LUNG CANCERCHAIR OF FACULTY SURGERY # 2

FIRST MOSCOW STATE MEDICAL UNIVERSITY

NATROSHVILI A.G.

LUNG CANCER: DEFINED• UNCONTROLLED GROWTH OF MALIGNANT CELLS IN ONE OR BOTH LUNGS AND TRACHEO-

BRONCHIAL TREE

• A RESULT OF REPEATED CARCINOGENIC IRRITATION CAUSING INCREASED RATES OF CELL REPLICATION

• PROLIFERATION OF ABNORMAL CELLS LEADS TO HYPERPLASIA, DYSPLASIA OR CARCINOMA IN SITU

EPIDEMIOLOGY• 21% OF ALL CANCER CASES

• MORE DEATHS FROM LUNG CANCER THAN PROSTATE, BREAST AND COLORECTAL CANCERS COMBINED

• IN 2025 ABOUT 3 500 000 PATIENTS PER YEAR WILL DIE BECAUSE OF LUNG CANCER

• DECREASING INCIDENCE AND DEATHS IN MEN; CONTINUED INCREASE IN WOMEN (FROM 1960 TO 1980 LUNG CANCER

FREQUENCY IN WOMEN INCREASED 135%

WHAT ARE THE RISK FACTORS FOR LUNG CANCER?

• TOBACCO AND SECOND-HAND SMOKE

• ASBESTOS

• RADON

• RADIATION EXPOSURE

SMOKING

• TOBACCO USE IS THE LEADING CAUSE OF LUNG CANCER

• 87% OF LUNG CANCERS ARE RELATED TO SMOKING

• RISK RELATED TO:• AGE OF SMOKING ONSET

• AMOUNT SMOKED

• GENDER

• PRODUCT SMOKED

• DEPTH OF INHALATION

SYMPTOMS**ASYMPTOMATIC IN EARLY STAGE

• FATIGUE (TIREDNESS)

• COUGH

• SHORTNESS OF BREATH

• CHEST PAIN

• LOSS OF APPETITE

• COUGHING UP PHLEGM

• HEMOPTYSIS (COUGHING UP BLOOD)

• IF CANCER HAS SPREAD, SYMPTOMS INCLUDE BONE PAIN, DIFFICULTY BREATHING, ABDOMINAL PAIN, HEADACHE, WEAKNESS, AND CONFUSION

METASTASES

• LYMPH NODES

• BRAIN

• LIVER

• ADRENAL GLAND (40%)

• BONES

SYNDROMES/SYMPTOMS SECONDARY TO REGIONAL METASTASES:

• ESOPHAGEAL COMPRESSION DYSPHAGIA

• LARYNGEAL NERVE PARALYSIS HOARSENESS

• SYMPTOMATIC NERVE PARALYSIS HORNER’S SYNDROME

• CERVICAL/THORACIC NERVE INVASION PANCOAST SYNDROME

• LYMPHATIC OBSTRUCTION PLEURAL EFFUSION

• VASCULAR OBSTRUCTION SUPERIOR V. CAVA SYNDROME

• PERICARDIAL/CARDIAC EXTENSION EFFUSION, TAMPONADE

HOW IS LUNG CANCER EVALUATED?• BECAUSE ALMOST ALL PATIENTS WILL HAVE A TUMOR IN THE LUNG, A CHEST X-RAY OR CT SCAN OF THE CHEST IS PERFORMED

• THE DIAGNOSIS MUST BE CONFIRMED WITH A BIOPSY (USE BRONCHOSCOPY)

• THE LOCATION(S) OF ALL SITES OF CANCER IS DETERMINED BY ADDITIONAL CT SCANS, PET (POSITRON EMISSION TOMOGRAPHY) SCANS, AND MRI (MAGNETIC RESONANCE IMAGING)

• IT IS IMPORTANT TO FIND OUT IF CANCER STARTED IN THE LUNG OR SOMEWHERE ELSE IN THE BODY. CANCER ARISING IN OTHER PARTS OF THE BODY CAN SPREAD TO THE LUNG AS WELL

