Lung Cancer
- epidemiology
- signs and symptoms
- diagnosis
- pathophysiology
- causes and risk factors
- treatments
- course
- patient education
- community resources
- references
Epidemiology
leading cause of cancer mortality
incidence: 60/100,000 in males; 40/100,000 in females
female lung cancer has increased 400%.
male lung cancer rates are decreasing.
Signs and Symptoms
cough: change in pattern: increasing
hemoptysis
shortness of breath: though not normally an initial symptom
pneumonia - persistent or recurrent, especially in same area
abnormal chest X-ray
nonpulmonary thoracic symptoms
- chest wall infiltration and pain
- pancoast tumour: at apex of chest; pain in elbow or wrist due to brachial plexus involvement
- recurrent laryngeal nerve paralysis, especially on left
- SVC syndrome: obstruction
- phrenic nerve paralysis
Peripheral nodules: no symptoms until it touches chest wall
central airway tumours:
airway obstruction, segmental lung collapse, infection, ventilation-perfusion mismatch, hemoptysis
metastatic disease: bone, brain, adrenals, liver
paraneoplastic syndromes
perhaps 50-75
not due to physical spread.
hypertrophic pulmonary osteoarthopathy (HPO) - pain at the ends of distal long bones.
syndrome of inappropriate ADH - low [sodium]
ACTH, other hormonal abnormalities
CNS
hematological abnormalities - anemia, thrombocytopenia
Differential Diagnosis
physical examination: feel for supraclavicular nodes
blood work: alkaline phosphatase
chest X ray
CT scan
timely referral
- smoking history
- old X rays
- TB, pneumonia, trauma, medical procedure history
- hamartoma
- collagen - vascular disease
- infective - Wagner's granuloma, fungi (histoplasmosis): ask about travel history
Diagnosis
bronchoscopy and chest x ray
CT scan
selective mediastinoscopy
needle biopsy usually for patients with inoperable tumours
mediastinal nodal involvement: poor prognosis
stage IIIa: mediastinal nodes; locally advanced tumour; small chance of cure
stage IV: metastatic
high suspicion: surgery
uncertin: serial CT scans or surgery
low suspicion: serial CT scans
PET scans in the future
Types of Lung Cancer
Non-small cell carcinoma
80%
squamous cell carcinoma
- central, bronchus
adenocarcinoma
- peripheral; now more common, potentially due to changes in cigarettes
- early brain metastases
- more common in females
bronchoalveolar
- more slowly growing
- more amenable to surgery
large cell anaplastic
Small cell carcinoma
- central
- neuroendocrine cells
- early lymph node spread; lymph nodes are often larger than primary tumour
- very aggressive
Pathophysiology
Causes and Risk Factors
Smoking causes 85% of cases.
Remaining cancers are caused by
- second hand smoke
- radon
- radioactive mining
- asbestos
- aluminum
- coke ovens
- nickel
- vinyl something...
Treatments
Decisions
cell type, stage, patient
cure:
non small cell, stage 1: surgery: 65-80%
stage II surgery/chemo: 40-55%
small cell limited stage: xxxx 20%
lobectomy, pulmonectomy, chemotherapy, all have risk of mortality
palliation:
- radiotherapy
- chemotherapy
- endobronchial treatment: laser, stenting, brachytherapy
- general supportive care: pain control
- antiobiotics, psychosocial/spiritual
Course
cure:
- males: 15%
- females: 18%
stage I: 60-80%
stage II: 40-55%
stage III: 10-15%
stage IV: 1-2%
Patient Education
Community Resources
References