Reasons why lung cancer survival is stil
--- Content provided by FirstRanker.com ---
variable and poor?? Late presentation
? Deprivation (not just smoking, but mainly)
? Lack of advocacy & research
--- Content provided by FirstRanker.com ---
? Stigma? Access to staff,diagnostics and treatment
Symptoms in patients who turn out to have lung
--- Content provided by FirstRanker.com ---
cancer
--- Content provided by FirstRanker.com ---
Red flags are not always reliable but......NICE says
? Any haemoptysis
? Three weeks of unexplained clubbing or.....
--- Content provided by FirstRanker.com ---
? Cough? Breathlessness
? Chest or shoulder pain
? Weight loss
? Hoarseness
--- Content provided by FirstRanker.com ---
? Chest signs? Or just because smokes and tired? Unclear. But probably.
? Don't wait for antibiotics to work
--- Content provided by FirstRanker.com ---
Causes and Risk factors of Lung Cancer--- Content provided by FirstRanker.com ---
Diagnostic Tests
? CXR
--- Content provided by FirstRanker.com ---
? CT Scans? MRI
? Sputum cytology
? Fibreoptic bronchoscopy
? Transthoracic fine needle aspiration
--- Content provided by FirstRanker.com ---
Laboratory Tests?Blood Tests
*CBC-to check red/white blood cell & platelets
--- Content provided by FirstRanker.com ---
-to check bone marrow and organ function*Blood Chemistry Test-to assess how organs
are functioning such as liver and kidney
--- Content provided by FirstRanker.com ---
?Biopsy-to determine if the tumor is cancer or not
-to determine the type of cancer
--- Content provided by FirstRanker.com ---
-to determine the grade of cancer (slowor fast)
Biopsy
--- Content provided by FirstRanker.com ---
Endoscopy
? Bronchoscopy
--- Content provided by FirstRanker.com ---
? Mediastinoscopy? VATS (video assisted thoracoscopic surgery)
--- Content provided by FirstRanker.com ---
Bronchoscopy
Mediastinoscopy
VATS (video assisted thoracoscopic surgery)
--- Content provided by FirstRanker.com ---
DIAGNOSTIC WORKUP
? History: metastasis symptoms
--- Content provided by FirstRanker.com ---
? PE: H & N lymph nodes
? Chest X-ray
--- Content provided by FirstRanker.com ---
? CT: the most valuable radiologic study for evaluation,staging, and therapeutic planning of lung cancer
? MRI: mediastninum or paravetebral region
--- Content provided by FirstRanker.com ---
? Bone scans: stage II before curative therapy
--- Content provided by FirstRanker.com ---
? PET influenced radiation delivery in 65% for definitive
radiotherapy (Kalff et al.).
--- Content provided by FirstRanker.com ---
? Brain CT scan: small cell carcinoma.? Pulmonary function tests: ability to undergo surgical
resection or withstand irradiation
--- Content provided by FirstRanker.com ---
? Sputum cytology: 20% to 30% sensitivity
? Bronchoscopic examination: 90% positive
--- Content provided by FirstRanker.com ---
? CT-guided Bx: 95% positive? Bx: Primary tumor lesion, scalene node
Pathology
--- Content provided by FirstRanker.com ---
? Sputum cytology: 20% to 30% sensitivity? Bronchoscopic examination: 90% positive
? CT-guided Bx: 95% positive
--- Content provided by FirstRanker.com ---
? Bx: Primary tumor lesion, scalene node
Incidence
--- Content provided by FirstRanker.com ---
Taiwan (TCOG) USANSCLC
85-88 %
--- Content provided by FirstRanker.com ---
80 %
SCLA
--- Content provided by FirstRanker.com ---
12-15 %20 %
--- Content provided by FirstRanker.com ---
Lung Cancer Re-cap
Small Cell Lung Cancer
--- Content provided by FirstRanker.com ---
Non-Small-Cell Lung Cancer
Squamous cel
--- Content provided by FirstRanker.com ---
AdenocarinomaSquamous cell carcinoma
? Moderate to poor differentiation
--- Content provided by FirstRanker.com ---
? makes up 30-40% of all lung cancers? more common in males
? most occur centrally in the large bronchi
? Uncommon metastasis that is slow effects the liver, adrenal glands and lymph
--- Content provided by FirstRanker.com ---
nodes.? Associated with smoking
? Not easily visualized on xray (may delay dx)
? Most likely presents as a Pancoasts tumor
--- Content provided by FirstRanker.com ---
Adenocacinoma
? Increasing in frequency. Most common type of Lung cancer (40-50% of all lung
--- Content provided by FirstRanker.com ---
cancers).
