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LUNG CANCER
CHAIR OF FACULTY SURGERY # 2
FIRST MOSCOW STATE MEDICAL UNIVERSITY
NATROSHVILI A.G.
LUNG CANCER: DEFINED
•
UNCONTROLLED GROWTH OF MALIGNANT CELLS IN ONE OR BOTH LUNGS AND TRACHEO-BRONCHIAL
•
A RESULT OF REPEATED CARCINOGENIC IRRITATION CAUSING INCREASED RATES OF CELL REPLICATION
• PROLIFERATION OF ABNORMAL CELLS LEADS TO HYPERPLASIA, DYSPLASIA OR CARCINOMA IN SITU
TREE
EPIDEMIOLOGY
• 21% OF ALL CANCER CASES
• MORE DEATHS FROM LUNG CANCER THAN PROSTATE, BREAST AND
COLORECTAL CANCERS COMBINED
• IN 2025 ABOUT 3 500 000 PATIENTS PER YEAR WILL DIE BECAUSE OF LUNG
CANCER
• DECREASING INCIDENCE AND DEATHS IN MEN; CONTINUED INCREASE IN
WOMEN (FROM 1960 TO 1980 LUNG CANCER FREQUENCY IN WOMEN
INCREASED 135%
WHAT ARE THE RISK FACTORS
FOR LUNG CANCER?
• TOBACCO AND SECOND-HAND SMOKE
• ASBESTOS
• RADON
• RADIATION EXPOSURE
SMOKING
• 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
•
PRODUCT SMOKED
•
DEPTH OF INHALATION
SYMPTOMS*
*ASYMPTOMATIC IN EARLY STAGE
• FATIGUE (TIREDNESS)
• COUGH
• SHORTNESS OF BREATH
• CHEST PAIN
• LOSS OF APPETITE
• COUGHING UP PHLEGM
• HEMOPTYSIS (COUGHING UP BLOOD)
• IF CANCER HAS SPREAD, SYMPTOMS INCLUDE BONE PAIN, DIFFICULTY
BREATHING, ABDOMINAL PAIN, HEADACHE, WEAKNESS, AND CONFUSION
METASTASES
SYNDROMES/SYMPTOMS
SECONDARY TO REGIONAL METASTASES:
• LYMPH NODES
• ESOPHAGEAL COMPRESSION  DYSPHAGIA
• BRAIN
• LARYNGEAL NERVE PARALYSIS  HOARSENESS
• LIVER
• CERVICAL/THORACIC NERVE INVASION  PANCOAST SYNDROME
• SYMPTOMATIC NERVE PARALYSIS  HORNER’S SYNDROME
• ADRENAL GLAND (40%)
• LYMPHATIC OBSTRUCTION  PLEURAL EFFUSION
• BONES
• PERICARDIAL/CARDIAC EXTENSION  EFFUSION, TAMPONADE
• VASCULAR OBSTRUCTION  SUPERIOR V. CAVA SYNDROME
HOW IS LUNG CANCER EVALUATED?
• BECAUSE ALMOST ALL PATIENTS WILL HAVE A TUMOR IN THE LUNG, A
CHEST X-RAY OR CT SCAN OF THE CHEST IS PERFORMED
• THE DIAGNOSIS MUST BE CONFIRMED WITH A BIOPSY (USE BRONCHOSCOPY)
• THE LOCATION(S) OF ALL SITES OF CANCER IS DETERMINED BY
ADDITIONAL CT SCANS, PET (POSITRON EMISSION TOMOGRAPHY)
SCANS, AND MRI (MAGNETIC RESONANCE IMAGING)
• IT IS IMPORTANT TO FIND OUT IF CANCER STARTED IN THE LUNG OR
SOMEWHERE ELSE IN THE BODY. CANCER ARISING IN OTHER PARTS OF THE
BODY CAN SPREAD TO THE LUNG AS WELL
EARLY DETECTION
• NO TESTS ARE RECOMMENDED FOR SCREENING THE GENERAL
POPULATION
IN THE PAST, BOTH CHEST X-RAYS AND SPUTUM CYTOLOGY WERE EVALUATED AS METHODS TO DETECT LUNG CANCER
AT AN EARLIER STAGE, BUT NEITHER OF THESE PROCEDURES WERE FOUND TO IMPROVE LONG-TERM SURVIVAL. HENCE,
ROUTINE CHEST X-RAYS ARE NO LONGER USED IN SMOKERS TO SCREEN FOR LUNG CANCER.
