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LUNG CARCINOMA
(BRONCHIAL CARCINOMA)
By:
Dr Waqar
MBBS, MRCP
Asst. Professor of Medicine
Carcinoma (cancer) in the lungs can be primary
( arising from the lung) or secondary (metastasis
from another site)
Today we will discuss primary lung cancer.
TYPES OF LUNG CARCINOMA
Small cell lung Ca.
( SCLC)
AdenoCa.
Non-Small cell lung Ca.
(NSCLC)
Squamous cell Ca. Large cell
Ca.
• This classification is based on histology
• 85% cases of Ca. lung are NSLC ( adeno. &
Squamous)
( how to remember: NSC ( 3 letters)
3 types
ETIOLOGY
I AM SURE YOU ALL KNOW THE MOST
COMMON CAUSE OF LUNG CANCER !
Etiology contd.
1) Cigarette smoking:
• 85% of cases are due to smoking
• “Passive” smoking also increases the risk of lung
cancer.
• 20-30% increased risk to get lung cancer if
someone at home smokes & u inhale that smoke.
2) Radon Gas:
• This is produced by breakdown of uranium in
earth’s crust.
* Long term exposure to radon can cause Ca. lung
* Second commonest cause in USA
Etiology contd
3) Asbestos:(A natural material used in building)
• Asbestos exposure can cause Ca. lung and
some other lung diseases.
4) Genetics: In some patients, it is due to some
genetic defect
5) Increased risk of lung cancer in COPD &
Idiopathic Pulmonary Fibrosis(IPF) patients.
Signs & Symptoms
1) Respiratory Symptoms:
* Cough wth sputum * Hemoptysis
* Dyspnea & wheezing * Chest pain (if tumor
spreads to chest wall)
2) Systemic S/S :
* Wt. loss * Fever * Weakness * Clubbing
Above are the most common presenting symptoms.
3) Chest Examination: It may show signs of
collapse, consolidation or pleural effusion( tumor
can spread to the pleura & cause effusion)
COMPLICATIONS
Ca lung can cause some complications which can
also be the presenting S/S:
1) Compressive symptoms
2) Pneumonia
3) Brachial plexus damage
4) Hoarseness
5) Para-neoplastic syndromes
COMPLICATIONS
1) Compressive S/S:
* Dysphagia ( due to esophageal compression)
* Face & neck edema( due to superior vena
cava obstruction)
2) Pneumonia: Tumor mass obstructs the airway
pooling of secretions
superimposed
infection
3) Brachial plexus damage :
* Occurs if cancer is in the apex of the lung ( Pan-coast’s tumor)
* Causes pain & other neuro. features in the arm
4) Hoarseness of voice ( involvement of recurrent
laryngeal nerve)
Cancer in lung apex
(Pancoast’s tumour)
Complications contd.
5) Paraneoplastic Syndromes:
* These are S/S not due to local spread of tumor
but due to hormones or other factors produced by
the tumor.
a) Excess ADH production (SIADH)
b) Excess ACTH production
Cushing’s
c) Eaton-Lambert syndrome: A disease
resembling myasthenia gravis.
d) Hypercalcemia: due to excess production
of parathyroid hormone ( squamous cell Ca.)
e) Cerebellar degeneration
f) Myopathy ( muscle weakness)
SOME POINTS
1) Adenocarcinoma:
* Most common type of lung cancer
* Located in the outer part of the lung
2) Squamous cell Ca. : Located in the central
area, close to the main bronchus.
3) Small cell lung cancer is more aggressive and
grows very fast. At the time of diagnosis, it is
widely spread ( metastasis)
METASTASIS
Lung carcinoma can metastasize to :
• Brain : causing neurological S/S (siezures etc)
• Bone: causing bone pain & fractures
• Liver
• Adrenals
• Pleura : Causing pleural effusion
DIAGNOSIS
Person with a history of smoking and having cough,
hemoptysis, wt. loss etc, should always be
investigated for carcinoma.
1) Chest X-Ray:
• This is the 1st thing to do.
• It may show a mass, solitary nodule, wide
mediastinum due to nodal spread, pleural
effusion, lung collapse of the affected area etc.
• A NORMAL X-RAY DOES NOT RULE OUT LUNG CA.
X-RAYS OF LUNG CANCER
Peripheral mass
(? Adenocarcinoma)
Peripheral tumor ( ?adenoca.)
Central mass (?squamous cell)
Ca. ( wth pleural effusion)
Ca. with wide mediastinum
Investigations contd.
2) C.T. Chest:
• It gives more details of the mass
3) Sputum cytology:
• Sputum may show malignant cells
4) Biopsy: This is the definitive test for diagnosis.
*For centrally located masses, bronchoscopy is
done & biopsy of the mass is taken.
*For peripheral lesions, biopsy through the
chest wall (with CT guidance) is done.
STAGING
Staging of the tumor is done based on the
investigations. It tells how far the cancer has
spread.
Stage 1: Cancer is located only in the lungs & has
has not spread to any lymph nodes.
Stage 2: Cancer is in the lungs & the nearby
nodes
Stage 3:Cancer is found in the lungs & in the
nodes in the middle of the chest. This
stage is further divided into stage 3 A & B
Stage 4: Cancer has spread to both lungs, pleura or
distant metastases.
TREATMENT
The three main types of treatment modalities
are:
1) Surgery
2) Radiotherapy
3) Chemotherapy
Which type of treatment to choose?
Depends on the type of lung cancer & its stage
Treatment (contd)
NSCLC:
a) Stage 1 &2 : Surgery
b) Stage 3 :
Radiotherapy + chemo.
c) Stage 4 : Chemo.
Chemo drugs: Cisplatin & carboplatin
SCLC: Mainly chemo. Surgery can not be done
coz it is very widely spread by the time it is
diagnosed.
PROGNOSIS
Overall prognosis is poor. The 5 year survival
rate is only 10-15%.