LUNG CANCER

LUNG CANCER
PRESENTED
Guide BY
BY:-:  SUPERVISOR:
PRESENTED BY:-
MOHAMMED KAREEM 
Dr. S.D.Patil DR.AMEER
Mr. Chandrakant S.More
MUSTAFAH.O.D
QAHTAN  M.Pharmacy ,
ALI JALIL
Department of Clinical Your text here 3 Department of Clinical
Pharmacy Pharmacy
(Sem-2)

R.C.PATEL INSTITUTE OF PHARMACEUTICAL

EDUCATION AND RESEARCH ,SHIRPUR

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 Contents
 Introduction

 Types of lung cancer

 Causes of lung cancer

 Symptoms of lung cancer

 Pathophysiology

 Stages of lung cancer

 Diagnosis

 Treatment

 References

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Lung Cancer-

Definition:-

Lung cancer is a solid tumor originating from bronchial epithelial cells. This
distinguishes between non-small cell lung cancer (NSCLC) and small cell lung cancer
(SCLC) because they have different natural histories and responses to therapy.

• Lung cancer, also known as lung carcinoma, is a malignant lung

tumor characterized by uncontrolled cell growth in tissues of the

lung.

• This growth can spread beyond the lung by the process of metastasis into
nearby tissue or other parts of the body.

• Most cancers that start in the lung, known as primary lung cancers, are
carcinomas.

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Types of lung cancer-

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1. Non-small cell lung cancer (NSCLC) :
• Most common type

• About 80-85% are NSCLC

• Grows more slowly

 It is further classified into the following:-

A. Epidermoid carcinoma or Squamous cell carcinoma:

• 30-35% of lung cancer

• Arise from bronchial epithelium

• Cavitation may also occur

• Slow growth, metastasis not common.

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B. Adenocarcinoma:
• 25-30% of lung cancer

• Arise from bronchiole mucus gland

• Slow growth,

• Rarely cavity

• Strongly linked to cigarette smoking

C. Large cell carcinoma:

• 10-20% of lung cancer

• Cavitation common

• Slow, metastasis may occur to kidney,

liver and adrenals

• May be located centrally, mid lung or

peripherally

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2. Small cell carcinoma :
It generally starts in one of the larger breathing tubes, grows fairly rapidly, and is

likely to be large by the time of diagnosis.

• Spreads more quickly and aggressively

• Accounts for 15% of cases

• Found mostly in heavy smokers

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STAGES OF LUNG CANCER

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 DAIGNOSIS:-
Medical history and physical exam:-
• Blood tests:-
 A complete blood count (CBC):- looks at whether patient blood has normal
numbers of different types of blood cells.
 Blood chemistry tests:- can help spot abnormalities in some of patient organs,
such as the liver or kidneys. For example, e.g. high level of lactate dehydrogenase
(LDH).

• IMAGING TESTS:-
i) Chest x-ray
▫ This is often the first test will do to look for any abnormal areas in the lungs.
ii) Computed tomography (CT) scan:-
• A CT scan uses to make detailed cross-sectional images of patient body.
• can show the size, shape, and position of any lung tumors and can help find
enlarged lymph nodes
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iii) CT-guided needle biopsy:

• If a suspected area of cancer is deep within patient body, a CT scan can

be used to guide a biopsy needle into the suspected area .

iv) Positron emission tomography (PET) scan:-

• For this test, a form of radioactive sugar (known as FDG) is injected

into the blood.

• This radioactivity can be seen with a special camera. PET/CT scan.

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v) Needle biopsy:- can often use a hollow needle to get a small sample

from a suspicious area (mass).

• fine needle aspiration (FNA) biopsy,

• core biopsy.

vi) Bronchoscopy:-

• Bronchoscopy can help the find some tumors or blockages in the

lungs.

vii) Thoracoscopy:-

• spread to the spaces between the lungs and the chest wall, or to the

linings

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 Treatment Management:
 Treatment of small cell lung carcinoma:-

• Depending on the stages of the cancer and other factors, treatment of SCLC are –

1) Chemotherapy

2) Radiation therapy

3) Surgery

4) Supportive therapy

5) Palliative treatments can also be used to help with symptoms.

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1. Supportive therapy

• Smoking caseation advice, counselling and pharmacotherapy

• Syndromes inappropriate ADH

i. Fluid restriction

ii. Saline infusion

iii. Antineoplastic therapy

iv. Demeclocyline

v. Vasopressin receptor inhibitor

• Cushing syndrome treated priorly

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2. Surgical treatment

• Stage 1 (T1-2, N0) is eligible for surgical resection, excess stage 1

has no benefits, after initial evaluation.

• Prior to surgery, all patients must undergo mediastinoscopy to rule

out occult nodal diseases

• Patient who undergoes complete resection must undergo post

operative chemotherapy.

• Patient with nodal mediastinal diseases must have chemotherapy

and mediastinal radiation therapy.

