Respiratory System

Week 9
Student’s Outcomes
• Describe the anatomy of the respiratory
passages from the nose to alveoli
• Describe the structure of the lungs
• Define respiratory membrane
• Identify & Classify lung pathology
Process of Respiration
• Ventilation or breathing
• Movement of air into and out of the lungs
• Gaseous exchange
• Exchange of O2 and CO2 in the lungs and the blood
• Transport of O2 and CO2 in the blood
• Exchange of O2 and CO2 between blood and tissues
Breathing
• Rid the body of potential toxic CO2
• Regulated blood pH
• By changing blood CO2 levels
• Voice production
• Air movement in the vocal cords makes sound & speech possible
• Olfaction
• Sensation of smell occurs when airborne molecules are drawn into the nasal cavity
• Innate immunity
• Prevent microorganisms & pathogens to enter the body & by removing them from
respiratory surfaces
Respiratory System
• Upper respiratory tract
• External nose, nasal cavity &
pharynx
• Lower respiratory tract
• Larynx, trachea, bronchi & lungs
External nose
• Visible structure that forms a
prominent feature of the face
• Most is composed of hyaline
cartilage
• The bridge is composed of a
bone
Nares
• External opening of the nose
Nasal Choanae
• Openings into the pharynx
Nasal cavity
• Extends from the nares to the
concahe
Nasal septum
• Partition
• Dividing the nasal cavity into
right and left
Deviated Nasal Septum
• Occurs whens the septum bulges
to one side
Hard Palate
• Forms the floor of the nasal
cavity
• Separate nasal cavity from the
oral cavity
Nasal Conchae
• Prominent bony ridges
• Present on the lateral walls of
each side of the nasal cavity
Nasal Chonchae
• Increase the nasal area of the
nasal cavity
• Cause the air to churn, so that it
can be cleansed, humidified &
warmed
PNS
• Air-filled spaces within bone
• Includes
• Maxillary
• Frontal
• Ethmoidal
• Sphenoidal
• Open into the nasal cavity
• Lined with mucous membrane
• Reduce the weight of the skull
• Produce mucous
• Influence the quality of voice by acting as
resonating chamber
Nasolacrimal ducts
• Carry tears from the eyes
• Open into the nasal cavity
• Sensory receptor for the sense
of smell
• Located in the superior part of
the nasal cavity
Sneeze Reflex
• Dislodge foreign body from the
nasal cavity
• During the sneeze reflex the
uvula and soft palate are
depressed
• Air are directed through nasal
passage
• Considerable amount passes
through oral cavity
Photic Sneeze Reflex
• 17-25% of People
• Stimulated by exposure to bright
light
• Called ACHOO
• Autosomal-dominant
Compelling-helio-ophthalmic-
outburst
 Pharynx
• Common passageway for both respiratory &
digestive system
• 3 regions
• Nasopharynx
• Superior part
• Post to chonae
• Superior to soft palate (floor )
• Oropharynx
• Uvula to epiglottis
• Lined w/ stratified squamous epithelium (protect
abrasion)
• 2 sets of tonsil (lateral wall)
• 1 ligual tonsil post. tongue
• Laryngophaynx
• Epiglottis to esophagus
• Allows small amount of air during swallowing
• Lined w/ stratified squamous epithelium & cioliated
columnar epithelium
Larynx
• Anterior throat
• Base of tongue to trachea
• Consist of 9 cartilage
• 3 unpaired
• Thyroid cartilage (Largest)
• Cricoid (most inferior)
• Epiglottis (elastic, prevent
swallowed material to enter
trachea)
• 6 of them form 3 pairs
6 paired cartilage
• Cuneiform
• Top on each side
• Corniculate
• Middle
• Arytenoid
• Bottom
• Articulate w/ cricoid inferiorly
• Forms an attachment site for the
vocal cords
Vocal folds
• Primary source of vocal
production
• Air passing causes them to
vibrate
• Muscles controls the length &
tension
Laryngitis
