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Lung Cancer Lung cancer is the leading cause of cancer deaths in both women and men in the United States Lung cancer is the leading cause of cancer deaths.

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Presentation on theme: "Lung Cancer Lung cancer is the leading cause of cancer deaths in both women and men in the United States Lung cancer is the leading cause of cancer deaths."— Presentation transcript:

1 Lung Cancer Lung cancer is the leading cause of cancer deaths in both women and men in the United States Lung cancer is the leading cause of cancer deaths in both women and men in the United States Only about 14% of all people who develop lung cancer survive for 5 years. Only about 14% of all people who develop lung cancer survive for 5 years. Most lung tumors are malignant. Most lung tumors are malignant.

2 Lung Cancer Lung cancers are usually divided into 2 groups that account for about 95% of all cases. Lung cancers are usually divided into 2 groups that account for about 95% of all cases. These two types are called simply small-cell lung cancer (SCLC) and non–small-cell lung cancer (NSCLC) These two types are called simply small-cell lung cancer (SCLC) and non–small-cell lung cancer (NSCLC) SCLCs are less common, but they grow more quickly than NSCLCs and are more likely to metastasize. Often, they have already spread to other parts of the body when the disease is diagnosed. SCLCs are less common, but they grow more quickly than NSCLCs and are more likely to metastasize. Often, they have already spread to other parts of the body when the disease is diagnosed. About 5% of lung cancers are of rare cell types such as carcinoid tumor, lymphoma, or metastatic (cancers from other parts of the body that spread to the lungs). About 5% of lung cancers are of rare cell types such as carcinoid tumor, lymphoma, or metastatic (cancers from other parts of the body that spread to the lungs).

3 Lung Cancer The specific types of primary lung cancers are as follows: The specific types of primary lung cancers are as follows: Adenocarcinoma (a NSCLC) is the most common type of lung cancer, making up 30-35% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonialike appearance on chest x-rays.Adenocarcinoma (a NSCLC) is the most common type of lung cancer, making up 30-35% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonialike appearance on chest x-rays.

4 Lung Cancer Squamous cell carcinoma (a NSCLC) is the second most common type, making up about 30% of all lung cancers.Squamous cell carcinoma (a NSCLC) is the second most common type, making up about 30% of all lung cancers. Large-cell cancer makes up 10% of all cases.Large-cell cancer makes up 10% of all cases. SCLC makes up 20% of all cases.SCLC makes up 20% of all cases.

5 Lung Cancer Cigarette smoking is the most significant cause of lung cancer Cigarette smoking is the most significant cause of lung cancer Cigar and pipe smoking increases your risk of lung cancer, but not as much as smoking cigarettes does Cigar and pipe smoking increases your risk of lung cancer, but not as much as smoking cigarettes does Passive smoking, or sidestream smoke Passive smoking, or sidestream smoke Air pollution from motor vehicles, factories Air pollution from motor vehicles, factories Asbestos exposure increases the risk of lung cancer by 9 times. A combination of asbestos exposure and cigarette smoking compounds the risk by as much as 50 times. Asbestos exposure increases the risk of lung cancer by 9 times. A combination of asbestos exposure and cigarette smoking compounds the risk by as much as 50 times. Radon exposure Radon exposure Symptoms of primary lung cancers include cough, coughing up blood, chest pain, and shortness of breath. Symptoms of primary lung cancers include cough, coughing up blood, chest pain, and shortness of breath.

6 Lung Cancer Lung cancer most often spreads to the liver, the adrenal glands, the bones, and the brain. Lung cancer most often spreads to the liver, the adrenal glands, the bones, and the brain. Metastatic lung cancer in the adrenal glands also typically Metastatic lung cancer in the adrenal glands also typically Metastasis to the bones is most common with small-cell type cancers but also occurs with other lung cancer types. Metastasis to the bones is most common with small-cell type cancers but also occurs with other lung cancer types. Paraneoplastic syndromes are the remote, indirect effects of cancer not related to direct invasion Paraneoplastic syndromes are the remote, indirect effects of cancer not related to direct invasion A chest x-ray will most likely be done first to look for a cause of your respiratory symptoms. A chest x-ray will most likely be done first to look for a cause of your respiratory symptoms.chest x-raychest x-ray The x-ray may or may not show an abnormalityThe x-ray may or may not show an abnormality Types of abnormalities seen in lung cancer include a small nodule(s) or a large massTypes of abnormalities seen in lung cancer include a small nodule(s) or a large mass Not all abnormalities are cancers, Not all abnormalities are cancers,

7 Lung Cancer NSCLCs that are inoperable are treated with chemotherapy or a combination of chemotherapy and radiation NSCLCs that are inoperable are treated with chemotherapy or a combination of chemotherapy and radiation Chemotherapy is the first-line treatment for SCLC. Chemotherapy is the first-line treatment for SCLC. Surgery is the most widely used treatment for NSCLC. Surgery is the most widely used treatment for NSCLC.

