The Size of the Problem 1 r 30,000 new cases of lung cancer per year in England (6,000 in Scotland) r Commonest cause of cancer death (33%) in men r Commonest cause of cancer death in women in Scotland (20%) r 90% mortality 1 year after diagnosis
Tobacco smoke…. r polycyclic hydrocarbons r aromatic amines r phenols r nickel r cyanates 20% of smokers die of lung cancer (also suffer laryngeal, cervical, bladder, mouth, oesophageal, colon cancer)
Other risk factors….. r Asbestos r nickel r chromates r radiation r atmospheric pollution r (genetics)
Clinical Presentation 1 r Local effects l obstruction of airway (pneumonia) l invasion of chest wall (pain) l ulceration (haemoptysis)
White tumour obstructing bronchus. Distal area of yellow discolouration represents pneumonia.
Clinical Presentation 2 r Metastases l nodes l bones l liver l brain
Metastatic small cell lung cancer in liver at autopsy.
Clinical Presentation 3 r Systemic effects l weight loss l “ectopic” hormone production u PTH (SQUAMOUS CANCER) u ACTH (SMALL CELL CANCER)
Classification of Lung Tumours r Very heterogeneous r 4 common smoking-associated types l adenocarcinoma (35%) l squamous carcinoma (30%) l small cell carcinoma (25%) l large cell carcinoma (10%) r Neuroendocrine tumours r Bronchial gland tumours
Treatment and Histology r Small cell known to be chemosensitive but with rapidly emerging resistance r Surgery the treatment of choice in other types. “Non-small cell” regimens have also been developed in chemotherapy/radiotherapy
The most simple classification of lung cancer: Small cell lung cancer (SCLC) V. Non-small cell lung cancer (NSCLC)
Peripheral Adenocarcinomas r Atypical adenomatous hyperplasia r Spread of neoplastic cells along alveolar walls (bronchioloalveolar carcinoma) r True invasive adenocarcinoma r THIS PATTERN IS BECOMING COMMONER
Other Lung Neoplasms r Carcinoid: Neuroendocrine neoplasms of low grade malignancy r Bronchial gland neoplasms (tumours more often seen in salivary glands) l Adenoid cystic carcinoma l Mucoepidermoid carcinoma