EARLY DETECTION• NO TESTS ARE RECOMMENDED FOR SCREENING THE

GENERAL POPULATION IN THE PAST, BOTH CHEST X-RAYS AND SPUTUM CYTOLOGY WERE EVALUATED AS METHODS TO DETECT LUNG CANCER AT AN EARLIER STAGE, BUT NEITHER OF THESE PROCEDURES WERE FOUND TO IMPROVE LONG-TERM SURVIVAL. HENCE, ROUTINE CHEST X-RAYS ARE NO LONGER USED IN SMOKERS TO SCREEN FOR LUNG CANCER.

• A LOW-DOSE HELICAL COMPUTERIZED TOMOGRAPHY (CT OR CAT) SCAN IS CURRENTLY BEING STUDIED FOR THIS PURPOSE

• ANY PERSON WHO IS AT INCREASED RISK DUE TO SMOKING OR ASBESTOS EXPOSURE SHOULD DISCUSS THE BENEFITS AND LIMITATIONS OF A SCREENING CT SCAN WITH HIS OR HER DOCTOR

A RECENT LARGE STUDY FOUND THAT HIGH RISK INDIVIDUALS WHO UNDERWENT ANNUAL CT SCREENING FOR 3 YEARS HAD A 20% REDUCED RISK OF DYING FROM LUNG CANCER. HIGH RISK IN THIS STUDY WAS DEFINED AS PEOPLE BETWEEN THE AGES OF 55 AND 74 WHO HAD AT LEAST A 30 PACK-YEAR HISTORY OF SMOKING.

CLASSIFICATION

• ACCORDING TO LOCALIZATION:

• CENTRAL

• PERIPHERAL

Frequency:Nucleus – 16,8%Trunk – 73,8%Cloak – 9,4%

CLASSIFICATION

NON SMALL CELL LUNG CANCER (NSCLC)

• ADENOCARCINOMA

• SQUAMOUS CELL CARCINOMA

• LARGE CELL CARCINOMA

SMALL CELL LUNG CANCER (SCLC)

• OAT CELL

• INTERMEDIATE

• COMBINED

TREATMENT

• TREATMENT DEPENDS ON THE STAGE AND TYPE OF LUNG CANCER • SURGERY• RADIATION THERAPY• CHEMOTHERAPY (OPTIONS INCLUDE A COMBINATION

OF DRUGS)• TARGETED THERAPY• LUNG CANCER IS USUALLY TREATED WITH A

COMBINATION OF THERAPIES

TREATMENT: SURGERY

• THE TUMOR AND THE NEARBY LYMPH NODES IN THE CHEST ARE TYPICALLY REMOVED TO OFFER THE BEST CHANCE FOR CURE

• FOR NON-SMALL CELL LUNG CANCER, A LOBECTOMY (REMOVAL OF THE ENTIRE LOBE WHERE THE TUMOR IS LOCATED), HAS SHOWN TO BE MOST EFFECTIVE

• SURGERY MAY NOT BE POSSIBLE IN SOME PATIENTS

TREATMENT: CHEMOTHERAPY

• DRUGS USED TO KILL CANCER CELLS

• A COMBINATION OF MEDICATIONS IS OFTEN USED

• MAY BE PRESCRIBED BEFORE OR AFTER SURGERY, OR BEFORE, DURING, OR AFTER RADIATION THERAPY

• CAN IMPROVE SURVIVAL AND LESSEN LUNG CANCER SYMPTOMS IN ALL PATIENTS, EVEN THOSE WITH WIDESPREAD LUNG CANCER

TREATMENT: RADIATION THERAPY

• THE USE OF HIGH-ENERGY X-RAYS OR OTHER PARTICLES TO DESTROY CANCER CELLS• SIDE EFFECTS INCLUDE FATIGUE, LOSS OF APPETITE,