• Inhibits voice production
Trachea
• Windpipe
• Membranous tube attached to the
larynx
• Lined w/ Connective tissue & smooth
muscles
• 16-20 C shaped hyaline cartilages
• Anterior & lateral, Protect & maintain
passage of air
• Post- no cartilage, ligamentous
membrane
• Adult 1.4-1.6 cm diameter, 10-11 cm
long
• Divides from L & R primary brochus
Bronchi
• Connect to the lungs
• Left is more horizontal ( bec. Of
the heart)
• Foreign object usually lodge at
the (R ) bronchus, wider, shorter,
more vertical, direct line
• Lined w/ pseudostratified
columnar epithelium
• Support w/ C-shape cartilages
Lungs
• Principal organ of respiration
• Cone shaped, base resting on
diaphragm
• Apex, extending superiorly to
clavicle for about 2.5 cm
• (R ) has 3 lobes, separated by deep,
prominent fissure
• Lobes are divide into
bronchopulmunary segments,
separated by connective tissue septa
Bronchial Tree
• Each bronchus divides into lobar
bronchi
• Lobar bronchi ( 2ndary segment) Trachea

• 2 (L) lung
• 3 # (R ) lung
Primary
• Give rise to Segmental Bronchi bronchi

( tertiary bronchi)
• Continue to branch as bronchioles Secondary
bronchi
• Subdivide to terminal bronchioles
• Which subdivided into respiratory Tertiary
bronchi
bronchioles
Alveolar sac and Ducts
• Each bronchioles subdivided into
alveolar ducts
• With many open door ways to
alveoli, which are small air sacs
• Alveolar duct ends as 2 or 3
alveolar sacs
• There are about 300 million
alveoli in the lungs
 Respiratory Membrane
• Gas exchange between air and blood
takes place
• 6 layers
1. A thin layer of fluid lining the alveolus
2. The alveolar epithelium, composed of
simple squamous epithelium
3. The basement membrane of the
alveolar epithelium
4. A thin interstitial space
5. The basement membrane of the
capillary endothelium
6. The capillary endothelium, composed
of simple squamous epitheliu,m
Pleural Cavities
• Mediastinum
• midline partition formed by the
heart, trachea, esophagus, and
associated structures, separates
the pleural cavities
• Parietal pleura
• covers the inner thoracic wall, the
superior surface of the diaphragm,
and the mediastinum
• Visceral pleura
• covers the surface of the lung
Pleural Cavity
• filled with pleural fluid
• acts as a lubricant, allowing the
parietal and visceral pleural
membranes to slide past each
other as the lungs and the
thorax change shape during
respiration
• Helps hold the parietal and
visceral pleural membranes
together
2 Lymphatic Supply
• The superficial lymphatic vessels
• are deep to the visceral pleura and
function to drain lymph from the
superficial lung tissue and the visceral
pleura.
• Deep lymphatic vessels
• follow the bronchi and function to drain
lymph from the bronchi and associated
connective tissues.
• No lymphatic vessels are located in the
walls of the alveoli.
• Both the superficial and deep
lymphatic vessels exit the lung at the
hilum.
• oxygenated blood
• Blood that has passed through the lungs
and picked up oxygen
• Brings oxygenated blood to the tissues
• from the thoracic aorta through
bronchial arteries to capillaries, where
oxygen is released
• Deoxygenated blood
• released some of its oxygen
• Flows through pulmonary arteries to
pulmonary capillaries
• becomes oxygenated, and returns to the
heart through pulmonary veins
Ventilation
• Process of moving air into and
out of the lungs
• requires a pressure gradient
from the outside of the body to
the alveoli
• airflow from the lungs requires
• a pressure gradient in the
opposite direction
Physics of airflow in tubes
• F is airflow
• P1 is pressure at point one,
• P2 is pressure at point two, and
R is resistance to airflow.
