LUNG CANCER

1 CHS 232
MRS. LAMIS AL-SAYYARI
FIRST, HOW DO LUNGS WORK?

 Your lungs are part of the respiratory system, a group of

organs and tissues that work together to help you
breathe. The respiratory system's main job is to move
fresh air into your body while removing waste gases.

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 ?WHAT ARE THE LUNGS
 The lungs are a pair of
spongy, air-filled organs
located on either side of
the chest (thorax). The
trachea (windpipe)
conducts inhaled air into
the lungs through its
tubular branches, called
bronchi.
 The bronchi then divide
into smaller and smaller
branches (bronchioles),
finally becoming
microscopic. 3
 ?WHAT ARE THE LUNGS
 The bronchioles eventually end in
clusters of microscopic air sacs
called alveoli.
 In the alveoli, oxygen from the
air is absorbed into the blood.
 Carbon dioxide, a waste product
of metabolism, travels from the
blood to the alveoli, where it can
be exhaled.
 Between the alveoli is a thin
layer of cells called the
interstitium, which contains
blood vessels and cells that help
support the alveoli. 4
?WHAT ARE THE LUNGS
 The lungs are covered by
a thin tissue layer called
the pleura.
 The same kind of thin
tissue lines the inside of
the chest cavity -- also
called pleura.
 A thin layer of fluid acts
as a lubricant allowing
the lungs to slip
smoothly as they expand
and contract with each 5
breath.
THE LUNGS
 From 0 to 1:42 minute
https://www.youtube.com/watch?v=Urn_ztf3TcQ

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?WHAT IS LUNG CANCER
 Lung cancer is the uncontrolled growth of abnormal
cells in one or both lungs.
 These abnormal cells do not carry out the functions of
normal lung cells and do not develop into healthy lung
tissue.
 As they grow, the abnormal cells can form tumors and
interfere with the functioning of the lung, which
provides oxygen to the body via the blood.

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THE GENETIC BASIS OF LUNG
CANCER
 All cells in the body contain the genetic material called
deoxyribonucleic acid (DNA).
 Every time a mature cell divides into two new cells, its
DNA is exactly duplicated.
 The cells are copies of the original cell, identical in
every way.
 In this way our bodies continually replenish themselves.

 Old cells die off and the next generation replaces them.

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THE GENETIC BASIS OF LUNG
CANCER
 A cancer begins with an error, or mutation, in a cell’s
DNA.
 DNA mutations can be caused by the normal aging
process or through environmental factors, such as
cigarette smoke, exposure to radon gas
 Researchers have found that it takes a series of
mutations to create a lung cancer cell.
 Before becoming fully cancerous, cells can be
precancerous, in that they have some mutations but still
function normally as lung cells.
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THE GENETIC BASIS OF LUNG
CANCER
 When a cell with a genetic mutation divides, it passes
along its abnormal genes to the two new cells, which
then divide into four cells with errors in their DNA and
so on.
 With each new mutation, the lung tissue cell becomes
more mutated and may not be as effective in carrying out
its function as a lung cell.
 At a later stage of disease, some cells may travel away
from the original tumor and start growing in other parts
of the body.

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PRIMARY VERSUS SECONDARY LUNG
CANCER
 Primary lung cancer starts in the lungs. The cancer cells
are abnormal lung cells.

 Sometimes, people will have cancer travel from another

part of their body or metastasize to their lungs. This is
called secondary lung cancer because the lungs are a
secondary site compared to the original primary location
of the cancer.