• PCI (prophylactic cranial irradiation) is recommended after

chemotherapy but is contraindicated in poor PS or impaired
neurocognitive functions.
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3. Chemotherapy for SCLC:-
• for lung cancer Chemotherapy (chemo) is treatment with anti-cancer
drugs injected into a vein or taken by mouth.
• Limited stages (max 4-6 cycles) --
i. Cisplatin 60mg day 1 + etoposide 120mg days 1,2,3

ii. Cisplatin 80mg day 1 + etoposide 100mg days 1,2,3

iii. Carboplatin AUC 5-6 day 1 + etoposide 100mg days 1,2,3

iv. During systemic therapy + RT, Cisplatin+ etoposide is recommended.

• Extensive therapy (max 4-6 cycles) --
i. Cisplatin 75mg day 1 + etoposide 100mg days 1,2,3

ii. Cisplatin 80mg day 1 + etoposide 80mg days 1,2,3

iii. Carboplatin AUC 5-6 day 1 +etoposide 100mg days 1,2,3

iv. Cisplatin 25mg days 1,2,3 + etoposide 100mg days 1,2,3

v. Carboplatin AUC 5 day 1 + irinotecan 50 mg days 1,8, 15

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4. Radiation therapy for SCLC
• Depending on the stage of small cell lung cancer (SCLC) and other factors,

radiation therapy might be used in several situations:

• In limited stage SCLC, radiation therapy can be given at the same time

as chemotherapy . Giving chemo and radiation together is called concurrent

chemoradiation. The radiation may be started with the first or second cycle of

chemo.

Dose and schedule:

• For limited stages, 45 Gy in 3 to 5 weeks. (1.5 to 1.8 Gy daily)

• There should be at least 6 hours interval to allow repair of normal tissue

Types of radiation used:

a) EBRT (external bean radiation therapy)

b) 3D CRT (3D conformal radiation therapy)

c) IMRT (intensity modulated radiation therapy)

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 Treatment for NSCLC

• Depending on the stage of the cancer and other factors treatment

include:

1) Surgery.

2) Radiofrequency ablation (RFA).

3) Radiation therapy.

4) Chemotherapy.

5) Targeted therapies.

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 1. Surgical treatment for NSCLC
 Lobectomy:

In this surgery, the entire lobe

containing the tumor is removed.

 Segmentectomy or wedge resection:

In these surgeries, only part of a lobe

is removed. This approach might be

used, for example, if a person doesn’t

have enough lung function to

withstand removing the whole lobe.

 Pneumonectomy:

This surgery removes an entire lung.

This might be needed if the tumor is

close to the center of the chest. 22

2. Radiofrequency ablation for NSCLC-
• RFA uses high-energy radio waves to heat the tumor.

• A thin, needle-like probe is put through the skin and moved in until the

tip is in the tumor.

• Placement of the probe is guided by CT scans. Once the tip is in place, an

electric current is passed through the probe, which heats the tumor and

destroys the cancer cells.

• RFA is usually done as an outpatient procedure, using local anesthesia.

3. Radiation therapy for NSCLC-

• There are 2 main types of radiation therapy:

1. External beam radiation therapy

2. Brachytherapy (internal radiation therapy)

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3. Radiation therapy for NSCLC
• In early stages (stage 1, 2a) SABR is recommended

• Locally advanced NSCLC (stage2-3) sequential chemotherapy + radiation

therapy

• Advanced metastatic NSCLC, definitive local radiation therapy to isolated

and limited metastatic sites.

4. Chemotherapy for NSCLC-

A. First line therapy

B. Maintenance therapy

C. Subsequent therapy

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A. First line therapy:-

• Cisplatin + pemetrexed

• Cisplatin + gemcitabine

• Response assessed after 2 cycles, then 2-4 cycles with CT of known sites

B. Maintenance therapy:-

• Use of one of the first line drug for 4-6 cycles in there is no progression of

disease

• Use different drug if there is progression

C. Subsequent therapy:-

• Response assessment with CT of know sites for 6-12 weeks

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5. Targeted therapy for NSCLC
• For tumors to grow, they need to form new blood vessels to keep them

nourished. This process is called angiogenesis. Some targeted drugs,

called angiogenesis inhibitors, block this new blood vessel growth:

• Bevacizumab (Avastin) is used to treat advanced NSCLC. It is a

monoclonal that targets vascular endothelial growth factor (VEGF), a

protein that helps new blood vessels to form. This drug is often used

with chemo for a time.

• Ramucirumab (Cyramza) can also be used to treat advanced NSCLC.

VEGF has to bind to cell proteins called receptors to act. This drug is a

monoclonal antibody that targets a VEGF receptor.

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REFERENCES
1) JOSEPH T. DIPIRO, pharmacotherapy handbook 7th edition.

2) Joyce M Black Jane Hokanson Hawks “ Medical surgical Nursing ” 7th edition

volume no 7 Elsevier publications page number :1814-1828.

3) Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on

nutrition and physical activity for cancer prevention: Reducing the risk of cancer

with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30-67.

4) K.D.TRIPATHI , essential of medical pharmacology 6th edition 2003, jaypee

publication.

5) HARSH MOHAN, textbook of pathology

6th edition 2010, jaypee publication.

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