• When P1 is greater than P2, gas
flows from P1 to P2 at a rate
that’s proportional to the
pressure difference.
Pulmonary Volumes and
Capacities
Tidal volume
• volume of air inspired or expired
during a normal inspiration or
expiration (approximately 500
mL).
Inspiratory reserve volume
• amount of air that can be
inspired forcefully after
inspiration of the normal tidal
volume (approximately 3000
mL).
Expiratory reserve volume
• amount of air that can be
forcefully expired after
expiration of the normal tidal
volume (approximately 1100
mL).
Residual volume
• volume of air still remaining in
the respiratory passages and
lungs after the most forceful
expiration (approximately 1200
mL).
• Residual air is important to
ensure that there is always some
air in the lungs , so that exchange
of gases is a continuous process,
even between breaths.
 Pulmonary capacities
Are the sum of two or more pulmonary volumes
Inspiratory capacity
• the tidal volume plus the
inspiratory reserve volume,
which is the amount of air that a
person can inspire maximally
after a normal expiration
• (approximately 3500 mL).
Functional residual capacity
• is the expiratory reserve volume
plus the residual volume,
• which is the amount of air
remaining in the lungs at the end
of a normal expiration
• (approximately 2300 mL).
Vital capacity
• the sum of the inspiratory
reserve volume, the tidal
volume, and the expiratory
reserve volume,
• which is the maximum volume of
air that a person can expel from
the respiratory tract after a
maximum inspiration
• (approximately 4600 mL)
Total lung capacity
• sum of the inspiratory and
expiratory reserve volumes plus
the tidal volume and the residual
volume
• (approximately 5800 mL).
Minute ventilation or Minute respiratory
volume (MRV
• the total amount of air moved into and out of
the respiratory system each minute,
• and it is equal to tidal volume times the
respiratory rate.
• is calculated by multiplying tidal volume by the
number of respirations per minute (average
range: 12 to 20 per minute).
• If tidal volume is 500 mL and the respiratory rate
is 12 breaths per minute, the MRV is 6000 mL, or
6 liters of air per minute, which is average.
• Shallow breathing usually indicates a smaller
than average tidal volume and would thus
require more respirations per minute to obtain
the necessary MRV.
Respiratory rate, or Respiratory frequency
• number of breaths taken per
minute.
• Because resting tidal volume is
approximately 500 mL
• and respiratory rate is
approximately 12 breaths per
minute, minute ventilation
averages
• approximately 6 L/min.
Respiratory Failure
Respiratory Failure
• Is a term used to describe lack of respiratory
function or oxygen and carbon dioxide
exchange
• This can occur in two levels
• Within the lungs- intrapulmonary gas
exchange
• Hypoxemia- low oxygen levels within arterial
blood and caused by toxic gas or smoke
inhalation, high altitudes, hypoventilation,
or impaired diffusion
• Result of impaired breathing- inability
to move air in and out of the lungs.
• Hypercapnia- inability to move air into and
out of the lungs, with consequent increased
in blood carbon dioxide content.
Congenital & Hereditary
Diseases
Cystic Fibrosis
• A generalized disorder resulting from a
genetic defect transmitted as an
autosomal recessive gene that affects the
function of the exocrine glands.
• It involves many organs in addition to
respiratory system, and nearly all exocrine
glands are affected
• Lungs are histologically normal at birth,
pulmonary damage is gradually initiated
by increasing secretions from hypertrophy
of bronchial glands, leading to obstruction
of the bronchial system.
• The signs & symptoms are:
• Chronic cough- accompanied by sputum,
gagging, vomiting and disturbed sleep.
• Wheezing – with recurrent of chronic
pulmonary infection
Cystic Fibrosis
• Progress into:
• Barrel-chest deformity
• Clubbing of the fingers
• cyanosis
• Adult pulmonary complications are associated with;
• Pneumothorax
• Hemoptysis
• ( R ) sided heart failure secondary to pulmonary hypertension
• Radiographs taken over a period of years demonstrate
gradually worsening structural abnormalities.