8 Location can suggest cell type Location can suggest cell type Central lesion- squamous cell or small cellCentral lesion- squamous cell or small cell Peripheral lesion – adenocarcinomaPeripheral lesion – adenocarcinoma Positron emission tomography (PET) detects increased glucose uptake by malignant tissues using a glucose analog, [2-18F]fluoro-2-deoxy-D-glucose (DFG). It provides a highly accurate and non- invasive method for detecting malignant lung tumors. Positron emission tomography (PET) detects increased glucose uptake by malignant tissues using a glucose analog, [2-18F]fluoro-2-deoxy-D-glucose (DFG). It provides a highly accurate and non- invasive method for detecting malignant lung tumors.

9 Adenocarcinoma Adenocarcinoma is also the most common cell type seen in women and nonsmokers. Adenocarcinoma is also the most common cell type seen in women and nonsmokers. Adenocarcinoma is sometimes associated with other concomitant lung diseases including diffuse fibrotic interstitial lung diseases, tuberculosis, and pulmonary infarction. Adenocarcinoma is sometimes associated with other concomitant lung diseases including diffuse fibrotic interstitial lung diseases, tuberculosis, and pulmonary infarction. Bronchioloalveolar carcinoma represents a subtype of adenocarcinoma. Bronchioloalveolar carcinoma represents a subtype of adenocarcinoma. The typical radiologic manifestation of adenocarcinoma is a solitary pulmonary nodule with well-defined, lobulated, irregular, or poorly defined borders. It may be quite difficult to see on plain radiolgraphy. The typical radiologic manifestation of adenocarcinoma is a solitary pulmonary nodule with well-defined, lobulated, irregular, or poorly defined borders. It may be quite difficult to see on plain radiolgraphy. Thin-section CT of small peripheral carcinomas may demonstrate air bronchograms or air bronchiolograms in 65% of cases. Peripheral adenocarcinomas may directly invade the pleura and grow in pleural space. The lesion may be spiculated Thin-section CT of small peripheral carcinomas may demonstrate air bronchograms or air bronchiolograms in 65% of cases. Peripheral adenocarcinomas may directly invade the pleura and grow in pleural space. The lesion may be spiculated Adenocarcinoma has been reported to occur in close relation to preexisting bulla and may manifest as a nodular opacity within the bulla, thickening of the bulla wall, change in the size of bulla, or spontaneous pneumothorax Adenocarcinoma has been reported to occur in close relation to preexisting bulla and may manifest as a nodular opacity within the bulla, thickening of the bulla wall, change in the size of bulla, or spontaneous pneumothorax

10 This chest X-ray shows adenocarcinoma of the lung. There is a rounded light spot in the right upper lung (left side of the picture) at the level of the second rib. The light spot has irregular and poorly defined borders and is not uniform in density. Diseases that may cause this type of X-ray result would be tuberculous or fungal granuloma, and malignant or benign tumors.

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15 Bronchioloalveolar carcinoma Bronchioloalveolar carcinoma is a subtype of adenocarcinoma and represents 2-6% of all lung cancers.It typically arises distal to the terminal bronchioles and spreads along the preexisting alveolar septa without causing significant amounts of lung destruction Bronchioloalveolar carcinoma is a subtype of adenocarcinoma and represents 2-6% of all lung cancers.It typically arises distal to the terminal bronchioles and spreads along the preexisting alveolar septa without causing significant amounts of lung destruction The cells secrete mucin and surfactant apoprotein-- can lead to bronchorrhea The cells secrete mucin and surfactant apoprotein-- can lead to bronchorrhea Bronchioloalveolar carcinoma can manifest as a single peripheral nodule or mass usually in the upper lung.Most commonly, this nodule is well-circumscribed Bronchioloalveolar carcinoma can manifest as a single peripheral nodule or mass usually in the upper lung.Most commonly, this nodule is well-circumscribed

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21 Squamous cell carcinoma Squamous cell carcinoma is a common form of lung cancer, accounting for approximately one-third of all cases of bronchogenic carcinomas. Squamous cell carcinoma is a common form of lung cancer, accounting for approximately one-third of all cases of bronchogenic carcinomas. Unlike adenocarcinoma, it is strongly linked with a history of cigarette smoking. Unlike adenocarcinoma, it is strongly linked with a history of cigarette smoking. Most squamous cell carcinomas arise centrally from either the main, lobar or segmental bronchi and ulcerate through the mucosa into the surrounding lung parenchyma. Most squamous cell carcinomas arise centrally from either the main, lobar or segmental bronchi and ulcerate through the mucosa into the surrounding lung parenchyma. Their central location also tends to produces symptoms at an earlier stage than tumors located peripherally. Their central location also tends to produces symptoms at an earlier stage than tumors located peripherally. Although symptoms tend not to be specific, most commonly a non-productive cough, they stem from the involvement of vital structures at the hilar area of the lung Although symptoms tend not to be specific, most commonly a non-productive cough, they stem from the involvement of vital structures at the hilar area of the lung They are the most common cause of the Pancoast or superior sulcus syndrome. They are the most common cause of the Pancoast or superior sulcus syndrome.

