1. L UNG T UMORS

2. Lung cancer is the leading cause of cancer deaths in both women and men about 2% of those diagnosed with lung cancer that has spread to other areas of the body are alive five years after the diagnosis Most lung tumors are malignant Primary or metastatic MALIGNANT LUNG TUMORS

3. P ICTURE OF THE L UNGS

4. L UNG C ANCER IN THE US According to 2004 statistics, there were 173,770 new cases and 160,440 deaths yearly More deaths from lung cancer than prostate, breast and colorectal cancers combined Decreasing incidence and deaths in men; continued increase in women

5. two main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)small cell lung cancernon-small cell lung cancer non-small cell lung cancernon-small cell lung cancer (NSCLC): Adenocarcinoma Squamous cell carcinoma Large cell cancer MALIGNANT LUNG TUMORS

6. AdenocarcinomaAdenocarcinoma (an NSCLC) is the most common type of lung cancer, making up 30%-40% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonia-like appearance on chest x-rays.carcinomapneumoniax-rays Squamous cell carcinomaSquamous cell carcinoma (an NSCLC) is the second most common type of lung cancer, making up about 30% of all lung cancers. Large cell cancer (another NSCLC) makes up 10% of all cases. SCLC makes up 20% of all cases.

7. Lung Cancer Causes Cigarette smoking Passive smoking Radiation Exposure Air pollution from motor vehicles Asbestos Lung diseases, such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD),tuberculosis chronic obstructive pulmonary diseaseCOPD MALIGNANT LUNG TUMORS

8. S MOKING F ACTS 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

9. S YMPTOMS cough dyspnea hemoptysis recurrent infections chest pain

10. S YNDROMES /S YMPTOMS SECONDARY TO REGIONAL METASTASES : Esophageal compression  dysphagia Laryngeal nerve paralysis  hoarseness Symptomatic nerve paralysis  Horner’s syndrome Lymphatic obstruction  pleural effusion Vascular obstruction  SVC syndrome Pericardial/cardiac extension  effusion, tamponade

11. D IAGNOSIS History and Physical exam Diagnostic tests Chest x-ray Biopsy (bronchoscopy, needle biopsy, surgery) Staging tests CT chest/abdomen Bone scan Bone marrow aspiration

12. W HERE DOES IT TRAVEL ? Lymph Nodes, Brain, Liver, Adrenal, Gland, Bones 40% of metastasis occurs in the Adrenal Gland

13. Lung Cancer Treatment depend on: SCLC or NSCLC tumor stage general physical condition MALIGNANT LUNG TUMORS

14.  Surgery  Chemotherapy and radiation therapy: A. cure in a small number of patients B. relieving symptoms C. Inoperable NSCL MALIGNANT LUNG TUMORS

15.  Surgery preferred treatment for patients with early stage NSCLC 60%-80% of all patients who have advanced or metastatic disease are not suitable for surgery The extent of removal depends on the size of the tumor, its location, and how far it has spread. Surgery is not widely used in SCLC. Because SCLC spreads widely and rapidly through the body, removing it all by surgery usually is impossible. MALIGNANT LUNG TUMORS

16. T REATMENT AND S TAGING NSCLC StageDescriptionTreatment Options Stage I a/bTumor of any size is found only in the lung Surgery Stage II a/bTumor has spread to lymph nodes associated with the lung Surgery Stage III aTumor has spread to the lymph nodes in the tracheal area, including chest wall and diaphragm Chemotherapy followed by radiation or surgery Stage III bTumor has spread to the lymph nodes on the opposite lung or in the neck Combination of chemotherapy and radiation Stage IVTumor has spread beyond the chestChemotherapy and/or palliative (maintenance) care

17. B ENIGN LUNG TUMORS bronchial adenomas hamartomas group of uncommon neoplasms (eg, chondromas, fibromas, lipomas, leiomyomas, hemangiomas, teratomas, pseudolymphomas, endometriosis).