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SYMPTOMS OF LUNG CANCER
 The signs and symptoms of lung cancer can take years to
develop and they may not appear until the disease is
advanced.
 Symptoms of lung cancer can happen in the chest or
elsewhere in the body
 If the original lung cancer has spread, a person may feel
symptoms in other places in the body.
 Common places for lung cancer to spread include other
parts of the lungs, lymph nodes, bones, brain, liver, and
adrenal glands.
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SYMPTOMS OF LUNG CANCER THAT
:ARE IN THE CHEST
 Coughing, especially if it persists or becomes intense
 Pain in the chest, shoulder, or back unrelated to pain from
coughing
 A change in color or volume of sputum

 Shortness of breath

 Changes in the voice or being hoarse

 Harsh sounds with each breath (stridor)

 Recurrent lung problems, such as bronchitis or pneumonia

 Coughing up phlegm or mucus, especially if it is tinged

with blood
 Coughing up blood 13
SYMPTOMS OF LUNG CANCER THAT
MAY OCCUR ELSEWHERE IN THE
BODY:
 Loss of appetite or unexplained weight loss
 Muscle wasting (also known as cachexia)

 Fatigue

 Headaches, bone or joint pain

 Bone fractures not related to accidental injury

 Neurological symptoms, such as unsteady walk or

memory loss
 Neck or facial swelling

 General weakness

 Bleeding
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 Blood clots
SYMPTOMS OF LUNG CANCER
 From 1:43 to 2:22
https://www.youtube.com/watch?v=Urn_ztf3TcQ

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TYPES AND STAGING OF LUNG
CANCER
There are two main types of lung cancer.
 Small cell lung cancer (a type of cancer made up of
small round cells in the lungs). (SCLC)
 Non-small cell lung cancer (cancer which grows in
cells other than small cells inside the lungs). (NSCLC)
 Early-stage lung cancer (stages I and II) is difficult to
detect, Why?

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NON-SMALL CELL LUNG CANCER
Non-small cell lung cancer accounts for about 85 percent
of lung cancers and includes:
 Adenocarcinoma, the most common form of lung
cancer in the United States among both men and women;
 Squamous cell carcinoma, which accounts for 25
percent of all lung cancers;
 Large cell carcinoma, which accounts for about 10
percent of NSCLC tumors.

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SMALL CELL LUNG CANCER
 Small cell lung cancer accounts for the remaining 15
percent of lung cancers in the United States.
 They tend to grow more quickly than NSCLC tumors.

 Usually, SCLC is more responsive to chemotherapy than

NSCLC

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STAGES OF SMALL CELL LUNG
CANCER
 Limited stage: In this stage, cancer is found on one side
of the chest, involving just one part of the lung and
nearby lymph nodes.

 Extensive stage: In this stage, cancer has spread to other

regions of the chest or other parts of the body

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STAGES OF LUNG CANCER
 From 2:23 to 5:26
 https://www.youtube.com/watch?v=Urn_ztf3TcQ

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TREATMENT OF LUNG CANCER
 Treatment will depend on the type of lung cancer

TREATMENT CARING TEAM

 doctors;
 nurses;

 pharmacists;

 physiotherapists;

 radiographers;

 occupational therapists; and

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 dietitians.
NON-SMALL CELL LUNG CANCER
TREATMENT
Surgery
 Most stage I and stage II non-small cell lung cancers are
treated with surgery to remove the tumor
Chemotherapy and Radiation
 For people with stage III lung cancer that cannot be
removed surgically, doctors typically recommend
chemotherapy in combination with definitive (high-dose)
radiation treatments.
 In stage IV lung cancer, chemotherapy is typically the
main treatment. In stage IV patients, radiation is used
only for palliation of symptoms.
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NON-SMALL CELL LUNG CANCER
TREATMENT
Targeted Treatments
 One of the most exciting developments in lung cancer
medicine is the introduction of targeted treatments.
 Unlike chemotherapy drugs, which cannot tell the
difference between normal cells and cancer cells,
targeted therapies are designed specifically to attack
cancer cells by attaching to or blocking targets that
appear on the surfaces of those cells.

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NON-SMALL CELL LUNG CANCER
TREATMENT
Immunotherapy
 New treatment

 While any cancer treatment can cause side effects,

immunotherapy is generally well-tolerated
 Our immune system is constantly working to keep us
healthy. It recognizes and fights against danger, such as
infections, viruses, and growing cancer cells.
 In general terms, immunotherapy uses our own immune
system as a treatment against cancer.

