Download lung cancer

SMOKING
and
LUNG CANCER
OCTOBER 13, 2005
ADNAN ALKHALILI, MD
WARS OF USA
American War Casualties
Number in
Action
Number of
Casualties
Smoking
Revolutionary
War
48,000,000
184,000
400,000/yr
4,435
War of 1812
286,703
6,765
Mexican War
78,718
13,283
SpanishAmerican
306,760
2,446
World War One
4,743,826
116,708
World War Two
16,353,659
407,316
Korean War
5,764,143
33,651
Vietnam War
8,744,000
58,168
Persian Gulf
War
467,539
268
Wars
American War Casualties
Wars
Lung Cancer
Number in Action
Number of
Casualties
48,000,000
160,440
(year 2004)
Revolutionary
War
184,000
War of 1812
286,703
6,765
Mexican War
78,718
13,283
Spanish-American
306,760
2,446
World War One
4,743,826
116,708
World War Two
16,353,659
407,316
Korean War
5,764,143
33,651
Vietnam War
8,744,000
58,168
Persian Gulf War
467,539
268
4,435
SMOKING
Smokers in USA:

An estimated 25.6 million men (25.2 percent)
and
22.6 million women (20.7 percent)
(about one-third of adults smoke)
Tobacco Facts

Cigarette smoking kills nearly about 430,000
people a year, making it more lethal than AIDS
or automobile accidents

Lung cancer has become the leading cancer
killer of both men and women (surpassing
breast cancer in 1986).
Tobacco Statistics

A person dies every 10 seconds from tobaccorelated causes.

90% of lung cancer deaths result from
smoking

Smoking is directly responsible for 87% of
lung cancer cases and causes most cases of
emphysema and chronic bronchitis.
Tobacco Statistics

Each year, exposure to second hand smoking
causes an estimated 3,000 non-smoking
Americans to die of lung cancer and causes up
to 300,000 children to suffer from lower
respiratory-tract infections.
Tobacco Facts

Smoking costs the U.S. approximately $130
billion each year in health-care costs and lost
productivity.
Tobacco Facts

If current smoking patterns continue, an
estimated 25 million people alive today,
including five million people currently under
age 18, will die prematurely of a smokingrelated disease

Smoking reduces smokers' life expectancy by
15 to 25 years
Tobacco Facts

Each year, more than five million years of life
could have been saved if every person who
died that year from cigarette smoking had
lived to their average life expectancy
Tobacco Industry
Tobacco companies argue against the control of
tobacco.
Tobacco is vital to the global economy because:

Produces tax revenues

Exports bring hard currency income

Creates jobs

Exists as a vital farm crop.
Tobacco Industry


The tobacco industry loses close to 5,000
customers every day in the U.S. alone —
including 3,500 who manage to quit and about
1,200 who die.
The most promising “replacement smokers”
are young people
Tobacco Industry

Tobacco companies are spending more than
$12.5 billion a year on advertising

One 1998 study estimated that advertising
could be responsible for a third of teenage
smoking
Tobacco Statistics

Every day 2,000 kids light up for the first time

The average smoker begins by age 15, and is a
daily smoker by age 18

Every year, 77.4 million packs of cigarettes
are bought or smoked by youth
Tobacco Statistics

Nearly 30% of middle school children and
over 63% of high school students had tried
smoking.
Tobacco Facts

What tobacco companies don't want us to
know:

1 pack at $2.50 in 50 years = $565,450.49

1 pack (Dunhill) at $3.35 in 50 years =
$757,703.66
LUNG CANCER

Lung cancer is the principal cause of cancerrelated death for both men and women in USA.

In 2005 there will be approximately 172,570 new
cases diagnosed:
- 93,010 men
- 79,560 women.
LUNG CANCER

It is estimated that 163,510 people will die of
lung cancer this year.

This figure approximates 95% of the number
of cases that will be newly diagnosed in 2005.
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
Pathology:

NSCLC
(80%) of malignant pulmonary tumors.
- Adenocarcinomas (40%)
- Squamous Cell Carcinoma (27%)
- Large Cell Carcinoma (8%)

SCLC (20%)
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
Over 80% of lung cancers are attributed to
tobacco exposure, with adenocarcinoma being
the most common type of lung cancer
diagnosed in smokers.
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


With early diagnosis, NSCLC is often
amenable to surgical resection but,
unfortunately, the majority of patients present
with advanced NSCLC (stage IIIB or IV) with
an overall survival of less than 10%.
Stage IIIB disease: 30%
Stage IV disease: 45%
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
Staging: AJCC System
TNM staging:
T : Tumor
N: Spread to LN
M: Metastasis
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
Metastasis:




Bone Mets: 25%
Mainly axial skeleton and proximal long bones
Hepatic Mets
Wt. loss and weakness
Brain Mets: 10%
Nausea, vomiting, headache, seizures……
LN: Supraclavicular fossa:
15 – 20%.
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
Prognosis and Survival:
The staging system is the most powerful
tool for predicting survival
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
Prognosis:
 Patients who have tumors that are resectable
(generally stages I and II) have the best
prognoses; however, long-term survival of
patients with completely resected NSCLC
tumors is suboptimal.
LUNG CANCER

The global 5-year survival rate of patients who
undergo complete surgical resection is
approximately 40% to 50%, meaning that
recurrence and progression to advanced
disease and death is common. The majority of
postsurgical relapses are characterized by
distant metastases with local recurrence risk
less than 10%.
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
Prognosis:

Most patients with locally advanced NSCLC have
significant symptoms and signs. Thus, with regard
to prognosis, they are generally considered to be in
the same category as patients with metastatic
(regionally advanced) disease. This prognosis is
unfavorable.
5-year survival rates - stage IIIB - 5% to 15%
- stage IV - < 5%
LUNG CANCER

A variety of factors influences the survival of patients
with stage IIIB and IV NSCLC:
• Eastern Cooperative Oncology Group (ECOG)
performance score >1
• Dyspnea
• Peripheral lymphadenomegaly
• Pleural effusion
• Not receiving curative radiotherapy (>50 Gy)
• Not receiving chemotherapy
LUNG CANCER

Prognosis:
Across all studies, the most important
prognostic factor among patients with
advanced NSCLC is performance status (PS)
at diagnosis.
For stage IV NSCLC
1-year survival rate: 36% for PS level 0
16% for PS level 1
9% for PS level 2
LUNG CANCER
Independent favorable prognostic factors:







Absence of change in cough or hoarseness
Absence of bone pain
Absence of other symptoms from metastases
Absence of anorexia
Normal LDH
High levels of Albumin
Low level of Alkaline Phosphatase
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
Unfavorable Prognostic Factors:




Pretreatment Weight loss
Male gender
Pretreatment Stage
Presence of bone, liver or brain metastasis.
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Treatment options:
RESECTABLE
Stages I, II, IIIA
VS
UNRESECTABLE
Stages IIIB, IV
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
Resectable:
Adjuvant therapy?
Chemotherapy?
Radiation Therapy?
Chemo-radiation?
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First Line Chemotherapy Regimens
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SMOKE FREE AMERICA
FREE AMERICA
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