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Lung cancer

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alaa mahmoud

on 4 June 2013

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Transcript of Lung cancer

Definition of lung cancer : lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs; usually in the cells that line the air passages.
The abnormal cells do not develop into healthy lung tissue, they divide rapidly and form tumors.
As tumors become larger and more numerous, they undermine the lung’s ability to provide the bloodstream with oxygen.
Tumors that remain in one place and do not appear to spread are known as “benign tumors”. Symptoms Early stages : Unfortunately, in its early stages lung cancer normally has no symptoms to be noticed and this may lead to delay in the discovery of it . Late stages: When symptoms start to appear, and these symptoms may include: •Chronic, hacking, raspy coughing, sometimes with blood-streaked mucus
•Recurring respiratory infections, including bronchitis or pneumonia
•Increasing shortness of breath, wheezing, persistent chest pain
•Hoarseness
•Swelling of the neck and face
•Pain and weakness in the shoulder, arm, or hand
•Fatigue, weakness, loss of weight and appetite, intermittent fever, severe headaches, and body pain
•Difficulty swallowing Causes : Cigarette -Cigarette smoking is the most important cause of lung cancer. Cigarette smoke contains more than 4,000 chemicals, many of which have been identified as causing cancer. A person who smokes more than one pack of cigarettes per day has a 20-25 times greater risk of developing lung cancer than someone who has never smoked. Once a person quits smoking, his or her risk for lung cancer gradually decreases.
About 15 years after quitting, the risk for lung cancer decreases to the level of someone who never smoked The risk of developing lung cancer is related to the following factors: -The number of cigarettes smoked
-The age at which a person started smoking
-How long a person has smoked (or had smoked before quitting) -About 90% of lung cancers arise due to tobacco use Passive smoking An estimated 3,000 lung cancer deaths occur each year in the U.S. that are attributable to passive smoking. Air pollution Air pollution from motor vehicles, factories, and other sources probably increase the risk for lung cancer, and many experts believe that prolonged exposure to polluted air is similar to prolonged exposure to passive smoking in terms of risk for developing lung cancer. Asbestos exposure -Asbestos exposure increases the risk of lung cancer nine times.
-A combination of asbestos exposure and cigarette smoking raises the risk to as much as 50 times.
-Another cancer known as mesothelioma (a type of cancer of the lining of the chest cavity called the pleura or of the lining of the abdominal cavity called the peritoneum) is also strongly associated with exposure to asbestos. -Lung diseases, such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD), also create a risk for lung cancer.

-A person with COPD has a four to six times greater risk of lung cancer even when the effect of cigarette smoking is excluded. Lung diseases Radon exposure -Radon is a by-product of naturally occurring radium, which is a product of uranium. -Radon is present in indoor and outdoor air. -An estimated 12% of lung cancer deaths are attributable to radon gas, or about 21,000 lung cancer-related deaths annually in the U.S. Radon gas is the second leading cause of lung cancer in the United States after cigarette smoking Certain occupations where exposure to arsenic, chromium, nickel, aromatic hydrocarbons, and ethers occurs may increase the risk of lung cancer. Exposure to certain substances Types of lung cancer Small cell lung cancer (SCLC) SCLC comprises about 20% of lung cancers. This type of lung cancer is the most aggressive and rapidly growing of all the types. SCLC is strongly related to cigarette smoking with only 1% of these tumors occurring in non-smokers SCLC metastasize rapidly to many sites within the body and are most often discovered after they have spread extensively. Non-small cell lung cancer (NSCLC) NSCLC is the most common lung cancers, accounting for about 80% of all cases. The NSCLC main types are: Adenocarcinomas -Adenocarcinomas are the most common type of NSCLC in the U.S. and comprise up to 30% to 40% of NSCLC.
-While adenocarcinomas are associated with smoking like other lung cancers, this type is especially seen as well in non-smokers especially women who develop lung cancer.
-Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs. They also have a tendency to spread to the lymph nodes and beyond. Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.
-It may also look like pneumonia on a chest X-ray. It is increasing in frequency and is very common in non-smoking women and in the Asian population. -Squamous cell carcinomas were formerly more common than adenocarcinomas; at present they account for about 30% of NSCLC cases.
-Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.
-This type of lung cancer most often stays within the lung, spreads to lymph nodes, and grows quite large, forming a cavity. Squamous cell carcinomas -Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC, accounting for 10%-15% of all lung cancers.
-This type of cancer, has a high tendency to spread to the lymph nodes and distant sites. Large cell carcinomas Mixtures of different types of NSCLC are also seen. X-ray Diagnosis : -The X-ray may or may not show an abnormality.

-Types of abnormalities seen in lung cancer include a small nodule or nodules or a large mass. CT scan & MRI -These tests help determine the stage of the cancer by showing the size of the tumor or tumors.

