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LUNG CANCER Dr.Mohammadzadeh • Lung cancer is the leading cancer killer in the United States. • Every year, it accounts for 30% of all cancer deaths— • more than cancers of the breast, prostate, and ovary combined. • It is the third most frequently diagnosed cancer in the United States, behind prostate cancer in men and breast cancer in women • Most patients are diagnosed at an advanced stage of disease, so therapy is rarely curative. • The overall 5-year survival for all patients with lung cancer is 15%, making lung cancer the most lethal of the leading four cancers Positive survival factors • Female sex (5-year survival of 18.3% for women versus 13.8% for men), • Younger age (5-year survival of 22.8% for those less than 45 years versus 13.7% for those over 65 years) • White race (5-year survival of 16.1% for whites versus 12.2% for blacks). Epidemiology • Cigarette smoking is the primary cause of lung cancer. • Secondhand (or passive) smoke exposure (an excess risk of 24% ) • Preexisting lung disease (13% ) • Exposure to a number of industrial compounds, including asbestos, arsenic, and chromium compounds • Chronic obstructive pulmonary disease (COPD) Field cancerization • Risk is increased for cancers of the oral cavity, pharynx, larynx, tracheobronchial tree and lung, and esophagus Preinvasive Lesions • Squamous Dysplasia and Carcinoma In Situ • Atypical Adenomatous Hyperplasia • Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia Invasive or Malignant Lesions • Non-Small-Cell Lung Carcinoma Squamous Cell Carcinoma Adenocarcinoma Bronchoalveolar Carcinoma Large-Cell Carcinoma • Neuroendocrine Neoplasms Grade I NEC Classic or typical carcinoid Grade II NEC Atypical carcinoid Grade III NEC Large-cell type Small-cell type • Salivary Gland–Type Neoplasms Metastatic Symptoms • CNS metastases : headache, nausea and vomiting, seizures, hemiplegia, and speech difficulty. • Bone metastases : lytic, producing localized pain • Spinal cord compression : • Liver metastases : incidental finding on CT scan • Adrenal metastases : asymptomatic • Skin and soft tissue metastases : painless subcutaneous or intramuscular masses Treatment • Early-Stage Disease : The current standard of treatment is surgical resection • Pancoast tumor (apical tumor) : an induction radiation dose of 30 to 35 Gy followed by surgery 4 to 5 weeks later • Stage III disease : a combination of chemotherapy and radiation Small-Cell Lung Carcinoma • Small-cell lung carcinoma (SCLC) accounts for about 20% of primary lung cancers • is not generally treated surgically. • These aggressive neoplasms have early widespread metastases • limited" SCLC : Patients present without evidence of distant metastatic disease, but often have bulky locoregional disease