• Early changes of bronchial thickening & hyperinflation
progress to:
• Extensive bronchiectasis
• Cyst formation
• Lobar atelectasis
• Scarring
• Pulmonary artery & ( R ) ventricular enlargement
• Over inflation of the lungs and chest wall Barrel-chest deformity
Cystic Fibrosis
• Respiratory failure resulting from
deterioration of the lungs is inevitable and
eventually leads to death in the late 2o’s to
early 30’s
• Treatment methods include;
• Antimicrobial drugs- to combat infection
• Bronchial dilators- administered through inhalers
• Respiratory physical therapy
• Development of pneumothorax can be
treated by closed chest tube thoracostomy
• Massive or recurrent hemoptysis is treated
by embolizing involved bronchial arteries
Hyaline Membrane Disease
• Also known as (RDS) respiratory
distress syndrome
• Affects infants and is a disorder of
prematurity or infants born less than a
37-week gestation
• Incomplete maturation of the
surfactant-producing system causes
unstable alveoli.
• The signs include:
• Rapid and labored breathing
immediately or within a few hours
after delivery with the atelectasis
• Respiratory failure
Inflammatory Diseases
Pneumonia
• Is the most frequent type of lung
infection, resulting in an
inflammation of the lung
( pneumonitis) and
compromised pulmonary
function
• The main cause of pneumonia
are:
• Bacteria
• Viruses
• Mycoplasmas
Bacterial
• Are most common in
adults
• Most common causes of
pneumonia are:
• Streptococcus
• Staphylococcus
• Pneumococcus
• Haemophilus influenzae
• Chlamydia pneumoiae
• Legionella pneumophila
Mycoplsama pneumoniae
• Is the most common
pneumonia in
adolescents and young
adults
Viral Pathogens
• Are most common in
infants and children
• They may also cause
pneumonia in adults
Fungal infection
• Pneumocystis carnii-
may also cause
pneumonia
• Especially in
immunodepressed
patients
Location of inflammation
• Lobar pneumonia- entire lobe of a lung
• Segmental pneumonia- segment of a lung
• Bronchopneumonia- bronchi & associated alveoli
• Interstitial pneumonia- interstitial lung tissue

Lobar Segmental Broncho Interstitial

Symptoms of Pneumonia
• Developed over days
• Cough
• Fever
• Sputum production
• Individuals with pneumonia
exhibit
• Tachypnea
• Crackles may heard on physical
evaluation on bronchial breath
sounds
Pneumococcal pneumonia (lobar)
• Is the most common bacterial pneumonia
• Often present in healthy throats
• Infections are preceded by an upper
respiratory tract infection.
• When the body defense are weakened, the
bacteria multiply, work their way into the
lungs, and inflame the alveoli
• Usually accompanied by:
• Chills
• Cough
• Fever
• Affects the entire lobe of a lung without
affecting the bronchi
Staphylococcal Pneumonia
• Occurs sporadically except during
epidemics of influenza, when
secondary infection of staphylococci is
common.
• It is severe and may be fatal in infants
• Radiographic appearance as a thin
walled, air-containing cyst
( pneumatocele ).
Pneumatocele
• These may enlarge and form
abscesses in the later stage of the
disease.
• It is more typically seen in children
• Drug therapy with particular
chemotherapeutic agents is the
treatment of choice.
Streptococcal Pneumonia
• Is even rarer, accounting for less
than 1% of all hospital admission
for acute bacterial pneumonia
• The radiographic appearance is
localized around the bronchi,
usually of the lower lobes
• Appropriate antibiotic therapy is
the treatment of choice for this
condition
Legionnaires Disease
• A severe bacterial pneumonia that
became known after it caused the
deaths of four people attending an
American Legion Convention in
Philadelphia in 1976.
• L. pneumophilia is the causative
bacteria, thrives in warm, moist places
and may be transmitted through
heating-cooling systems.
