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

• 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/

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 Risc Factors

• Tobacco, hookah smoke

• Secondhand smoke
• Asbestos
• Radon
• Diesel exhaust
• Family history
• Others

http://www.lung.org/

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 Types of Bronchogenic Cancer
• Non-small-cell lung cancer (NSCLC)

• Adenocarcinoma • Squamous-cell • Large-cell carcinoma

(~40%) carcinoma (~30%) (~10%)

Hermes School 2014 Lung cancer

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 Types of Bronchogenic Cancer

• Small-cell lung cancer

(SCLC) (~20% in
Germany, ~13-
20% in USA)

SCLC

Hermes School 2014 Lung cancer

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Genetic abnormalities

Hermes School 2014 Lung cancer

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TNM and Staging

Hermes School 2014 Lung cancer

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 When a lung cancer should be
suspected ?
Lung Tissues Invasion Tumor Compression Symptoms
Horner’s Syndrome
Cough 40 –75 %

Haemoptysis 15–35 % Shoulder and Arm Pain

Dyspnoea 30 –40% Hoarseness

Chest Pain 5%
Dysphagia 2%
Post obstructive Stridor 2%
Pneumonia- 25% Superior vena cava syndrome

Clubbing 20% Non-specific Symptoms

Weight loss 8%
Pleural Effusion Generalized Weakness 10%
NICE Clinical Guidelines, No. 27
 When a lung cancer should be
suspected ?
Systemic Paraneoplastic Syndromes

Endocrine Hematologic Neurologic

Hypercalcemia of malignancy Granulocytosis Subacute Sensory

25% Neuropathy
Hyponatriemia of malignancy
Trombocytosis Encephalomyelitis
Ectopic ACTH production 40%
Paraneoplastic cerebellar
Ectopic production of growth Thrombembolism Degeneration
hormone-releasing hormone 20%
Lambert-Eaton Syndrome
Fishman, Fisman’s Pulm Deas and Disordes, 2008
 Lung Cancer Metastasis

Brain 50% Lung 50% Bone 30-40 Liver 30% Adrenal Gland 30%

Movsas et al: Cancer Management , May 01, 2014

 Radiological signs suggestive for LC

Solitary Pulmonary
nodule Lung Mass Pancoast Tumor

Parker et al Thoracic Imaging , 2014

 Radiological signs suggestive for LC
Mass lesion Central Mass
with Cavitation Golden S Sign 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 diagnosis
Central lesions
washing - 48% ◼
brushing - 59% ◼
BAL 35%- 69% ◼
flexible bronchoscopy, 3 direct forceps biopsies 74 % ◼
!!! overall Sn for flexible bronchoscopy 88%.

Peripheral lesions
Bronchoscopy <2 cm- Sn 33%
>2 cm- Sn 62%
BAL : 11%

EBUS/+EUS provides access to all ◼

mediastinal lymph node stations
!!! diagnostic accuracy similar to mediastinoscopy
Semenzato 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
Fishman, Fisman’s Pulm Deas and Disordes, 2008
Surgical biopsy ◼ Hirai S, Ann Thorac Cardiovasc Surg .2006 Dec;12(6):388-92 .
Mortality - 3 to 7 percent
 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 Nodule
Sensitivity- 97%
Specificity-78%

PET negative LC
Nodule size <1 cm
Nodule attenuation (sub solid)

Nodal (N) disease

Sensitivity- 85%
Specificity- 90%

Metastatic (M) disease

Pleural 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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