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PRESENTING LUNG CANCER Lung Cancer: Defined Uncontrolled growth of malignant cells in one or both lungs and tracheo-bronchial tree A result of repeated carcinogenic irritation causing increased rates of cell replication Proliferation of abnormal cells leads to hyperplasia, dysplasia or carcinoma in situ Picture of the Lungs Lung Cancer in the US According to 2004 statistics, there were 173,770 new cases and 160,440 deaths yearly More deaths from lung cancer than prostate, breast and colorectal cancers combined Decreasing incidence and deaths in men; continued increase in women Women & Lung Cancer 80,660 new cases were reported in 2004 - Account for 12 % of all new cases 68,510 deaths were reported in 2004 - An increase of 150% between 1974 and 1994 Women are more prone to tobacco effects 1.5 times more likely to develop lung cancer than men with same smoking habits Where Does it Come From? Radiation Exposure Smoking Environmental/ Occupational Exposure Asbestos Radon Passive smoke Smoking Facts Tobacco use is the leading cause of lung cancer 87% of lung cancers are related to smoking Risk related to: age of smoking onset amount smoked gender product smoked depth of inhalation Where does it travel? Lymph Nodes, Brain, Liver, Adrenal, Gland, Bones 40% of metastasis occurs in the Adrenal Gland Diagnosis History and Physical exam Diagnostic tests Chest x-ray Biopsy (bronchoscopy, needle biopsy, surgery) Staging tests CT chest/abdomen Bone scan Bone marrow aspiration PET scan Symptoms cough dyspnea hemoptysis recurrent infections chest pain Syndromes/Symptoms secondary to regional metastases: Esophageal compression þ dysphagia Laryngeal nerve paralysis þ hoarseness Symptomatic nerve paralysis þ Horner’s syndrome Cervical/thoracic nerve invasion þ Pancoast syndrome Lymphatic obstruction þ pleural effusion Vascular obstruction þ SVC syndrome Pericardial/cardiac extension þ effusion, tamponade Two Lung Cancer Cells, Classified Non Small Cell Lung Cancer (NSCLC) Small Cell Lung Cancer (SCLC) Adenocarcinoma Oat Cell Squamous Cell Carcinoma Intermediate Large Cell Carcinoma Combined Treatment and Staging NSCLC Stage Description Treatment Options Stage I a/b Tumor of any size is found only in the lung Surgery Stage II a/b Tumor has spread to lymph nodes associated with the lung Surgery Stage III a Tumor has spread to the lymph nodes in Chemotherapy followed by the tracheal area, including chest wall radiation or surgery and diaphragm Stage III b Tumor has spread to the lymph nodes on the opposite lung or in the neck Combination of chemotherapy and radiation Stage IV Tumor has spread beyond the chest Chemotherapy and/or palliative (maintenance) care SCLC Limited Stage Defined as tumor involvement of one lung, the mediastinum and ipsilateral and/or contralateral supraclavicular lymph nodes or disease that can be encompassed in a single radiotherapy port. Extensive Stage Defined as tumor that has spread beyond one lung, mediastinum, and supraclavicular lymph nodes. Common distant sites of metastases are the adrenals, bone, liver, bone marrow, and brain. Conclusion Smoking cessation is essential for prevention of lung cancer. New screening tools under way. Clinical trials under way. New treatments under way. Treatment can palliate symptoms and improve quality of life. Read first bullet again!!