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Lung Cancer
St John Hospital and Medical Center
Hematology/Oncology Fellowship
What we’ll be talking about
What is Lung cancer?
How common is Lung cancer?
What are the risk factors?
What are the Symptoms?
Diagnosing Lung cancer
Classification and Treatments
Lung Cancer Screening
Can Lung cancer be prevented?
Respiratory System
Lower Respiratory System
Trachea
Bronchial tree
Left and right
main bronchus
Carina
Lobar bronchus
Segmental bronchus
Bronchiole
Alveoli
Lower Respiratory System
Lower Respiratory System
Regional LN of the Lung
How Common is Lung Ca
How Common is Lung Ca
Risk Factors
Risk Factors
Smoking and Lung Ca
Smoking and Lung Ca
Smoking and Lung Ca
Smoking and Lung Ca
Smoking and Lung Ca
Smoking and Lung Ca
Secondhand Smoking and Lung
Ca
Symptoms of Lung Cancer
Diagnosis of Lung Cancer
•Diagnostic
evaluation of a lung mass depends on its size and location as well as the
presence or absence of enlarged mediastinal lymph nodes or radiographic evidence of
metastatic disease.
•Centrally located lesions can be assessed by sputum cytology or bronchoscopy.
•Peripheral masses often require CT-guided needle biopsy for diagnosis.
•CT- or ultrasound-guided needle biopsy is also indicated to evaluate suspected sites of
metastatic involvement.
•If a lung mass appears to be resectable and there is no overt mediastinal lymph node
enlargement, a surgeon may choose to obtain diagnostic tissue during surgical resection
rather than preoperatively.
•Distinguishing between SCLC and NSCLC is important because each has different
treatment options.
• SCLC tends to disseminate systemically before diagnosis, which precludes surgical
resection even if the cancer is apparently confined to one lung.
• NSCLC accounts for most lung cancers and is potentially curable with surgical
resection if limited-stage disease is found at diagnosis.
Classification of Lung
Cancer
NSCLC - Staging
NSCLC - Staging
• The
histologic subtypes of NSCLC are all staged similarly.
• A solitary tumor without regional (peribronchial or hilar) or
mediastinal lymph node involvement is classified as
stage I.
• Tumors measuring less than 3 cm are classified as stage
IA and greater than 3 cm as stage IB.
• Stage II tumors are characterized by regional lymph node
involvement or the presence of primary tumors that
invade local structures such as the pleura or chest wall or
are located near the carina.
• Stage III disease is defined mainly by mediastinal lymph
node involvement.
• Metastatic disease, as well as an ipsilateral malignant
pleural effusion, is classified as stage IV.
NSCLC - Evaluation
•After
NSCLC is diagnosed based on biopsy findings of a suspicious lung
mass, staging studies are obtained to develop an appropriate treatment plan.
•Because the cancer may spread systemically, studies are also done to detect
common sites of involvement, typically liver, bone, adrenal glands, or
brain.
•Imaging studies include CT of the chest and abdomen plus a bone scan
or PET/CT plus contrast-enhanced MRI of the brain.
•Once advanced-stage IV disease is excluded, a thoracic surgeon should
decide whether complete surgical resection is feasible, which is based on the
presence or absence of mediastinal lymph node involvement.
• If positive lymph nodes are found by mediastinoscopy or bronchoscopic
ultrasonography, surgery is not usually indicated for definitive therapy.
NSCLC - Evaluation
New Therapeutic
Approaches
SCLC - Staging
SCLC - Treatment
Prophylactic Cranial Radiation
Therapy
• Patients
with limited-stage SCLC who complete combination chemotherapy
and radiation therapy have a 50% to 80% chance of developing central
nervous system (CNS) metastases if they survive for 2 years.
• In 20% of patients, the CNS is the initial site of systemic disease spread.
• Prophylactic brain irradiation may reduce the likelihood of symptomatic
brain metastases and slightly improve overall survival.
What to do when a nodule
is found?
Why not screen using
conventional X-ray?
Prevention
Prevention
NRT vs. Varenicline
Thank you