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Lung Cancer

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Lung Cancer * Low dose CT scans cost ~$300 each. CT Chest: 7 mSv, LDCT: 1.5 mSv, CXR: 0.1 mSv * * * * * * If you have a limited tissue sample, the NCCN guidelines rec ... – PowerPoint PPT presentation

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Title: Lung Cancer


1
Lung Cancer
2
Lung Cancer
  • The most common cancer worldwide, and the
    deadliest
  • 1.37 million deaths worldwide (WHO 2008)
  • 203,000 people diagnosed in the US each year,
    158,000 deaths (CDC 2007)

3
Risk Factors
  • Cigarette smoking
  • Smokers are 10-20 times more likely to get lung
    cancer
  • 85-90 of deaths from lung cancer are smoking
    related
  • Risk is dose dependent the more a person smokes,
    the higher the risk
  • Quitting decreases a person's risk

4
Risk Factors
  • Radon accounts for 21,000 lung cancer deaths (EPA
    2003)
  • Industrial exposures Asbestos, coal tar fumes,
    nickel, chromium, arsenic, etc
  • Family history
  • High cholesterol diet? Alcohol?
  • Beta carotene (Vitamin A) supplements in heavy
    smokers

5
Prevention
  • QUIT SMOKING (or failing that, cut down)
  • Decrease exposure to second hand smoke
  • Decrease exposure to radon, asbestos and other
    industrial carcinogens
  • Healthy diet
  • Physical activity

6
National Lung Cancer Screening Trial
  • 53,454 participants
  • 55-74 y/o
  • gt 30 pack year hx of cigarette smoking
  • Quit smoking lt 15 yrs prior if a former smoker
  • No hx lung ca or other life-threatening cancers
  • No sx's of hemoptysis or wt loss
  • No chest CT prior 18 mo

7
NLST
  • Participants randomized to low dose chest CT vs
    PA chest x-ray annually for 3 years
  • LDCT arm showed a 20 reduction in lung cancer
    deaths compared to the CXR arm (p0.004)
  • NEJM 2011 Aug 4365(5)395-409

8
Screening and Diagnosis
  • Chest x-rays have not been shown to be a good
    screening tool for lung cancers
  • NCCN guidelines for LDCT screening
  • 55-74 y/o and
  • gt 30 pack years of smoking and
  • Smoking cessation lt 15 yrs
  • Or gt 50 y/o and gt 20 pack year hx of smoking and
    one additional risk factor (not second hand smoke)

9
Symptoms
  • About 25 of people with lung cancer have no
    symptoms
  • Central tumors obstructive sx's, cough, dyspnea,
    atelectasis, postobstructive pneumonia, wheezing,
    hemoptysis
  • Peripheral tumors pleural effusion, pain if
    invading pleura or chest wall

10
Symptoms
  • Pancoast tumor tumor in the superior sulcus
  • Shoulder pain
  • Low brachial plexopathy
  • Horner's syndrome (ptosis, miosis, anhidrosis)

11
Diagnosis
12
NCCN Guidelines
  • Nodule lt 8 mm radiologic surveillance
  • Nodule gt 8 mm, solid, non-calcified consider
    PET, bx or excise if suspicious
  • lt10 mm non-solid or part-solid nodule radiologic
    surveillance
  • gt10 mm non-solid or part-solid nodule LDCT in
    3-6 mo

13
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14
Beyond IHC
  • Molecular analysis of certain mutations has
    become increasingly important for determining
    therapy
  • EGFR mutations are a target for TKI's
  • KRAS mutations indicate a resistance to TKI's
  • ALK mutations provide a target for ALK inhibitors
    (crizotinib)

15
Further Work Up
  • PET scan, MRI of the brain
  • Bronchoscopy
  • Mediastinoscopy/US
  • PFT's
  • Lab tests CBC, electrolytes
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