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SMALL CELL LUNG CANCER
TREATMENT
Chemotherapy and Radiation Therapy
 For people with small cell lung cancer, regardless of
stage, chemotherapy is an essential part of treatment.
 Radiation treatment may be used as well depending on
the stage of cancer.
Surgery
 A very small percentage of people who have limited-
stage small cell lung cancer and no lymph node tumors
may benefit from surgery, after which adjuvant
chemotherapy is given.
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MANAGING TREATMENT SIDE
EFFECTS
 Blood clots
 Bone issues

Cancer that starts in or spreads to the bones can lead to

bone pain and an increase in risk for complications,
including weakening of the bone, fractures, and high
calcium levels in the blood.
 Chemobrain

Problems with memory and concentration, along with a

general feeling of not functioning as well mentally as
usual.
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MANAGING TREATMENT SIDE
EFFECTS
 Dental issues
Tooth decay and other mouth issues, including dry mouth
and mouth sores.
 Diarrhea

Defined as two or more loose bowel movements per day,

diarrhea may be caused by some types of chemotherapy
and radiation to certain areas of the body.

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MANAGING TREATMENT SIDE
EFFECTS
 Fatigue
Fatigue is the most commonly reported side effect of
cancer and its treatment.

Hair loss
Hair loss from chemotherapy treatment occurs because hair
follicles are weakened by chemotherapy, which causes
the hair to fall out much more quickly than it would
normally.

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MANAGING TREATMENT SIDE
EFFECTS
 Lymphedema
With lymph node removal and/or radiation
A painful swelling that happens when the body’s lymphatic
fluid is unable to circulate properly and builds up in the
soft tissues instead.

 Mouth sores
“Oral mucositis” refers to mouth sores caused by irritation
of the mucosa—the soft tissues that cover the tongue and
inside of the mouth.
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MANAGING TREATMENT SIDE
EFFECTS
Nausea and vomiting
Medicines exist that can help control these side effects.

Neuropathy
Numbness or tingling in hands and feet, what doctors call
peripheral neuropathy.

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MANAGING TREATMENT SIDE
EFFECTS
 Pain
 Rash

 Weight loss or gain

Cancer treatments can usually lead to weight loss, but

people with cancer can also experience weight gain from
chemotherapy treatment, steroid medications, and
hormone therapy.

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TREATMENT OF LUNG CANCER
 From 5:27 to 7:47
 https://www.youtube.com/watch?v=Urn_ztf3TcQ

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LUNG CANCER RISKS
 Because our lungs draw in and utilize the air from
outside of our body, anything that we breathe in can
affect their health.

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LUNG CANCER RISKS
 The most important risk factor for lung cancer is smoking
tobacco.
 Nearly 87% of all lung cancers in the United States are
smoking-related.
 Quitting smoking helps to reduce that risk

 Exposure to secondhand smoke also increases the risk of lung

cancer.
 According to the Surgeon General’s Report on the effects of
secondhand smoke, nonsmokers exposed to secondhand
smoke at home or at work increase their risk of developing
lung cancer by 20 percent to 30 percent.
 Secondhand smoke also increases the risk of heart disease 36
and other ailments.
THE HISTORY OF THE DISCOVERY OF
THE CIGARETTE–LUNG CANCER LINK

 What is the surgeon general’s report?

 What was the first report about?

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THE TREND OF SMOKING IN USA

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THE HISTORY OF THE DISCOVERY OF
THE CIGARETTE–LUNG CANCER LINK
 Rarity of lung cancer
 In 1878, malignant lung tumors represented only 1% of
all cancers seen at autopsy in the Institute of Pathology
of the University of Dresden in Germany.
 By 1918, the percentage had risen to almost 10% and by
1927 to more than 14%.
 In the 1930 it was duly noted that malignant lung tumors
had begun to increase at the turn of the century and
perhaps even more so after World War I and that,
possibly, they still were on the increase

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THE HISTORY OF THE DISCOVERY OF
THE CIGARETTE–LUNG CANCER LINK
 Mass marketing towards the end of the 19th century
popularized the cigarette habit, however, causing a
global lung cancer epidemic.
 Cigarettes were recognized as the cause of the epidemic
in the 1940s and 1950s, with the confluence of studies
from epidemiology, animal experiments, cellular
pathology and chemical analytics.
 Cigarette manufacturers disputed this evidence, as part
of an orchestrated conspiracy to salvage cigarette sales.