AND SKIN IRRITATION AT THE TREATMENT SITE • RADIATION PNEUMONITIS IS THE IRRITATION AND

INFLAMMATION OF THE LUNG; OCCURS IN 15% OF PATIENTS • IT IS IMPORTANT THAT THE RADIATION TREATMENTS

AVOID THE HEALTHY PARTS OF THE LUNG

STAGING

• STAGING IS A WAY OF DESCRIBING A CANCER, SUCH AS THE SIZE OF THE TUMOR AND WHERE IT HAS SPREAD • STAGING IS THE MOST IMPORTANT TOOL WE HAVE TO

DETERMINE A PATIENT’S PROGNOSIS

THE TYPE OF TREATMENT A PERSON RECEIVES DEPENDS ON THE STAGE OF THE CANCER• STAGING IS DIFFERENT FOR NON-SMALL CELL LUNG

CANCER AND SMALL CELL LUNG CANCER

STAGE I NON-SMALL CELL LUNG CANCER

• CANCER IS FOUND ONLY IN THE LUNG

• SURGICAL REMOVAL RECOMMENDED

• RADIATION THERAPY AND/OR CHEMOTHERAPY MAY ALSO BE USED

STAGE II NON-SMALL CELL LUNG CANCER

• THE CANCER HAS SPREAD TO LYMPH NODES IN THE LUNG

• TREATMENT IS SURGERY TO REMOVE THE TUMOR AND NEARBY LYMPH NODES

• CHEMOTHERAPY RECOMMENDED; RADIATION THERAPY SOMETIMES GIVEN AFTER CHEMOTHERAPY

STAGE III NON-SMALL CELL LUNG CANCER • THE CANCER HAS SPREAD TO THE LYMPH

NODES LOCATED IN THE CENTER OF THE CHEST, OUTSIDE THE LUNG

• STAGE IIIA CANCER HAS SPREAD TO LYMPH NODES IN THE CHEST, ON THE SAME SIDE WHERE THE CANCER ORIGINATED

• STAGE IIIB CANCER HAS SPREAD TO LYMPH NODES ON THE OPPOSITE SIDE OF THE CHEST, UNDER THE COLLARBONE, OR THE PLEURA (LINING OF THE CHEST CAVITY)

• SURGERY OR RADIATION THERAPY WITH CHEMOTHERAPY RECOMMENDED FOR STAGE IIIA

• CHEMOTHERAPY AND SOMETIMES RADIATION THERAPY RECOMMENDED FOR STAGE IIIB

STAGE IV NON-SMALL CELL LUNG CANCER

• THE CANCER HAS SPREAD TO DIFFERENT LOBES OF THE LUNG OR TO OTHER ORGANS, SUCH AS THE BRAIN, BONES, AND LIVER

• STAGE IV NON-SMALL CELL LUNG CANCER IS TREATED WITH CHEMOTHERAPY

SMALL CELL LUNG CANCER–ALL STAGES

• PATIENTS WITH LIMITED STAGE SMALL CELL LUNG CANCER ARE TREATED WITH SIMULTANEOUS RADIATION THERAPY AND CHEMOTHERAPY

• PATIENTS WITH EXTENSIVE STAGE SMALL CELL LUNG CANCER ARE TREATED WITH CHEMOTHERAPY ONLY

• BECAUSE SMALL CELL LUNG CANCER CAN SPREAD TO THE BRAIN, PREVENTATIVE RADIATION THERAPY TO THE BRAIN IS ROUTINELY RECOMMENDED TO ALL PATIENTS WHOSE TUMORS DISAPPEAR FOLLOWING CHEMOTHERAPY AND RADIATION THERAPY

Limited StageDefined as tumor involvement of one lung, the mediastinum and ipsilateral and/or

contralateral supraclavicular lymph nodes or disease that can be encompassed in a single radiotherapy port.

Extensive StageDefined as tumor that has spread beyond one lung, mediastinum, and supraclavicular lymph

nodes. Common distant sites of metastases are the adrenals, bone, liver, bone marrow, and brain.