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Lung Cancer

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Lung Cancer Lung cancer is the leading cause of cancer deaths in both women and men in the United States Only about 14% of all people who develop lung cancer survive ... – PowerPoint PPT presentation

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Title: Lung Cancer


1
Lung Cancer
  • Lung cancer is the leading cause of cancer deaths
    in both women and men in the United States
  • Only about 14 of all people who develop lung
    cancer survive for 5 years.
  • Most lung tumors are malignant.

2
Lung Cancer
  • Lung cancers are usually divided into 2 groups
    that account for about 95 of all cases.
  • These two types are called simply small-cell lung
    cancer (SCLC) and nonsmall-cell lung cancer
    (NSCLC)
  • SCLCs are less common, but they grow more quickly
    than NSCLCs and are more likely to metastasize.
    Often, they have already spread to other parts of
    the body when the disease is diagnosed.
  • About 5 of lung cancers are of rare cell types
    such as carcinoid tumor, lymphoma, or metastatic
    (cancers from other parts of the body that spread
    to the lungs).

3
Lung Cancer
  • The specific types of primary lung cancers are as
    follows
  • Adenocarcinoma (a NSCLC) is the most common type
    of lung cancer, making up 30-35 of all cases. A
    subtype of adenocarcinoma is called
    bronchoalveolar cell carcinoma, which creates a
    pneumonialike appearance on chest x-rays.

4
Lung Cancer
  • Squamous cell carcinoma (a NSCLC) is the second
    most common type, making up about 30 of all lung
    cancers.
  • Large-cell cancer makes up 10 of all cases.
  • SCLC makes up 20 of all cases.

5
Lung Cancer
  • Cigarette smoking is the most significant cause
    of lung cancer
  • Cigar and pipe smoking increases your risk of
    lung cancer, but not as much as smoking
    cigarettes does
  • Passive smoking, or sidestream smoke
  • Air pollution from motor vehicles, factories
  • Asbestos exposure increases the risk of lung
    cancer by 9 times. A combination of asbestos
    exposure and cigarette smoking compounds the risk
    by as much as 50 times.
  • Radon exposure
  • Symptoms of primary lung cancers include cough,
    coughing up blood, chest pain, and shortness of
    breath.

6
Lung Cancer
  • Lung cancer most often spreads to the liver, the
    adrenal glands, the bones, and the brain.
  • Metastatic lung cancer in the adrenal glands also
    typically
  • Metastasis to the bones is most common with
    small-cell type cancers but also occurs with
    other lung cancer types.
  • Paraneoplastic syndromes are the remote, indirect
    effects of cancer not related to direct invasion
  • A chest x-ray will most likely be done first to
    look for a cause of your respiratory symptoms.
  • The x-ray may or may not show an abnormality
  • Types of abnormalities seen in lung cancer
    include a small nodule(s) or a large mass
  • Not all abnormalities are cancers,

7
Lung Cancer
  • NSCLCs that are inoperable are treated with
    chemotherapy or a combination of chemotherapy and
    radiation
  • Chemotherapy is the first-line treatment for
    SCLC.
  • Surgery is the most widely used treatment for
    NSCLC.

8
  • Location can suggest cell type
  • Central lesion- squamous cell or small cell
  • Peripheral lesion adenocarcinoma
  • Positron emission tomography (PET) detects
    increased glucose uptake by malignant tissues
    using a glucose analog, 2-18Ffluoro-2-deoxy-D-gl
    ucose (DFG). It provides a highly accurate and
    non-invasive method for detecting malignant lung
    tumors.

9
Adenocarcinoma
  • Adenocarcinoma is also the most common cell type
    seen in women and nonsmokers.
  • Adenocarcinoma is sometimes associated with other
    concomitant lung diseases including diffuse
    fibrotic interstitial lung diseases,
    tuberculosis, and pulmonary infarction.
  • Bronchioloalveolar carcinoma represents a subtype
    of adenocarcinoma.
  • The typical radiologic manifestation of
    adenocarcinoma is a solitary pulmonary nodule
    with well-defined, lobulated, irregular, or
    poorly defined borders. It may be quite difficult
    to see on plain radiolgraphy.
  • Thin-section CT of small peripheral carcinomas
    may demonstrate air bronchograms or air
    bronchiolograms in 65 of cases. Peripheral
    adenocarcinomas may directly invade the pleura
    and grow in pleural space. The lesion may be
    spiculated
  • Adenocarcinoma has been reported to occur in
    close relation to preexisting bulla and may
    manifest as a nodular opacity within the bulla,
    thickening of the bulla wall, change in the size
    of bulla, or spontaneous pneumothorax

10
This chest X-ray shows adenocarcinoma of the
lung. There is a rounded light spot in the right
upper lung (left side of the picture) at the
level of the second rib. The light spot has
irregular and poorly defined borders and is not
uniform in density. Diseases that may cause this
type of X-ray result would be tuberculous or
fungal granuloma, and malignant or benign
tumors.

