LUNG CANCER

Dr.Mohammadzadeh

• Lung cancer is the leading cancer killer in the United States.

• Every year, it accounts for 30% of all cancer deaths—

• more than cancers of the breast, prostate, and ovary combined.

• It is the third most frequently diagnosed cancer in the United States, behind prostate cancer in men and breast cancer in women

• Most patients are diagnosed at an advanced stage of disease, so therapy is rarely curative.

• The overall 5-year survival for all patients with lung cancer is 15%, making lung cancer the most lethal of the leading four cancers

Positive survival factors

• Female sex (5-year survival of 18.3% for women versus 13.8% for men),

• Younger age (5-year survival of 22.8% for those less than 45 years versus 13.7% for those over 65 years)

• White race (5-year survival of 16.1% for whites versus 12.2% for blacks).

Epidemiology• Cigarette smoking is the primary cause of lung

cancer.

• Secondhand (or passive) smoke exposure (an excess risk of 24% )

• Preexisting lung disease (13% )

• Exposure to a number of industrial compounds, including asbestos, arsenic, and chromium compounds

• Chronic obstructive pulmonary disease (COPD)

Field cancerization

• Risk is increased for cancers of the oral cavity, pharynx, larynx, tracheobronchial tree and lung, and esophagus

Preinvasive Lesions• Squamous Dysplasia and Carcinoma In

Situ

• Atypical Adenomatous Hyperplasia

• Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia

Invasive or Malignant Lesions• Non-Small-Cell Lung Carcinoma

Squamous Cell Carcinoma

Adenocarcinoma

Bronchoalveolar Carcinoma

Large-Cell Carcinoma• Neuroendocrine Neoplasms

Grade I NEC Classic or typical carcinoid

Grade II NEC Atypical carcinoid

Grade III NEC Large-cell type  

Small-cell type• Salivary Gland–Type Neoplasms

Metastatic Symptoms• CNS metastases : headache, nausea and vomiting,

seizures, hemiplegia, and speech difficulty.

• Bone metastases : lytic, producing localized pain

• Spinal cord compression :

• Liver metastases : incidental finding on CT scan

• Adrenal metastases : asymptomatic

• Skin and soft tissue metastases : painless subcutaneous or intramuscular masses

Treatment• Early-Stage Disease :

The current standard of treatment is surgical resection

• Pancoast tumor (apical tumor) :

an induction radiation dose of 30 to 35 Gy followed by surgery 4 to 5 weeks later

• Stage III disease :

a combination of chemotherapy and radiation

Small-Cell Lung Carcinoma• Small-cell lung carcinoma (SCLC)

accounts for about 20% of primary lung cancers

• is not generally treated surgically. • These aggressive neoplasms have early

widespread metastases• limited" SCLC : Patients present without

evidence of distant metastatic disease, but often have bulky locoregional disease