• Risk factor includes:
• Smoking
• Alcohol abuse
• Immunosuppression from corticosteroids
• Tretment:
• Primary antibiotic- erythromycin,
azithromycin
• Oxygen therapy
Mycoplasma pneumonia
• Caused by mycoplasmas, the
smallest group of living organism,
having both characteristics of both
bacteria and viruses.
• Most common in older children and
young adults
• In severe cases, the radiographic
appearance may mimic TB.
• The morbidity rate of mycoplasma
pneumonia is very low, even when
the disease is not treated.
Aspiration Pneumonia (chemical)
• Caused by acid vomitus aspirated into
the lower respiratory tract, resulting in
a chemical pneumonitis
• It may follow :
• Anesthesia
• Alcohol intoxication
• Stroke
• Treatment is strictly
supportive including:
• Correction of hypoxia
• Control of secretions
• Replacement of fluids
Viral Pneumonia (interstitial )
• Can be caused binfluenza A and B.y various
viruses, most commonly
• It is more common than bacterial pneumonia,
but less severe.
• This disease is spread by infected person
shedding the virus to a non-immune individual
• Symptoms include:
• Dry cough
• Fever
• Complications include:
• Secondary bacterial infection-termed super
infection, which result from a lowered resistance
brought on by the inflammatory response to the
virus
• Treatment focuses on relief of symptoms
because viral infection do not respond to
antibiotic agents.
Bronchiectasis
• Permanent, abnormal dilation of
one or more large bronchi as a
result of destruction of the elastic
and muscular components of the
bronchial wall.
• It is either congenital or acquired
weakness, following inflammation
of the bronchial wall
• Most common symptoms of early
stage is a chronic cough.
• Chest radiographs demonstrates
increased bronchovascular markings
• HR CT chest with or without
contrast enhancement is able to
diagnose bronchiectasis
Pulmonary Tuberculosis
• Infection caused by inhalation of
Mycobacterium tuberculosis.
• It can also affects other parts of the body:
• Genitourinary system
• Skeletal system
• Central Nervous system
• Signs appear when the lesion or nodular scars
are large enough to be seen on a chest
radiograph and are most commonly seen in
the apical region.
• Necrosis is a prominent feature of the disease
because of its infiltration affects lung
parenchyma, that may expand and produce
that formation of a cavity (cavitation )
PTB
 Chronic Obstructive Pulmonary Disease
( COPD )
• Refers to a group of disorders that
cause chronic air way obstruction
• The most common forms are:
• Chronic bronchitis
• Emphysema
• May be associated with asthma &
bronchiectasis
• The predominant risk is cigarette
smoking
• The following has an increased
risk of developing COPD
• Air pollution
• Airborne chemical fumes
• Inhalation of hazardous dust ( silica)
COPD
Chronic Bronchitis
• Often arises from long-term
heavy cigarette smoking or
prolonged exposure to high
levels of industrial air pollution,
• which irritates the mucous
lining of the bronchial tree and
• increase susceptibility to both
bacterial and viral infections,
that leads to hyperplasia
(overdevelopment ) of the
mucous gland, hypertrophy of
the smooth muscle, and
thickening of the bronchial wall.
Chronic Bronchitis
• Effects of this disease
develop slowly and
progressively over
months and years,
gradually resulting in
bronchial obstruction
from excess secretion of
mucus
• The lungs remain in a
chronically inflated state
because more air is
inhaled than is exhaled.
Chronic Bronchitis
• Signs and Symptoms
• Wheezing
• Shortness of breath
• Hypoxemia
• Leading to right sided heart
hypertrophy
• Failure
Pneumoconioses
• Occupational lung diseases
• Inhalation of foreign inorganic dust from
a particular work environment results in
pulmonary fibrosis
• Dust greater than 10 um are filtered out
in the nasal passages, smaller than 1 um
are suspended in air and exhaled, 1-5
um are trapped in the bronchial tree.