                                 
11
adenocarcinoma
12
adeno
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Bronchioloalveolar carcinoma
  • Bronchioloalveolar carcinoma is a subtype of
    adenocarcinoma and represents 2-6 of all lung
    cancers.It typically arises distal to the
    terminal bronchioles and spreads along the
    preexisting alveolar septa without causing
    significant amounts of lung destruction
  • The cells secrete mucin and surfactant
    apoprotein-- can lead to bronchorrhea
  • Bronchioloalveolar carcinoma can manifest as a
    single peripheral nodule or mass usually in the
    upper lung.Most commonly, this nodule is
    well-circumscribed

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Squamous cell carcinoma
  • Squamous cell carcinoma is a common form of lung
    cancer, accounting for approximately one-third of
    all cases of bronchogenic carcinomas.
  • Unlike adenocarcinoma, it is strongly linked with
    a history of cigarette smoking.
  • Most squamous cell carcinomas arise centrally
    from either the main, lobar or segmental bronchi
    and ulcerate through the mucosa into the
    surrounding lung parenchyma.
  • Their central location also tends to produces
    symptoms at an earlier stage than tumors located
    peripherally.
  • Although symptoms tend not to be specific, most
    commonly a non-productive cough, they stem from
    the involvement of vital structures at the hilar
    area of the lung
  • They are the most common cause of the Pancoast or
    superior sulcus syndrome.

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The lung windows CT demonstrates a mass in the
lumen of the right main stem bronchus and
narrowing of the pulmonary artery. A
bronchoscopic view also shows the tumor in the
right main stem bronchus
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Malignant mesothelioma
  • Malignant mesothelioma is an uncommon neoplasm
    yet it is the most common primary malignancy of
    the pleura
  • most significant etiological factor for the
    development of malignant mesothelioma is asbestos
    exposure
  • Radiological Findings
  • Chest x-ray may show pleural effusions or pleural
    thickening on the affected side.
  • Computed tomography (CT) may also show pleural
    effusions or pleural thickening with irregular
    nodularity. CT may be helpful to evaluate local
    invasion of the chest wall, pericardium,
    diaphragm, as well as mediastinal/great vessel
    invasion and nodal involvement.

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CT image demonstrates pleural thickening
posteriomedially in the right hemithorax
29
Large cell carcinoma
  • Large cell carcinoma represents 10-20 of
    bronchogenic tumors.
  • They tend to grow rapidly, metastasize early, and
    are strongly associated with smoking.

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Small cell carcinoma
  • Small cell carcinoma accounts for approximately
    20 of all lung cancers.
  • It is characterized by itsorigin in large central
    airways
  • Small cell carcinoma causes a number of
    paraneoplastic syndromes.Small cell carcinoma is
    the most common type of cancer to cause clinical
    hormone syndromes.The tumor cells may produce
    ectopic adrenocorticotropic hormone (ACTH),
    resulting in Cushing's syndrome. The symptoms of
    Cushing's syndrome are nonspecific and are often
    attributed to other factors. Another
    paraneoplastic hormone syndrome that commonly
    occurs is the syndrome of inappropriate
    anti-diuretic hormone (SIADH). This is caused
    bysecretion of ADH from the tumor. Symptoms are
    related to the plasma hypotonicity that is
    secondary to water retention.
  • Over 90 of small cell tumors are found in a
    central location.

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Mets
  • Metastatic tumors in the lungs are malignancies
    (cancers) that developed at other sites and
    spread via the blood stream to the lungs. Common
    tumors that metastasize to the lungs include
    breast cancer, colon cancer, prostate cancer,
    sarcoma, bladder cancer, neuroblastoma, and
    Wilms tumor. However, almost any cancer has the
    capacity to spread to the lungs.
  • Pulmonary metastases occur predominantly in the
    lower lobes
  • Cavitation is uncommon and occurs more frequently
    in upper lobe lesions.

37
Mets Facts
  • Cannon Ball Mets
  • Head and Neck Cancer, Testicular and Ovarian,
    Breast, Renal and Colon
  • Ca Mets
  • Osteosarcoma and Chondrosarcoma ( these are Bone
    cancer mets)
  • Mucinous Mets ovarian, thyroid, pancreas, colon
    and stomach

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Breast
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