• A LOW-DOSE HELICAL COMPUTERIZED TOMOGRAPHY (CT OR CAT)
SCAN IS CURRENTLY BEING STUDIED FOR THIS PURPOSE
• ANY PERSON WHO IS AT INCREASED RISK DUE TO SMOKING OR ASBESTOS
EXPOSURE SHOULD DISCUSS THE BENEFITS AND LIMITATIONS OF A
SCREENING CT SCAN WITH HIS OR HER DOCTOR
A RECENT LARGE STUDY FOUND THAT HIGH RISK INDIVIDUALS WHO UNDERWENT ANNUAL CT SCREENING FOR 3 YEARS
HAD A 20% REDUCED RISK OF DYING FROM LUNG CANCER. HIGH RISK IN THIS STUDY WAS DEFINED AS PEOPLE
BETWEEN THE AGES OF 55 AND 74 WHO HAD AT LEAST A 30 PACK-YEAR HISTORY OF SMOKING.
CLASSIFICATION
• ACCORDING TO LOCALIZATION:
• CENTRAL
• PERIPHERAL
Frequency:
Nucleus – 16,8%
Trunk – 73,8%
Cloak – 9,4%
CLASSIFICATION
NON SMALL CELL LUNG
CANCER (NSCLC)
SMALL CELL LUNG
CANCER (SCLC)
• ADENOCARCINOMA
• OAT CELL
• SQUAMOUS CELL CARCINOMA
• INTERMEDIATE
• LARGE CELL CARCINOMA
• COMBINED
TREATMENT
• TREATMENT DEPENDS ON THE STAGE AND TYPE OF LUNG CANCER
• SURGERY
• RADIATION THERAPY
• CHEMOTHERAPY (OPTIONS INCLUDE A COMBINATION OF DRUGS)
• TARGETED THERAPY
• LUNG CANCER IS USUALLY TREATED WITH A COMBINATION OF
THERAPIES
TREATMENT: SURGERY
• THE TUMOR AND THE NEARBY LYMPH NODES IN THE CHEST ARE
TYPICALLY REMOVED TO OFFER THE BEST CHANCE FOR CURE
• FOR NON-SMALL CELL LUNG CANCER, A LOBECTOMY (REMOVAL OF
THE ENTIRE LOBE WHERE THE TUMOR IS LOCATED), HAS SHOWN TO BE
MOST EFFECTIVE
• SURGERY MAY NOT BE POSSIBLE IN SOME PATIENTS
TREATMENT: CHEMOTHERAPY
• DRUGS USED TO KILL CANCER CELLS
• A COMBINATION OF MEDICATIONS IS OFTEN USED
• MAY BE PRESCRIBED BEFORE OR AFTER SURGERY, OR BEFORE, DURING,
OR AFTER RADIATION THERAPY
• CAN IMPROVE SURVIVAL AND LESSEN LUNG CANCER SYMPTOMS IN ALL
PATIENTS, EVEN THOSE WITH WIDESPREAD LUNG CANCER
TREATMENT: RADIATION THERAPY
• THE USE OF HIGH-ENERGY X-RAYS OR OTHER PARTICLES TO DESTROY
CANCER CELLS
• SIDE EFFECTS INCLUDE FATIGUE, LOSS OF APPETITE, AND SKIN IRRITATION
AT THE TREATMENT SITE
• RADIATION PNEUMONITIS IS THE IRRITATION AND INFLAMMATION OF THE
LUNG; OCCURS IN 15% OF PATIENTS
• IT IS IMPORTANT THAT THE RADIATION TREATMENTS AVOID THE HEALTHY
PARTS OF THE LUNG
STAGING
• STAGING IS A WAY OF DESCRIBING A CANCER, SUCH AS THE SIZE OF
THE TUMOR AND WHERE IT HAS SPREAD