18. 2-5% of all primary lung tumors Hamartomas are the most common type Hamartomas can be easily enucleated, but wedge resection is also appropriate B ENIGN LUNG TUMORS

19. Complications: Pneumonia atelectasis hemoptysis malignancy B ENIGN LUNG TUMORS

20. purpose of surgical intervention for benign lung tumors is to avoid missing potentially malignant lesions remove benign lung tumors when they are symptomatic, which indicates the presence of complications such as pneumonia, atelectasis, and/or hemoptysis. minimally invasive technique or bronchoscopic resection B ENIGN LUNG TUMORS

21. Workup: Chest radiograph computed tomography (CT) scan Fiberoptic bronchoscopy: Percutaneous biopsy/guided transthoracic needle aspiration biopsy Video-assisted thoracoscopy Open biopsy B ENIGN LUNG TUMORS

22. MALIGNANT LUNG TUMORS

23. Treatment: solitary nodule in a young nonsmoking patient can be monitored with serial radiographs as long as the solitary nodule does not double in size in less than a year and it does not significantly increase in the pattern of calcification and shape consistent with a malignancy. B ENIGN LUNG TUMORS

24. extent of surgery : simple endoscopic resection, thoracotomy with bronchotomy/local excision, segmental resection, lobectomy, pneumonectomy

25. D IAPHRAGM major muscle of respiration and the second most important muscle after the heart

26. D IAPHRAGM

27. Spontaneous breathing relies primarily on diaphragmatic excursion to produce negative intrathoracic pressure. D IAPHRAGM

28. D IAPHRAGMATIC DISEASES Diaphragmatic hernia Eventration Tumors paralysis

29. D IAPHRAGMATIC HERNIA divided into 2 categories: congenital defects acquired defects:Blunt trauma accounts for 75% of ruptures, and penetrating trauma accounts for the rest.

30. D IAPHRAGMATIC RUPTURE Left-sided rupture is more common

31.  Clinical findings include : (1) marked respiratory distress, (2) decreased breath sounds on the affected side, (3) palpation of abdominal contents upon insertion of a chest tube, (4) auscultation of bowel sounds in the chest, (5) paradoxical movement of the abdomen with breathing, and/or (6) diffuse abdominal pain.

32. DX Chest radiography :Abdominal contents in the thorax Nasogastric tube seen in the thorax Nasogastric tube Elevated hemidiaphragm (>4 cm higher on left vs right)

35. TREATMENT surgical intervention whether the patient presents high incidence of concomitant intra-abdominal injuries dictates the need for emergency abdominal exploration in

36. C ONGENITAL DIAPHRAGMATIC HERNIA (CDH absence of the diaphragm, or a hole in the diaphragm. most common on the left.

37. Bochdalek hernia: This type involves an opening on the back side of the diaphragm. The stomach, intestines and liver or spleen usually move up into the chest cavity. Morgagni hernia: This type is rare and involves an opening in the front of the diaphragm, just behind the breast bone. The liver or intestines may move up into the chest cavity. T HERE ARE TWO TYPES OF DIAPHRAGMATIC HERNIA :

38. P RESENTATION difficulty breathing fast breathing fast heart rate cyanosis (blue color of the skin) abnormal chest development, with one side being larger than the other abdomen that appears caved in (concave).

39. T X : SURGERY

40. E VENTRATION OF THE DIAPHRAGM all or part of the diaphragmatic muscle is replaced by fibroelastic tissue diaphragm retains its continuity and attachments to the costal margin congenital or acquired partial or diffuse

42. D IAPHRAGMATIC TUMORS The diaphragm is commonly involved with malignant pleural disease or malignant peritoneal disease. Only rarely, however, is the diaphragm the source of either benign or malignant processes.

43. D IAPHRAGMATIC TUMORS Primary tumors of the diaphragm are very rare Benign tumors are most common:lipomas and cystic masses Most malignant tumors are sarcomas

44. Tumors of the diaphragm are not associated with any characteristic symptom. 50% of patients were asymptomatic and were found incidentally. If any symptom is characteristic, it is that lower chest discomfort, heaviness and referred pain to the top of the shoulder.