LUNG CANCER
PRESENTATION BY: DR SAMWELI M, MD 2017
CONTENTS
1. Introduction
2. Types of lung cancer
3. Classification of lung cancer
4. Epidemiology
5. Risk factors
6. Clinical features
7. Diagnosis
8. Staging
9. Treatment
Introduction
A variety of benign and malignant tumors may arise in
the lung, but the vast majority (90% to 95%) are
carcinomas,
about 5% are bronchial carcinoids, and
2% to 5% are mesenchymal and other miscellaneous
neoplasms
Types of Lung Cancer
For practical purposes, lung cancers are divided into
small cell and
non-small cell lung cancer (NSCLC), which are seen in a ratio of about
1:4:
Histological classification of Lung
cancer
Small cell lung cancers
were known as oat cell cancers because of the packed nature of small
dense cells.
These represent about 20 per cent of all lung cancer.
They tend to metastasize early to lymph nodes and by blood-borne spread.
The median survival is measured in months.
The tumours are very responsive to chemotherapy such that median
survival may be doubled (but is still short), but they are rarely, if ever, cured.
Surgery is rarely offered unless in very limited stage disease.
SCLC originates from Kulchitzky cells (K-cells) in airway mucosa
K-cells are rare neuroendocrine cells found in bronchial glands
neurosecretory -- produce and release regulatory peptides & neurotransmitters
Small cell carcinomas have a strong relationship to cigarette smoking; only
about 1% occur in nonsmokers
• They occur both in major bronchi and in the periphery of the lung
• They are the most aggressive of lung tumors, metastasize widely, and
• are virtually incurable by surgical means
Adenocarcinoma
Is now the most common of the NSCLC types, having overtaken squamous cancer.
The increasing incidence is partly due to an increasing incidence in women and may be the result, in
part, of a move towards lower-tar cigarettes that are inhaled more deeply to get the same effect.
Histological classification cont
Squamous carcinoma
Typically appears as a cavitating tumour.
Squamous cell carcinoma is most commonly found in men and is closely correlated
with a smoking history
Squamous cell carcinomas show the highest frequency of p53 mutations of all
histologic types of lung carcinoma
Large cell undifferentiated
Is a discrete histological type of NSCLC and is included within neuroendocrine tumours.
Bronchioalveolar carcinoma
Has a distinct pattern of growth following the pre-existing pulmonary architecture and is thus much
less dense;
It appears as a patchy diffuse shadow (‘ground glass’) on the radiograph, rather than a solid mass.
Bronchoalveolar cont.
Occurs in the pulmonary parenchyma in the terminal
bronchioloalveolar regions
Macroscopically, the tumor almost always occurs in the
peripheral proportions of the lung either as a single
nodule or, more often, as multiple diffuse nodules that
sometimes coalesce to produce a pneumonia-like
consolidation
Normal lung left, carcinoma right
Epidemiology
Lung cancer is one of the most common cancers throughout the
world.
In the UK, there are 40 000 cases a year, making it the most common
cause of cancer death.
From the time of diagnosis, 80 per cent of patients are dead within
one year and only 5 per cent survive for five years.
Epidemiology cont …
Carcinoma of the lung is the leading cause of cancer death in both
men and women.
In terms of new patients it ranks second to prostate cancer in men and
second to breast cancer in women.
Mortality rate is approximately 85 – 90 %.
Median survival – 12 months after the diagnosis .
Risk factors
Cigarette smoking
is undoubtedly the major risk factor for developing bronchial
carcinoma and accounts for 85–95 per cent of all cases.
Atmospheric pollution especially radon
certain occupations (radioactive ore and chromium mining)
Industrial hazard such as asbestos
Genetics predisposition
Immunodefieciency
Risk factor of lung cancer
Clinical features of lung cancer
Clinical features of lung carcinoma depend on:
• the site of the lesion;
• the invasion of neighbouring structures;
• the extent of metastases.
Common symptoms include
a persistent cough,
weight loss,
dyspnea
and non-specific chest pain.
Clinical features cont
Haemoptysis occurs in fewer than 50 per cent of patients presenting
for the first time.
Cough, or a changed cough, is a common presentation but non-
specific in this population.
Severe localised pain suggests chest wall invasion with the infiltration
of an intercostal nerve. Invasion of the apical area may involve the
brachial plexus, leading to Pancoast’s syndrome.
Clinical features cont
Dyspnoea may come from loss of functioning lung tissue, lymphatic
invasion or the development of a large pleural effusion.
Pleural fluid is an ominous feature and the presence of blood in a
pleural effusion suggests that the pleura has been directly invaded.
Clubbing.
Invasion of the mediastinum may result in hoarseness
(because of recurrent laryngeal nerve involvement)
dysphagia
Diagnosis
Increasing emphasis in recent years has been the early detection of
lung cancer, with guidance on symptoms and signs of potential lung
cancer that require urgent chest x-ray and referral to lung cancer
team
Chest x-ray
• A chest x-ray will detect most lung cancers but some, particularly
early curable tumours, are hidden by other structures.
• Secondary effects such as pleural effusion, distal collapse and raised
hemidiaphragm may be evident
Diagnosis cont
CT scan
• This is the first investigation in suspected lung cancer.
• The surgeon needs to know if the primary is resectable (T stage) and
which if any lymph nodes are involved (N stage).
Sputum cytology
• Sputum cytology may reveal malignant cells, but the false negative
rate is high
Bronchoscopy
Satging
TNM staging
PRIMARY TUMOUR ( T)
T0= No evidence of primary tumour
T1= less than 3cm
T2= more than 3cm but less than 7cm
T3= tumour more than 7cm or invading the chest wall, phrenic nerve
T4= tumour of any size invading mediastinum or involving heart
Staging cont.
NODAL INVOLVEMENT ( N )
N0=No metastasis to lymph node
N1=Mets to Ipsilateral hilar lymph node
N2= Mets to ipsilateral, mediastinum, subcarinal lymphnode
N3= mets to contralateral mediastinum, contralateral hilar lymph node,
supraclavicular lymph node
Staging cont
DISTANT METASTASIS ( M )
M0=No known distant mets
M1=Distant mets
Treatment
Careful investigation is required to determine which tumours are
operable and will benefit from a major thoracic resection.
The internationally agreed tumour–node–metastasis (TNM) staging
system gives prognostic information on the natural history of the
disease.
Tumours graded up to T3, N1, M0 can be encompassed within an
anatomical surgical resection and have a much improved prognosis
when treated surgically, so the tumour must be staged accurately
before resection
References
1. Barley & Love’s Short Practice of Surgery
• The end