• STAGING IS THE MOST IMPORTANT TOOL WE HAVE TO DETERMINE A
PATIENT’S PROGNOSIS
THE TYPE OF TREATMENT A PERSON RECEIVES DEPENDS ON THE STAGE OF
THE CANCER
• STAGING IS DIFFERENT FOR NON-SMALL CELL LUNG CANCER AND
SMALL CELL LUNG CANCER
STAGE I NON-SMALL CELL LUNG CANCER
• CANCER IS FOUND ONLY IN THE LUNG
• SURGICAL REMOVAL RECOMMENDED
• RADIATION THERAPY AND/OR
CHEMOTHERAPY MAY ALSO BE USED
STAGE II NON-SMALL CELL LUNG CANCER
• THE CANCER HAS SPREAD TO LYMPH NODES
IN THE LUNG
• TREATMENT IS SURGERY TO REMOVE THE
TUMOR AND NEARBY LYMPH NODES
• CHEMOTHERAPY RECOMMENDED; RADIATION
THERAPY SOMETIMES GIVEN AFTER
CHEMOTHERAPY
STAGE III NON-SMALL CELL LUNG CANCER
• THE CANCER HAS SPREAD TO THE LYMPH
NODES LOCATED IN THE CENTER OF THE
CHEST, OUTSIDE THE LUNG
• STAGE IIIA CANCER HAS SPREAD TO LYMPH
NODES IN THE CHEST, ON THE SAME SIDE
WHERE THE CANCER ORIGINATED
• STAGE IIIB CANCER HAS SPREAD TO LYMPH
NODES ON THE OPPOSITE SIDE OF THE CHEST,
UNDER THE COLLARBONE, OR THE PLEURA
(LINING OF THE CHEST CAVITY)
• SURGERY OR RADIATION THERAPY WITH
CHEMOTHERAPY RECOMMENDED FOR STAGE
IIIA
• CHEMOTHERAPY AND SOMETIMES RADIATION
THERAPY RECOMMENDED FOR STAGE IIIB
STAGE IV NON-SMALL CELL LUNG CANCER
• THE CANCER HAS SPREAD TO DIFFERENT
LOBES OF THE LUNG OR TO OTHER ORGANS,
SUCH AS THE BRAIN, BONES, AND LIVER
• STAGE IV NON-SMALL CELL LUNG CANCER IS
TREATED WITH CHEMOTHERAPY
SMALL CELL LUNG CANCER–ALL STAGES
Limited Stage
Defined as tumor involvement of one lung, the mediastinum and ipsilateral and/or contralateral
supraclavicular lymph nodes or disease that can be encompassed in a single radiotherapy port.
Extensive Stage
Defined as tumor that has spread beyond one lung, mediastinum, and supraclavicular lymph nodes.
Common distant sites of metastases are the adrenals, bone, liver, bone marrow, and brain.
• PATIENTS WITH LIMITED STAGE SMALL CELL LUNG CANCER ARE TREATED WITH SIMULTANEOUS RADIATION
THERAPY AND CHEMOTHERAPY
• PATIENTS WITH EXTENSIVE STAGE SMALL CELL LUNG CANCER ARE TREATED WITH CHEMOTHERAPY ONLY
• BECAUSE SMALL CELL LUNG CANCER CAN SPREAD TO THE BRAIN, PREVENTATIVE RADIATION THERAPY
TO THE BRAIN IS ROUTINELY RECOMMENDED TO ALL PATIENTS WHOSE TUMORS DISAPPEAR FOLLOWING
CHEMOTHERAPY AND RADIATION THERAPY