• Silica
• Coal
• Asbestos
• Beryllium
• Silicosis – the oldest known
pneumoconiosis, inhaling silica (quartz)
dust and is common among miners,
grinders and blasters
Pneumoconiosis
Fungal Diseases
Fungal diseases
• Fungi are plants without
chlorophyll and are
widely found in nature,
are not usually
pathogenic unless they
enter a compromised
host, and most fungal
infections are termed
opportunistic
Histoplasmosis
• – is a systemic fungal infection
caused by a fungus thrives in soil
fueled by bird or bat excreta
Coccidiodomycosis
• - also a systemic fungal infection
caused by fungus that thrives in
semiarid soil, that become
airborne from winds, digging or
other disruption.
Lung Abscess
• Is a localized area of dead lung tissue
( necrotic ) surrounded by
inflammatory debris
• Result from;
• Periodontal
• Pneumonia
• Neoplasms
• Other organism that invade the lungs
• Most common in the right lung
because of the vertical orientation of
the right bronchus.
• Signs and symptom are:
• Fever
• Cough
• Expectoration of pus & foul sputum
Lung Abscess:
Pleurisy
• Inflamation of the pleura
is loosely termed as
pleurisy
• Indicative of a serious
condition such as:
• Pneumonia
• Pulmonary embolism
• TB
• Malignant disease
Pleural Effusion
• Results when excess fluid collects in the
pleural cavity
• Exudates- caused by inflammation such
as:
• Pleurisy
• Pulmonary embolism
• neoplasm
• Transudates- result from microvascular
changes such as those associated with
• heart failure
• Ascites
• Hemothorax- blood containing and is
most frequently follows trauma to the
thorax or thoracic surgery
Sinusitis
• The communication with nasal cavity
subjects the paranasal sinuses to infection
and inflammation
• Common cause are:
• Often follows acute viral infection of the
respiratory tract, ethmoid sinuses is the
most commonly affected because of their
proximity to the nose.
• Symptoms are:
• Nasal discharge
• Headache
• Tenderness over the affected area
• Toothache
• General malaise
• The following may exacerbate the condition
• Extreme humidity or temperature
• Poor oral hygiene
• Presence of a deviated septum
Sinusitis
Neoplastic Disease
Types Of Lung Cancer
• Squamous cell – 25-40%, epidermoid derived
• Adenocarcinoma – 25-40%, bronchial, acinar, papillary, solid,
broncioalveolar
• Small cell – 20-25%, oat, intermediate cell
• Large cell – 10-15%, undifferentiated, giant or clear cell
• Combined – squamous and adenocarcinoma
Bronchial Carcinoid
• Are usually ( adenomas )
considered benign but are
included in the World Health
Organization’s classification
of lung cancer because they
tend to invade local tissues,
sometimes metastasize to
regional lymph nodes and
are treated much like other
malignant neoplasms.
Bronchogenic Carcinoma
• Is the most common fatal primary malignancy
accounting for 90% of all lung tumors,
between 45 and 70 years, especially cigarette
smokers
• Four main histologic type
• Squamous cell
• Undifferentiated small (oat) cell
• Undifferentiated large cell
• Adenocarcinoma
• The most common radiographic presentation
is airway obstruction caused by unilateral
hilar mass
• The second most common presentation
consist of a solitary radiopaque lung nodule,
called coin lesion.