-They can also help identify spread of the cancer into nearby lymph nodes or certain other organs. Biopsy Sputum testing -This is a simple test that is sometimes performed to detect cancer in the lungs . -Sputum is thick mucus that may be produced during a cough. -Cells in the sputum can be examined to see if they are cancerous. This is called cytologic review. -This is not a completely reliable test. If negative, the findings usually need to be confirmed by further testing. Bronchoscopy Treatment Surgery -If the cancer has not spread beyond the lungs, general health is reasonably good and breathing capacity is sufficient, the treatment gives the best chance of cure is surgery. -The most common operation is called a lobectomy, removes the affected part of the lung. Sometimes, the whole lung needs to be removed and this is called a pneumonectomy. -In patients with reduced lung function, smaller parts of the lung are removed to try to preserve breathing capacity.
-While these operations preserve breathing capacity, there is more likely to be a recurrence.
-Doctor will give advice about the best operation for their patients. Chemotherapy Radiotherapy Alexandria university,
Faculty of medicine,
Chest conference. Presented by : Alaa Mahmoud El reffaiy
Omnia Mohamed Zakria History of the case : Gender : male
Age : 39
Height : 181 cm
Weight : 90 kg Past medical history : Asthma Chief complaint : Cough Hemoptysis ( coughing up of blood) Dyspnea (shortness of breath ) Fatigue
weakness
Chest pain Smoker (1packet/day)since 15 years (since 45 days) X-ray CT Diagnosis pleural effusion mass Pleural effusion is:
excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation. Tapping -A pleural tap procedure involves the removal of fluid from the area between the chest cavity and the pleura -Pleural effusions may be of two types:
1-Transudative effusions: result from the leakage of fluid into the pleural area caused by a rise in pressure or low protein level of the blood vessels.
2- Exudative effusions: result from leakages in the blood vessels due to inflammation of the pleura. The common causes of this are lung disease such as cancer Tapping of pleural effusion shows that : it was malignant (exudative effusions ) Bronchoscopy is :
a technique of visualizing the inside of the airways for diagnostic . An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs. Biopsy -This procedure involves collection of sputum, removal of a small piece of the tumor tissue -The retrieved cells are reviewed under a microscope by a doctor who specializes in diagnosing diseases by looking at cell and tissue types (a pathologist). The boipsy shows that it was : small cell lung cancer Treatment Chemotherapy -Chemotherapy is the treatment of choice for patients with small cell carcinoma. As this type of cancer spreads quickly, chemotherapy works well in treating it. -This is the treatment of cancer with anti-cancer drugs. The aim is to destroy cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from multiplying. So the patient started 1st line chemotherapy : - He took 3 cycles of cisplatin vp-16 - Then , another CT was done and the tumor was regressive (shrinkage of the tumor ) - He took another 3 cycles of cisplatin vp-16 -Unfortunately, the patient stopped his doses. - The patient didn't follow up with the Dr for about
3 years & 4 months (from 24/3/2009 : 14/5/2009) (10/6/2009 : 1/8/2009) - The patient's CT after that interruptions showed that the tumor was progressive (increased growth speed and invasiveness of the tumor cells) -So, the patient started 2nd line chemotherapy. - He took 3 cycles of cisplatin vp-16 (1/1/2013 : 4/4/2013) -It was supposed to do another CT to follow up with the progress of the tumor. Radiotherapy -Radiotherapy treats cancer by using radiation to destroy or inure cancer cells.

-The radiation can be targeted onto cancer sites in your body.

-Treatment is carefully planned to do as little harm as possible to your normal body tissue. -Treatment is painless and may take only two to three minutes.

-Usually, radiotherapy is given as a number of treatments over a period of weeks.

-Normal tissues are less likely to be damaged using this method, which is called ‘fractionation’. Metastatic workup
-A full met workup means looking for metastatic everywhere instead of just looking for what the symptoms and signs says.
-What tests are done depends on what the primary tumor is.
-Usually consists of: head CT, CXR or thorax CT, abdominal CT, bone scan - The patient was clear. small tumor in the left upper lobe Thank you References : 1- "Lung Carcinoma: Tumors of the Lungs". Merck Manual Professional Edition, Online edition. Retrieved 2007-08-15.
2- Horn, L; Pao W, Johnson DH (2012). "Chapter 89". Harrison's Principles of Internal Medicine (18th ed.). McGraw-Hill. ISBN 0-07-174889-X.
3-Thun, MJ; Hannan LM, Adams-Campbell LL et al. (September 2008). "Lung cancer occurrence in never-smokers: an analysis of 13 cohorts and 22 cancer registry studies". PLoS Medicine 5 (9): e185. doi:10.1371/journal.pmed.0050185. PMC 2531137. PMID 18788891.
4- Alberg AJ, Samet JM (2010). "Chapter 46". Murray & Nadel's Textbook of Respiratory Medicine (5th ed.). Saunders Elsevier. ISBN 978-1-4160-4710-0.
5- O'Reilly, KM; Mclaughlin AM, Beckett WS, Sime PJ (March 2007). "Asbestos-related lung disease". American Family Physician 75 (5): 683–688. PMID 17375514.
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