? Clearly defined peripheral lesions (RLL lesion)
? Glandular appearance under a microscope
--- Content provided by FirstRanker.com ---
? Easily seen on a CXR? Can occur in non-smokers
? Highly metastatic in nature
? Pts present with or develop brain, liver,
--- Content provided by FirstRanker.com ---
adrenal or bone metastasis
Large cell carcinomas
--- Content provided by FirstRanker.com ---
? makes up 15-20% of all lung cancers? Poorly differentiated cells
? Tends to occur in the outer part (periphery) of lung, invading sub-segmental
bronchi or larger airways
--- Content provided by FirstRanker.com ---
? Metastasis is slow BUT
? Early metastasis occurs to the kidney, liver organs as well as the adrenal glands
TMN Staging system for Lung Cancer
--- Content provided by FirstRanker.com ---
T= Tumors : tumor size, (localinvasion)
--- Content provided by FirstRanker.com ---
N= Node : node involvement(size and type)
M= Metastasis : general
--- Content provided by FirstRanker.com ---
involvement in organs and
tissues
--- Content provided by FirstRanker.com ---
Lung Cancer Staging Continued? T: Tx, T0, Tis, T1-T4 (T3-tumors greater
than 7cm, T4 is a tumor of any size)
--- Content provided by FirstRanker.com ---
? N: N0, N1, N2, N3
? M: M0, M1a, M1b
Stage grouping (AJCC 2002)
--- Content provided by FirstRanker.com ---
T1 T2 T3 T4N0 IA IB I B I IB
N1 I A I B I IA I IB
--- Content provided by FirstRanker.com ---
N2 I IA I IA I IA I IB
N3 I IB I IB I IB I IB
--- Content provided by FirstRanker.com ---
Man, age: 76, cough and BWLMan, age: 72, LLL
Smal cell lung Ca
--- Content provided by FirstRanker.com ---
Limited stageWoman, age: 68
SVC syndrome
--- Content provided by FirstRanker.com ---
Treatment? Surgery is preferred radical option
? `Resectable' versus `operable'
--- Content provided by FirstRanker.com ---
? Radical RT (or SBRT) should be considered even if patient not fit for surgery
(`operable')
--- Content provided by FirstRanker.com ---
? Performance status at diagnosis is crucial:Grade
Explanation of activity
--- Content provided by FirstRanker.com ---
0
Fully active, able to carry on all pre-disease performance without restriction
--- Content provided by FirstRanker.com ---
1Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or
sedentary nature, e.g., light house work, office work
--- Content provided by FirstRanker.com ---
2
Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more
--- Content provided by FirstRanker.com ---
than 50% of waking hours3
Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours
--- Content provided by FirstRanker.com ---
4
Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair
--- Content provided by FirstRanker.com ---
5Dead
Medical Management
--- Content provided by FirstRanker.com ---
?The three main cancer treatmentsare: *surgery (lung resections)
*radiation therapy
--- Content provided by FirstRanker.com ---
*chemotherapy
?Other types of treatment that are
--- Content provided by FirstRanker.com ---
used to treat certain cancers arehormonal therapy, biological therapy,
Immunotherapy, targeted
--- Content provided by FirstRanker.com ---
chemotherapy or stem cell transplant.
Prognostic Factors
--- Content provided by FirstRanker.com ---
?The best estimate on how a patient will do based on:*type of cancer cells
*grade of the cancer
*size or location of the tumor
--- Content provided by FirstRanker.com ---
*stage of the cancer at the time of diagnosis*age of the person
*gender
*results of blood or other tests
*a persons specific response to treatment
--- Content provided by FirstRanker.com ---
*overall health and physical condition