Michael Clark,clinicalmedicine.fourth edition.

-Davidsons;principles and practice ofmedicine ;19THedition.

-R.R Baliga, 250 cases in clinicalmedicine,international edition.

-R.A.Hope, etal;Oxford hand book of clinicalmedicine,4THedition


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Thank you

lung cancer [autosaved].ppt

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