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24 The lung windows CT demonstr ates a mass in the lumen of the right main stem bronchus and narrowing of the pulmonar y artery. A bronchos copic view also shows the tumor in the right main stem bronchus

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26 Malignant mesothelioma Malignant mesothelioma is an uncommon neoplasm yet it is the most common primary malignancy of the pleura Malignant mesothelioma is an uncommon neoplasm yet it is the most common primary malignancy of the pleura most significant etiological factor for the development of malignant mesothelioma is asbestos exposure most significant etiological factor for the development of malignant mesothelioma is asbestos exposure Radiological Findings Radiological Findings Chest x-ray may show pleural effusions or pleural thickening on the affected side.Chest x-ray may show pleural effusions or pleural thickening on the affected side. Computed tomography (CT) may also show pleural effusions or pleural thickening with irregular nodularity. CT may be helpful to evaluate local invasion of the chest wall, pericardium, diaphragm, as well as mediastinal/great vessel invasion and nodal involvement.Computed tomography (CT) may also show pleural effusions or pleural thickening with irregular nodularity. CT may be helpful to evaluate local invasion of the chest wall, pericardium, diaphragm, as well as mediastinal/great vessel invasion and nodal involvement.

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28 CT image demo nstrat es pleura l thicke ning poster iomed ially in the right hemit horax

29 Large cell carcinoma Large cell carcinoma represents 10- 20% of bronchogenic tumors. Large cell carcinoma represents 10- 20% of bronchogenic tumors. They tend to grow rapidly, metastasize early, and are strongly associated with smoking. They tend to grow rapidly, metastasize early, and are strongly associated with smoking.

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32 Small cell carcinoma Small cell carcinoma accounts for approximately 20% of all lung cancers. Small cell carcinoma accounts for approximately 20% of all lung cancers. It is characterized by itsorigin in large central airways It is characterized by itsorigin in large central airways Small cell carcinoma causes a number of paraneoplastic syndromes.Small cell carcinoma is the most common type of cancer to cause clinical hormone syndromes.The tumor cells may produce ectopic adrenocorticotropic hormone (ACTH), resulting in Cushing's syndrome. The symptoms of Cushing's syndrome are nonspecific and are often attributed to other factors. Another paraneoplastic hormone syndrome that commonly occurs is the syndrome of inappropriate anti-diuretic hormone (SIADH). This is caused bysecretion of ADH from the tumor. Symptoms are related to the plasma hypotonicity that is secondary to water retention. Small cell carcinoma causes a number of paraneoplastic syndromes.Small cell carcinoma is the most common type of cancer to cause clinical hormone syndromes.The tumor cells may produce ectopic adrenocorticotropic hormone (ACTH), resulting in Cushing's syndrome. The symptoms of Cushing's syndrome are nonspecific and are often attributed to other factors. Another paraneoplastic hormone syndrome that commonly occurs is the syndrome of inappropriate anti-diuretic hormone (SIADH). This is caused bysecretion of ADH from the tumor. Symptoms are related to the plasma hypotonicity that is secondary to water retention. Over 90% of small cell tumors are found in a central location. Over 90% of small cell tumors are found in a central location.

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36 Met’s Metastatic tumors in the lungs are malignancies (cancers) that developed at other sites and spread via the blood stream to the lungs. Common tumors that metastasize to the lungs include breast cancer, colon cancer, prostate cancer, sarcoma, bladder cancer, neuroblastoma, and Wilm´s tumor. However, almost any cancer has the capacity to spread to the lungs. Metastatic tumors in the lungs are malignancies (cancers) that developed at other sites and spread via the blood stream to the lungs. Common tumors that metastasize to the lungs include breast cancer, colon cancer, prostate cancer, sarcoma, bladder cancer, neuroblastoma, and Wilm´s tumor. However, almost any cancer has the capacity to spread to the lungs.breast cancercolon cancerprostate cancerbladder cancerneuroblastoma Wilm´s tumorbreast cancercolon cancerprostate cancerbladder cancerneuroblastoma Wilm´s tumor Pulmonary metastases occur predominantly in the lower lobes Pulmonary metastases occur predominantly in the lower lobes Cavitation is uncommon and occurs more frequently in upper lobe lesions. Cavitation is uncommon and occurs more frequently in upper lobe lesions.

37 Mets Facts Cannon Ball Mets Cannon Ball Mets Head and Neck Cancer, Testicular and Ovarian, Breast, Renal and ColonHead and Neck Cancer, Testicular and Ovarian, Breast, Renal and Colon Ca+ Mets Ca+ Mets Osteosarcoma and Chondrosarcoma ( these are Bone cancer mets)Osteosarcoma and Chondrosarcoma ( these are Bone cancer mets) Mucinous Mets: ovarian, thyroid, pancreas, colon and stomachMucinous Mets: ovarian, thyroid, pancreas, colon and stomach

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