Download Lung Cancer

Lung Cancer
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Lung cancer is the leading cause of
cancer deaths in both women and
men in the United States
Only about 14% of all people who
develop lung cancer survive for 5
years.
Most lung tumors are malignant.
Lung Cancer
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Lung cancers are usually divided into 2 groups that account
for about 95% of all cases.
These two types are called simply small-cell lung cancer
(SCLC) and non–small-cell lung cancer (NSCLC)
SCLCs are less common, but they grow more quickly than
NSCLCs and are more likely to metastasize. Often, they
have already spread to other parts of the body when the
disease is diagnosed.
About 5% of lung cancers are of rare cell types such as
carcinoid tumor, lymphoma, or metastatic (cancers from
other parts of the body that spread to the lungs).
Lung Cancer
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The specific types of primary lung
cancers are as follows:
• Adenocarcinoma (a NSCLC) is the most
common type of lung cancer, making up
30-35% of all cases. A subtype of
adenocarcinoma is called
bronchoalveolar cell carcinoma, which
creates a pneumonialike appearance on
chest x-rays.
Lung Cancer
• Squamous cell carcinoma (a NSCLC) is
the second most common type, making
up about 30% of all lung cancers.
• Large-cell cancer makes up 10% of all
cases.
• SCLC makes up 20% of all cases.
Lung Cancer
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Cigarette smoking is the most significant cause of lung
cancer
Cigar and pipe smoking increases your risk of lung cancer,
but not as much as smoking cigarettes does
Passive smoking, or sidestream smoke
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Air pollution from motor vehicles, factories
Asbestos exposure increases the risk of lung cancer by 9
times. A combination of asbestos exposure and cigarette
smoking compounds the risk by as much as 50 times.
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Radon exposure
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Symptoms of primary lung cancers include
cough, coughing up blood, chest pain, and
shortness of breath.
Lung Cancer
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Lung cancer most often spreads to the liver, the adrenal
glands, the bones, and the brain.
Metastatic lung cancer in the adrenal glands also typically
Metastasis to the bones is most common with small-cell
type cancers but also occurs with other lung cancer types.
Paraneoplastic syndromes are the remote, indirect effects of
cancer not related to direct invasion
A chest x-ray will most likely be done first to look for a
cause of your respiratory symptoms.
• The x-ray may or may not show an abnormality
• Types of abnormalities seen in lung cancer include a small
nodule(s) or a large mass
• Not all abnormalities are cancers,
Lung Cancer
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NSCLCs that are inoperable are
treated with chemotherapy or a
combination of chemotherapy and
radiation
Chemotherapy is the first-line
treatment for SCLC.
Surgery is the most widely used
treatment for NSCLC.
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Location can suggest cell type
• Central lesion- squamous cell or small cell
• Peripheral lesion – adenocarcinoma
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Positron emission tomography (PET)
detects increased glucose uptake by
malignant tissues using a glucose analog,
[2-18F]fluoro-2-deoxy-D-glucose (DFG). It
provides a highly accurate and noninvasive method for detecting malignant
lung tumors.
Adenocarcinoma
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Adenocarcinoma is also the most common cell type seen in women and
nonsmokers.
Adenocarcinoma is sometimes associated with other concomitant lung
diseases including diffuse fibrotic interstitial lung diseases, tuberculosis,
and pulmonary infarction.
Bronchioloalveolar carcinoma represents a subtype of adenocarcinoma.
The typical radiologic manifestation of adenocarcinoma is a solitary
pulmonary nodule with well-defined, lobulated, irregular, or poorly defined
borders. It may be quite difficult to see on plain radiolgraphy.