Lung Mets
Mechanism of cancer formation
• Begins as in situ cytologic atypia that multiplies into tumor formation
• May progress into the lumen, spread to adjacent areas of carina or
mediastinum with nodal involvement, pleural invasion
• Intraparenchymal mass formation
• Rapid growth may cause local obstruction, hemorrhage or necrosis
depending on rate of growth and location
What lung cancer likes
• Adrenals - ~50% of cancers
• Liver – 30-50%
• Brain – 20%
• Bone – 20%
Adenocarcinoma
• Includes bronchial-derived and
bronchioloalveolar, 80% contain mucin
• Incidence greatly increased in the past
20 years
• Most common form in women,
probably in men too; being seen more
in smokers
• Cause for the increase? Perhaps
related to addition of filters and
deeper inhalation
Squamous
Cell Ca
• More often found in men, usually
associated with long smoking
history
• Centrally located lesions and
spread locally
• Later metasteses
Small Cell Ca
• Oat cell’s given small histologic appearance
• High neuroendocrine activity:
• PTH-like peptides
• Neuron-specific enolase
• Strongly associated with Tob exposure
• Centrally located
 Large Cell Ca

• Likely represent squamous

cell and adenocarcinomas
that are undifferentiated
Complications of Lung Ca
• Obstruction – emphysema vs. atelectasis
• PNA – abscess formation
• SVC syndrome
• Pericarditis
• Pleuritis
• Neuroendocrine abnormalities
• Hypercoagulable states
Diagnosis
• Start with H&P
• Illicit good history, especially social including exposure risks
• Cough, hemoptysis, weight loss, chest pain, SOB
• Physical exam
Immediate Diagnosis
• CXR – identifies nodules usually >1cm
• CT Chest – more definitive view of lung parenchyma and adjacent
lymph nodes
• PET scan – helpful in staging to determine degree of metastases
• MRI/CT brain – useful in looking at CNS involvement
Symptoms of Lung Ca
• PNA
• Effusions
• Hoarseness/dysphagia
• SOB, diaphragm paralysis, chest pain, rib involvement
• SVC Syndrome
• Horner’s Syndrome – Pancoast tumors
• Pericarditis/tamponade
Paraneoplastic syndromes
• SIADH – small cell
• ACTH-producing tumors – small cell
• PTH/PTH-rp – squamous cell
• Calcitonin
• Gonadotropin
• Serotonin
• Lambert-Eaton syndrome – small cell
Work-up
• If cancer is the answer, tissue is the issue
• i.e. bronch vs. VATS vs. CT-guided bx or peripheral bx
Staging - TNM
• Tumor size:
• T1 < or = to 3cm
• T2 > 3cm
• T3 = local extension (parietal pleura, chest wall or within 2cm of carina)
• T4 = spread to great vessels, trachea, mediastinum, esophagus or malignant
effusion (nonresectable)
Staging - TNM
• Lymph Node
• N0 = no involvement
• N1 = hilar nodes
• N2 = mediastinal nodes
• N3 = contralateral nodes or ipsilateral supraclavicular (nonresectable)
Staging - TNM
• Metastases
• M0 = none
• M1 = presence (nonresectable)
Staging Continued
• Stage IA - T1 N0 M0
• Stage IB - T2 N0 M0 (T > 3cm)
Staging Continued
• Stage IIA - T1 N1 M0
• Stage IIB - T2 N1 M0
T3 N0 M0
Staging Continued
• Stage IIIA - T3 N1 M0
T1-3 N2 M0
• Stage IIIB - Any T N3 M0
T4 Any N M0
Staging Continued
Stage IV - Any T Any N M1
Treatment Options
• Thoracotomy with resection is the only curative treatment available
• Surgical options available if NOT a small cell ca
• Chemotherapy (platinum based, topoisomerase and mitotic
inhibitors), radiation and adjuvant debulking surgery (usually only
palliative unless used in conjunction with curative resection)
Metastases from other sites
• Pulmonary metastases are much more common than
primary lung neoplasm
• The most common primary sites are:
• Breasts
• GI tract
• Female reproductive system
• Prostate
• Skin (melanoma)
• Kidneys
• Malignancy is spread to the lungs from primary sites via
five different routes:
• Through blood stream in hematogenous metastases
• Through the lymph system in lymphogenous metastases
• Direct extension in local invasion
• Through tracheobronchial system in bronchogenic metastases
• Rarely by directimplantation from biopsies or other surgical
procedues
Skin mets