LUNG TUMORS

Lung cancer is the leading cause of cancer deaths in both women and men

about 2% of those diagnosed with lung cancer that has spread to other areas of the body are alive five years after the diagnosis

Most lung tumors are malignant

Primary or metastatic

MALIGNANT LUNG TUMORS

PICTURE OF THE LUNGS

LUNG CANCER IN THE US

According to 2004 statistics, there were

173,770 new cases and 160,440 deaths yearly More deaths from lung

cancer than prostate, breast and colorectal cancers combined

Decreasing incidence and deaths in men; continued increase in women

0

200,000400,000

600,000

800,000

1,000,000

1,200,000

1,400,0001,600,000

1,800,000

1 3 5 10

New Cases

Deaths

two main types: small cell lung cancer (SCLC) and

non-small cell lung cancer (NSCLC)

non-small cell lung cancer (NSCLC): Adenocarcinoma Squamous cell carcinoma Large cell cancer

MALIGNANT LUNG TUMORS

MALIGNANT LUNG TUMORS Adenocarcinoma (an NSCLC) is the most common type of

lung cancer, making up 30%-40% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonia-like appearance on chest x-rays.

Squamous cell carcinoma (an NSCLC) is the second most common type of lung cancer, making up about 30% of all lung cancers.

Large cell cancer (another NSCLC) makes up 10% of all cases.

SCLC makes up 20% of all cases.

Lung Cancer Causes Cigarette smoking Passive smoking Radiation Exposure Air pollution from motor vehicles Asbestos Lung diseases, such as tuberculosis (TB) and

chronic obstructive pulmonary disease (COPD),

MALIGNANT LUNG TUMORS

SMOKING FACTS Tobacco use is the

leading cause of lung cancer

87% of lung cancers are related to smoking

Risk related to:age of smoking onsetamount smoked genderproduct smoked depth of inhalation

SYMPTOMS

coughdyspneahemoptysisrecurrent infectionschest pain

SYNDROMES/SYMPTOMS SECONDARY TO REGIONAL

METASTASES: Esophageal compression dysphagia Laryngeal nerve paralysis hoarseness Symptomatic nerve paralysis Horner’s

syndrome Lymphatic obstruction pleural effusion Vascular obstruction SVC syndrome Pericardial/cardiac extension effusion,

tamponade

DIAGNOSIS History and Physical exam Diagnostic tests

Chest x-ray Biopsy (bronchoscopy, needle biopsy, surgery)

Staging tests CT chest/abdomen Bone scan Bone marrow aspiration

WHERE DOES IT TRAVEL?

Lymph Nodes, Brain, Liver, Adrenal, Gland, Bones

40% of metastasis occurs in the Adrenal Gland

Lung Cancer Treatment depend on:

SCLC or NSCLC tumor stage general physical condition

MALIGNANT LUNG TUMORS

Surgery Chemotherapy and radiation therapy:A. cure in a small number of patientsB. relieving symptomsC. Inoperable NSCL

MALIGNANT LUNG TUMORS

Surgery preferred treatment for patients with early

stage NSCLC 60%-80% of all patients who have advanced

or metastatic disease are not suitable for surgery

The extent of removal depends on the size of the tumor, its location, and how far it has spread.

Surgery is not widely used in SCLC. Because SCLC spreads widely and rapidly through the body, removing it all by surgery usually is impossible.

MALIGNANT LUNG TUMORS

TREATMENT AND STAGINGNSCLC

Stage Description Treatment Options

Stage I a/b Tumor of any size is found only in the lung

Surgery

Stage II a/b Tumor has spread to lymph nodes associated with the lung

Surgery

Stage III a Tumor has spread to the lymph nodes in the tracheal area, including chest wall and diaphragm

Chemotherapy followed by radiation or surgery

Stage III b Tumor has spread to the lymph nodes on the opposite lung or in the neck

Combination of chemotherapy and radiation

Stage IV Tumor has spread beyond the chest Chemotherapy and/or palliative (maintenance) care

BENIGN LUNG TUMORS bronchial adenomas

hamartomas group of uncommon neoplasms (eg,

chondromas, fibromas, lipomas, leiomyomas, hemangiomas, teratomas, pseudolymphomas, endometriosis).