Thin-section CT of small peripheral carcinomas may demonstrate air
bronchograms or air bronchiolograms in 65% of cases. Peripheral
adenocarcinomas may directly invade the pleura and grow in pleural
space. The lesion may be spiculated
Adenocarcinoma has been reported to occur in close relation to
preexisting bulla and may manifest as a nodular opacity within the
bulla, thickening of the bulla wall, change in the size of bulla, or
spontaneous pneumothorax
This chest X-ray shows
adenocarcinoma of the lung. There
is a rounded light spot in the right
upper lung (left side of the picture)
at the level of the second rib. The
light spot has irregular and poorly
defined borders and is not uniform
in density. Diseases that may
cause this type of X-ray result
would be tuberculous or fungal
granuloma, and malignant or
benign tumors.
adenocarcinoma
adeno
Bronchioloalveolar carcinoma
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Bronchioloalveolar carcinoma is a subtype of
adenocarcinoma and represents 2-6% of all lung cancers.It
typically arises distal to the terminal bronchioles and
spreads along the preexisting alveolar septa without
causing significant amounts of lung destruction
The cells secrete mucin and surfactant apoprotein-- can
lead to bronchorrhea
Bronchioloalveolar carcinoma can manifest as a single
peripheral nodule or mass usually in the upper lung.Most
commonly, this nodule is well-circumscribed
Squamous cell carcinoma
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Squamous cell carcinoma is a common form of lung cancer,
accounting for approximately one-third of all cases of
bronchogenic carcinomas.
Unlike adenocarcinoma, it is strongly linked with a history of
cigarette smoking.
Most squamous cell carcinomas arise centrally from either the
main, lobar or segmental bronchi and ulcerate through the
mucosa into the surrounding lung parenchyma.
Their central location also tends to produces symptoms at an
earlier stage than tumors located peripherally.
Although symptoms tend not to be specific, most commonly a
non-productive cough, they stem from the involvement of vital
structures at the hilar area of the lung
They are the most common cause of the Pancoast or superior
sulcus syndrome.
The lung
windows
CT
demonstr
ates a
mass in
the lumen
of the
right main
stem
bronchus
and
narrowing
of the
pulmonar
y artery. A
bronchos
copic
view also
shows the
tumor in
the right
main
stem
bronchus
Malignant mesothelioma
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Malignant mesothelioma is an uncommon neoplasm yet it is
the most common primary malignancy of the pleura
most significant etiological factor for the development of
malignant mesothelioma is asbestos exposure
Radiological Findings
• Chest x-ray may show pleural effusions or pleural
thickening on the affected side.
• Computed tomography (CT) may also show pleural
effusions or pleural thickening with irregular nodularity.
CT may be helpful to evaluate local invasion of the chest
wall, pericardium, diaphragm, as well as
mediastinal/great vessel invasion and nodal
involvement.
CT
image
demo
nstrat
es
pleura
l
thicke
ning
poster
iomed
ially in
the
right
hemit
horax
Large cell carcinoma
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Large cell carcinoma represents 1020% of bronchogenic tumors.
They tend to grow rapidly,
metastasize early, and are strongly
associated with smoking.
Small cell carcinoma
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Small cell carcinoma accounts for approximately 20% of all
lung cancers.
It is characterized by itsorigin in large central airways
Small cell carcinoma causes a number of paraneoplastic
syndromes.Small cell carcinoma is the most common type
of cancer to cause clinical hormone syndromes.The tumor
cells may produce ectopic adrenocorticotropic hormone
(ACTH), resulting in Cushing's syndrome. The symptoms of
Cushing's syndrome are nonspecific and are often
attributed to other factors. Another paraneoplastic hormone
syndrome that commonly occurs is the syndrome of
inappropriate anti-diuretic hormone (SIADH). This is caused
bysecretion of ADH from the tumor. Symptoms are related
to the plasma hypotonicity that is secondary to water
retention.
Over 90% of small cell tumors are found in a central
location.
Met’s
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Metastatic tumors in the lungs are malignancies (cancers)
that developed at other sites and spread via the blood
stream to the lungs. Common tumors that metastasize to
the lungs include breast cancer, colon cancer, prostate
cancer, sarcoma, bladder cancer, neuroblastoma, and
Wilm´s tumor. However, almost any cancer has the capacity
to spread to the lungs.
Pulmonary metastases occur predominantly in the lower
lobes
Cavitation is uncommon and occurs more frequently in
upper lobe lesions.
Mets Facts
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Cannon Ball Mets
• Head and Neck Cancer, Testicular and
Ovarian, Breast, Renal and Colon
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Ca+ Mets
• Osteosarcoma and Chondrosarcoma (
these are Bone cancer mets)
• Mucinous Mets: ovarian, thyroid,
pancreas, colon and stomach
Breast