Presentation on theme: "Ca lung Dr. D.P. Singh Professor, Surgery.. Primary lung cancer – risk factors Cigarette smoking Number of years Number of packs Passive smoking Atmospheric."— Presentation transcript:
Ca lung Dr. D.P. Singh Professor, Surgery.
Primary lung cancer – risk factors Cigarette smoking Number of years Number of packs Passive smoking Atmospheric pollution Occupational (radioactive ore, chromium mining, asbestos, arsenic) Previous h/o TB with smoking
Pathological types Small cell lung carcinoma (oat cell carcinoma) Non Small cell lung carcinoma SCLC:NSCLC :: 1:4
Histological classification Small cell lung cancer Non small cell lung cancer Adenocarcinoma 25-40% Large cell undifferentiated 10-20% Squamous cell carcinoma 30-40% Bronchoalveolar carcinoma 5%
Clinical features Depend on Site of lesion Invasion of neighboring structures Extent of metastases
Clinical features Symptoms Hemoptysis Cough or changed cough Dyspnoea, wheezing Pleural effusion Severe localized pain suggests chest wall invasion Invasion of mediastinum – hoarseness, dysphagia, SVC obstruction Pancoast’s syndrome – invasion of brachial plexus Clubbing Small cell carcinoma may cause myopathies.
Investigations Chest radiography Computerized tomography MRI EUS PET Bronchoscopy Sputum cytology CT guided biopsy Mediastinoscopy Mediastinotomy Assessment of functional status - spirometry
Staging : T: Tumor status TX - Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washing but not visualized by imaging or bronchosocopy T0 - evidence of primary tumor Tis - Carcinoma in situ T1 - 3 cm or less without invasion of visceral pleura T2 - >3 cm or any size with associated atelectasis or obstructive pneumonitis, or invasion of visceral pleura T3 - Any size with direct extension into chest wall, diaphragm, mediastinal pleura without involvement of great vessels or vital mediastinal structures and extent of bronchial spread with 2 cm of, but not involving, the carina T4 - Any size with invasion of the heart or mediastinal vital structures or carina, malignant pleural effusion
N: Nodal involvement NX - Regional lymph nodes cannot be assessedN0None N1 - Peribronchial or ipsilateral hilar lymph nodes N2 - Ipsilateral mediastinal lymph nodes, including subcarinal N3 - Contralateral mediastinal or hilar lymph nodes, ipsilateral or contralateral scalene or supraclavicular lymph nodes