2-5% of all primary lung tumors

Hamartomas are the most common type

Hamartomas can be easily enucleated, but wedge resection is also appropriate

BENIGN LUNG TUMORS

Complications: Pneumonia atelectasis hemoptysis malignancy

BENIGN LUNG TUMORS

purpose of surgical intervention for benign lung tumors is to avoid missing potentially malignant lesions

remove benign lung tumors when they are symptomatic, which indicates the presence of complications such as pneumonia, atelectasis, and/or hemoptysis.

minimally invasive technique or bronchoscopic resection

BENIGN LUNG TUMORS

Workup: Chest radiograph computed tomography (CT) scan Fiberoptic bronchoscopy: Percutaneous biopsy/guided transthoracic

needle aspiration biopsy Video-assisted thoracoscopy Open biopsy

BENIGN LUNG TUMORS

MALIGNANT LUNG TUMORS

Treatment:

solitary nodule in a young nonsmoking patient can be monitored with serial radiographs as long as the solitary nodule does not double in size in less than a year and it does not significantly increase in the pattern of calcification and shape consistent with a malignancy.

BENIGN LUNG TUMORS

extent of surgery : simple endoscopic resection, thoracotomy with bronchotomy/local

excision, segmental resection, lobectomy, pneumonectomy

DIAPHRAGM major muscle of respiration and the second

most important muscle after the heart

DIAPHRAGM

Spontaneous breathing relies primarily on diaphragmatic excursion to produce negative intrathoracic pressure.  

DIAPHRAGM

DIAPHRAGMATIC DISEASES

Diaphragmatic hernia

Eventration

Tumors

paralysis

DIAPHRAGMATIC HERNIA

divided into 2 categories:

congenital defects

acquired defects:Blunt trauma accounts for 75% of ruptures, and penetrating trauma accounts for the rest.

DIAPHRAGMATIC RUPTURE

Left-sided rupture is more common

Clinical findings include : (1) marked respiratory distress, (2) decreased breath sounds on the affected

side, (3) palpation of abdominal contents upon

insertion of a chest tube, (4) auscultation of bowel sounds in the

chest, (5) paradoxical movement of the abdomen

with breathing, and/or (6) diffuse abdominal pain.

DX

Chest radiography :Abdominal contents in the thorax

Nasogastric tube seen in the thorax

Elevated hemidiaphragm (>4 cm higher on left vs right)

TREATMENT

surgical intervention whether the patient presents

high incidence of concomitant intra-

abdominal injuries dictates the need for emergency abdominal exploration in

CONGENITAL DIAPHRAGMATIC HERNIA (CDH

absence of the diaphragm, or a hole in the diaphragm.

most common on the left.

Bochdalek hernia: This type involves an opening on the back side of the diaphragm. The stomach, intestines and liver or spleen usually move up into the chest cavity.

Morgagni hernia: This type is rare and involves an opening in the front of the diaphragm, just behind the breast bone. The liver or intestines may move up into the chest cavity.

THERE ARE TWO TYPES OF DIAPHRAGMATIC HERNIA:

PRESENTATION

difficulty breathing fast breathing fast heart rate cyanosis (blue color of the skin) abnormal chest development, with one side

being larger than the other abdomen that appears caved in (concave).

TX:SURGERY

EVENTRATION OF THE DIAPHRAGM

all or part of the diaphragmatic muscle is replaced by fibroelastic tissue

diaphragm retains its continuity and attachments to the costal margin

congenital or acquired

partial or diffuse

DIAPHRAGMATIC TUMORS

The diaphragm is commonly involved with malignant pleural disease or malignant peritoneal disease.

Only rarely, however, is the diaphragm the source of either benign or malignant processes.

DIAPHRAGMATIC TUMORS

Primary tumors of the diaphragm are very rare

Benign tumors are most common:lipomas and cystic masses

Most malignant tumors are sarcomas

Tumors of the diaphragm are not associated with any characteristic symptom.

50% of patients were asymptomatic and were found incidentally.

If any symptom is characteristic, it is that lower chest discomfort, heaviness and referred pain to the top of the shoulder.