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THE HISTORY OF THE DISCOVERY OF
THE CIGARETTE–LUNG CANCER LINK
 Propagandizing the public proved successful, judging
from secret tobacco industry measurements of the impact
of denialist propaganda.
 As late as 1960 only one-third of all US doctors believed
that the case against cigarettes had been established.
 The cigarette is the deadliest artifact in the history of
human civilization!

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LUNG CANCER ENVIRONMENTAL
SUBSTANCES OR EXPOSURES RISKS
 Asbestos are tiny, hair-like fibers found in some types of
rock.
 Asbestos is a natural mineral that is fireproof and
insulating and was used in building construction
materials and in some manufacturing processes.

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 LUNG CANCER ENVIRONMENTAL
SUBSTANCES OR EXPOSURES RISKS
 When asbestos is inhaled, the
fibers can irritate the lung and
may eventually cause lung
disease.

 Fortunately, professional
protective breathing equipment
can reduce the risk of breathing
in asbestos fibers for those who
work with or around asbestos.

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LUNG CANCER ENVIRONMENTAL
SUBSTANCES OR EXPOSURES RISKS
 Radon is an odorless gas released by some soil and
rocks that contain uranium.
Some homes may have high levels of radon, especially on
the lower levels, because they are built on soil that
naturally contains radon.
Environmental Protection Agency-approved kits in
hardware stores can be used to measure the amount of
radon in homes.

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RADON IN KSA

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http://www.alriyadh.com/825293
LUNG CANCER ENVIRONMENTAL
SUBSTANCES EXPOSURES RISKS
 Industrial substances can include arsenic, uranium,
beryllium, vinyl chloride, nickel chromates, coal
products, mustard gas, chloromethyl ethers, gasoline,
and diesel exhaust.
 Radiation exposure such as X-rays to the chest area can
increase the risk of lung cancer, especially in people who
smoke.
 Air pollution can contain trace amounts of diesel
exhaust, coal products, and other industrial substances.

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LUNG CANCER ENVIRONMENTAL
SUBSTANCES EXPOSURES RISKS
 Tuberculosis can cause scarring of lung tissue, which
can be a risk factor for developing lung cancer.
 Genetics

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SCREENING FOR LUNG CANCER
 Unlike mammography for breast cancer or colonoscopy
for colon cancer, a widely accepted screening tool for
early-stage lung cancer has not been available until
recently.

 Regular chest X-rays are not reliable enough to find lung

tumors in their earliest stages, when many doctors
believe the tumors are at their smallest and most curable
state.

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SCREENING FOR LUNG CANCER
 Recent guidelines from the American Society of Clinical
Oncologists suggests annual screening with low-dose
computed tomography (LDCT) for smokers and
former smokers at high risk for developing lung cancer. ?

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WHO IS AT HIGH RISK FOR DEVELOPING
? .LUNG CANCER
 High risk factors include being between the age of 55 to
74, having smoked for 30 years or more, and either
continuing to smoke or having quit within the past 15
years.

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PREVENTION OF LUNG CANCER
 Managing risk factors examples?

 From 7:47 onwards

 https://www.youtube.com/watch?v=Urn_ztf3TcQ

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QUIT SMOKING !

 https://www.youtube.com/watch?v=fLbQfMmrISE

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QUIT SMOKING ADS

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QUIT SMOKING ADS

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QUIT SMOKING ADS

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QUIT SMOKING ADS

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QUIT SMOKING ADS

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QUIT SMOKING ADS

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REFERENCES
 http://www.lungcancer.org/find_information/publications
/163-lung_cancer_101/265

 http://tobaccocontrol.bmj.com/content/21/2/87.full
 http://www.surgeongeneral.gov/library/reports/

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