Download Lung Cancer - Ain Shams University

Prof.Taher El Naggar
Professor of pulmonary medicine
Ain Shams University
Definition of Lung Cancer
 The term lung cancer is used to describe cancer
that arises in airways or pulmonary
parenchyma.
Epidemiology
 The Size of the Problem:
 killing > 85% of those it afflicts within 5 years.
 Cause of death: 1st in men & 2nd or 3rd in females.
Age ~ 50-70 years
Male > female, a decade ago 10:1, Now 2:1
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
Etiology:
Causes:
As the most tumors the causes are unknown.
 Uncontrolled growth of malignant cells
 A result of repeated carcinogenic irritation causing
increased rates of cell replication
 Proliferation of abnormal cells leads to hyperplasia,
dysplasia or carcinoma in situ
Where Does it Come From?
(Risk factors)
 Radiation Exposure
 Smoking
 Environmental/ Occupational
Exposure
 Asbestos
 Radon
 Passive smoke
Risk Factors.(cont.)
Lung lesions:
 Old fibrosis as in TB may result in scar
carcinoma.
Genetic factors:
 Genetic predisposition result from a difference in
carcinogen metabolism.
Diet:
 Individuals whose diet is low in (3- carotene and
vitamin A are at increased risk for lung cancer.
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
 depth of inhalation
Pathology of lung cancer:
 A correct histologic diagnosis of lung cancer
is important to determine treatment and
prognosis.
 Histopathologic classification of lung cancer
as designed by World Health Organization
(WHO).
Table (15): Pathological Classification of lung cancer.
Classification
1 -Small-cell lung cancer (SCLC)
2-Non small cell lung cancer
(NSCLC)
Adenocarcinoma
Squamous cell carcinoma
Large- cell carcinoma
Others Carcinoid, pulmonary
lymphoma, mucoepidermoid
carcinoma, sarcoma.
Site
Incidence %
Central
20
Peripheral
Central
Peripheral
35
30
10
Central or peripheral
5
1-Local spread:
Spread
A- To the pleura in the peripheral type leading to pleural
effusion as in adenocarcinoma.
B- To the mediastinum in the central type leading
to mediastinal syndrome.
2-Hematogenous spread:
Lead to dissemination all over the body to distant organs e.g;
bones, liver, brain, and kidneys, specially in small cell lung
cancer.
3-Lymphatic spread:
To hilar, mediastinal, axillary, or cervical lymph nodes.
Symptoms of lung cancer:
1-History of smoking, occupational exposure to
irradiation, history of T.B
2-Asymptomatic presentation: 1/4 of patients are
presented with no symptoms at the diagnosis.
3-General non specific symptoms e.g. weight
loss, loss of appetite, anorexia, fever, and easy
fatigability.
Symptoms of lung cancer:
4-Primary tumor symptoms e.g. cough, expectoration,
dyspnea, chest pain, and haemoptysis.
5- Symptoms due to intra thoracic spread e.g.
hoarseness of voice, dysphagia, chest wall swelling,
superior vena caval obstruction with swelling of
face or arms.
6. Symptoms due to extra thoracic spread e.g. cervical
lymph nodes, bony aches or swelling, pain in right
hypochondrium, and neurological symptoms
Signs of lung cancer:
1- No signs can be detected in early symptomatic
cases; the condition may be detected
accidentally on routine chest X-ray.
2-General Examination may show-Inequality in
pulse, edema of face and upper limb, palpable
cervical lymph node, congested non pulsating
neck vein (signs of superior vena cava
obstruction and superior sulcus syndrome).
3. Signs due to distant organ metastasis:
 Liver metastasis : jaundice, palpable tender
liver mass.
 Bone metastasis : bone pain or pathological
fracture.
 C.N.S metastasis: paralysis or paresis,
polyneuropathy, myopathy, any area of sensory
loss, and any muscular atrophy.
 C.V.S : arrhythmia or manifestation of
pericardial effusion.
4. Systemic non metastatic manifestations
(paraneoplastic syndromes)
 Cachexia.
 Clubbing of fingers (hypertrophic pulmonary osteo-
arthropathy may be found).
 Endocrine abnormalities e.g. Cushing
syndrome, hypercalcaemia, inappropriate
antidiuretic hormone.
Systemic non metastatic manifestations
 Neurological abnormalities e.g.
polyneuropathy, autonomic neuropathy and
myasthenic.
 Hematologic abnormalities e.g. thromboembolic
manifestation, anemia, and leukomoid reaction.
 Cutaneaues manifestations e.g. acanthosis
negricans, dermatomyositis.
Cutaneaues manifestations
Gottron's papules. Characteristic raised
erythematous papule overlying the proximal
interphalangeal joint in a patient with
dermatomyositis.
5. Local chest signs
A- Local signs due to direct effect of the tumor like
consolidation, collapse,abscess, and effusion .
B- Manifestation of underlying diseases e.g.
pneumoconiosis, COPD and old pulmonary TB,IPF
(Scar carcinoma).
C- Infiltrating the lower trunk of brachial plexus
leading to pain, hypothesia, weakness and atrophy
of small muscles of the hand, which are supplied
the ulnar nerve.
5 - Local chest signs (cont.)
D- Obstruction of vessels of the thoracic inlet leading
to arterial ischemia and inequality of the pulse and
venous engorgement.
E- Honer's syndrome: ptosis, myosis, enophthalmos
and unilateral anhydrosis due to compression or
involvement of cervical sympathetic chain.
Superior vena cava obstruction (Superior vena
cava syndrome mediastinal syndrome):
 It is a sign of inoperability.
 It is caused by compression or direct invasion by
tumor to: Superior vena cava, Subclavian artery,
Trachea, Esophagous, left recurrent laryngial nerve
and phernic nerve.
 The patients with mediastinal syndrome may
presents with headach,bull neck, odema of face and
upper limb, congested non pulsating neck veins,
inequality of radial pulse, stridor, hoarseness of
voice and dilated veins on chest wall.