Lung Cancer

1
ANKIT BHANDARI

Background information
2

More people die from lung cancer than from any

other cancer
5-Year survival Rate is

49 Percent when confined to one part

16 percent spread within chest
2 Percent if it has spread outside of the chest

Risk Factors
3

Cigarette smoking
Asbestos
Radon

Who should be Screened?

4

U.S. Preventive services task force Recommends low

Dose computer Tomography.

Two Sub Groups of Lung cancer

5

Small cell lung cancer

Non-small cell Lung cancer

Clinical Features
6

Fever, weight loss and Hemoptysis

Chest X-ray

Lung Mass

CT Scan w/ IV
contrast

Symptoms
7

Local Invasion

Recurrent laryngeal nerve palsy

Horners syndrome
SVC syndrome
Phrenic nerve palsy

SVC syndrome
8

Phrenic Nerve Palsy

9

Paraneoplastic syndrome associated with lung cancers.

10

Syndrome

Causes

Cushing syndrome

ACTH

Lambert-Eaton Syndrome Ab to voltage gated

calcium channel

Likely Subtype

Small cell carcinoma

Hyponatermia

SIADH

Hypercalcemia

PTHrp

Squamous cell carcinoma

Hypertrophic pulmonary
osteoarthropathy

Painful periosteal growth

and clubbing

Adenocarcinoma

Pulmonary Nodule
11

No symptoms, X-ray

Pulmonary Nodule
Nodule changed
in size > 2 yr?

Stop Workup
Follow Yearly

New Nodule
CT with thin sections through
nodule
Suspicious
Benign

Biopsy
Resect

Follow every 3
mo

Film not available

Benign Versus Malignant Solitary Pulmonary

nodules
12

Factors favor Benign diagnosis

Factors that favor Malignancy

Age Less than 50 years

Age more than 50 years

Non smoker

Smoker or previous smoker

Size of nodule <2.0 cm

Size of nodule > 3.0 cm

No Growth over 2 year period

Steady growth on serial radiographs

Nodule circular and regular shaped

Nodule grossly irregular or speculated

margins

Central laminated calcification

Stippled or eccentric pattern

Pathologic Confirmation
13

Bronchoscopy- central
CT guided percutaneous biopsy- peripheral
Video Assisted thoracoscopy- inside lung

parenchyma
Pleural effusion is present get cytology

Therapy
14

Prognosis and management is based on tumor

staging

Non-small cell lung cancer

Staging Evaluation

CT abdomen and a combined PET and CT scan

Bone pain: bone scan and calcium and ALP levels

Staging and Prognosis for non-small

cell Lung cancer
15
Stage

Definition

Prognosis

Tumor surrounded by
lung or pleura and 2 cm
from carina

60% to 70 long term

disease-free survival

II

Locally advanced disease

without mediastinal
involvement

40% to 50% long term

disease-free survival

III

Mediastinal involvement,
or two separate tumor
nodules in same lobe
without mediastinal
involvement

5% to 20% long term

disease-free survival

IV

Metastatic

Median survival 7 months

Treatment
16

NSCLC

Overall Surgery is best option

Stage

Treatment

Surgery and in few cases

adjuvant chemotherapy

II

Surgery and adjuvant

chemotherapy

III

Combinations

IV

Chemotherapy only

Therapy
17

SCLC

Limited

Combination of Chemotherapy and Radiation therapy

Widespread

Only Chemotherapy first and Radiation to decrease the incidence

of brain metastases

Even if good response to Chemotherapy, response is

short lived.

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1) A 62-year-old man is evaluated for a persistent cough of 9 months' duration and a

4.5-kg (10-lb) unintentional weight loss over the past 6 weeks. The patient has a 30pack-year history of smoking cigarettes and continues to smoke.
On physical examination, his vital signs are normal. His body mass index is 24. There
are decreased breath sounds and dullness to percussion at the right base. The
remainder of the physical examination is normal.
Chest radiography confirms a right pleural effusion. Chest computed tomography (CT)
confirms a right pleural effusion and a 2.1-cm spiculated nodule in the right middle
lobe.
Which of the following is the most appropriate next Diagnostic Test?
A. CT-Guided biopsy of the lung nodule
B. Integrated Whole body PET-CT scan
C. Magnetic resonance imaging of the brain
D. Radiographic bone survey
E. Thoracentesis and pleural fluid cytology

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2) A 65-year-old woman seeks consultation in the office regarding lung

cancer screening. She has a 40-pack-year history of cigarette smoking and
continues to smoke. Her only active medical problem is chronic obstructive
pulmonary disease treated with daily tiotropium inhaler and an albuterol
inhaler as needed.
On physical examination, her vital signs are normal. Breath sounds are
distant with occasional wheezing. The remainder of the physical
examination is normal.
Which of the following screening tests can be recommended?
A. Annual Chest radiography
B. Annual Sputum for cytology
C. Combination annual chest radiography and sputum for cytology
D. Low-dose spiral chest computed tomography

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3) A 62-year-old man is evaluated following the incidental discovery of a 3-mm left

lower lobe lung nodule on a recent computed tomography (CT) scan of the
abdomen performed to evaluate for kidney stones. He has never smoked and has
an otherwise unremarkable medical history. He takes no medications.
On physical examination, his vital signs are normal. The physical examination is
unremarkable.
A dedicated CT of the chest shows only the 3-mm left lower lobe nodule and is
otherwise normal. There are no other chest images available for comparison.
Which of the following is the most appropriate next step in management of this
patient?
A. CT of the chest in 3 months
B. CT of the chest in 6 months
C. CT of the chest in 12 months
D. No follow-up imaging

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4) A 55-year-old woman is evaluated for a cough, weakness, and fatigue of 4 weeks'

duration. She has a 40-pack-year history of cigarette smoking.
On physical examination, her temperature is normal, blood pressure is 136/78 mm Hg,
and pulse rate is 68 beats/min. No palpable lymphadenopathy is noted. The
cardiopulmonary and neurologic examinations are normal.
A chest radiograph demonstrates a 5-cm left upper lobe pulmonary mass. A subsequent
computed tomography (CT) scan shows the mass but no evident mediastinal
lymphadenopathy. A positron emission tomography (PET) scan displays radiographic
uptake in the mass but no disease elsewhere. A CT-guided biopsy demonstrates
squamous cell carcinoma.
Which of the following is the most appropriate treatment?
A. Combination chemotherapy and radiation
B. Radiation
C. Surgery and adjuvant chemotherapy
D. Systemic chemotherapy