Lung CancerLung Cancer

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

Only about 14% of all people who Only about 14% of all people who develop lung cancer survive for 5 develop lung cancer survive for 5 years. years.

Most lung tumors are malignant. Most lung tumors are malignant.

Lung CancerLung Cancer Lung cancers are usually divided into 2 groups that account Lung cancers are usually divided into 2 groups that account

for about 95% of all cases. for about 95% of all cases. These two types are called simply small-cell lung cancer These two types are called simply small-cell lung cancer

(SCLC) and non–small-cell lung cancer (NSCLC)(SCLC) and non–small-cell lung cancer (NSCLC) SCLCs are less common, but they grow more quickly than SCLCs are less common, but they grow more quickly than

NSCLCs and are more likely to metastasize. Often, they NSCLCs and are more likely to metastasize. Often, they have already spread to other parts of the body when the have already spread to other parts of the body when the disease is diagnosed. disease is diagnosed.

About 5% of lung cancers are of rare cell types such as About 5% of lung cancers are of rare cell types such as carcinoid tumor, lymphoma, or metastatic (cancers from carcinoid tumor, lymphoma, or metastatic (cancers from other parts of the body that spread to the lungs). other parts of the body that spread to the lungs).

Lung CancerLung Cancer

The specific types of primary lung The specific types of primary lung cancers are as follows: cancers are as follows: • Adenocarcinoma (a NSCLC) is the most Adenocarcinoma (a NSCLC) is the most

common type of lung cancer, making up common type of lung cancer, making up 30-35% of all cases. A subtype of 30-35% of all cases. A subtype of adenocarcinoma is called adenocarcinoma is called bronchoalveolar cell carcinoma, which bronchoalveolar cell carcinoma, which creates a pneumonialike appearance on creates a pneumonialike appearance on chest x-rays. chest x-rays.

Lung CancerLung Cancer

• Squamous cell carcinoma (a NSCLC) is Squamous cell carcinoma (a NSCLC) is the second most common type, making the second most common type, making up about 30% of all lung cancers. up about 30% of all lung cancers.

• Large-cell cancer makes up 10% of all Large-cell cancer makes up 10% of all cases. cases.

• SCLC makes up 20% of all cases.SCLC makes up 20% of all cases.

Lung CancerLung Cancer Cigarette smoking is the most significant cause of lung Cigarette smoking is the most significant cause of lung

cancercancer Cigar and pipe smoking increases your risk of lung cancer, Cigar and pipe smoking increases your risk of lung cancer,

but not as much as smoking cigarettes does but not as much as smoking cigarettes does Passive smoking, or sidestream smokePassive smoking, or sidestream smoke

Air pollution from motor vehicles, factoriesAir pollution from motor vehicles, factories Asbestos exposure increases the risk of lung cancer by 9 Asbestos exposure increases the risk of lung cancer by 9

times. A combination of asbestos exposure and cigarette times. A combination of asbestos exposure and cigarette smoking compounds the risk by as much as 50 times. smoking compounds the risk by as much as 50 times.

Radon exposure Radon exposure

Symptoms of primary lung cancers include cough, Symptoms of primary lung cancers include cough, coughing up blood, chest pain, and shortness of coughing up blood, chest pain, and shortness of breathbreath..

Lung CancerLung Cancer Lung cancer most often spreads to the liver, the adrenal Lung cancer most often spreads to the liver, the adrenal

glands, the bones, and the brain. 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 Metastasis to the bones is most common with small-cell

type cancers but also occurs with other lung cancer types. type cancers but also occurs with other lung cancer types. Paraneoplastic syndromes are the remote, indirect effects of Paraneoplastic syndromes are the remote, indirect effects of

cancer not related to direct invasion cancer not related to direct invasion A A chest x-raychest x-ray will most likely be done first to look for a will most likely be done first to look for a

cause of your cause of your respiratory symptoms. respiratory symptoms. • 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 Types of abnormalities seen in lung cancer include a small

nodule(s) or a large mass nodule(s) or a large mass • Not all abnormalities are cancers, Not all abnormalities are cancers,

Lung CancerLung Cancer

NSCLCs that are inoperable are NSCLCs that are inoperable are treated with chemotherapy or a treated with chemotherapy or a combination of chemotherapy and combination of chemotherapy and radiation radiation

Chemotherapy is the first-line Chemotherapy is the first-line treatment for SCLC. treatment for SCLC.

Surgery is the most widely used Surgery is the most widely used treatment for NSCLC. treatment for NSCLC.

Location can suggest cell type Location can suggest cell type • Central lesion- squamous cell or small cell Central lesion- squamous cell or small cell • Peripheral lesion – adenocarcinomaPeripheral lesion – adenocarcinoma

Positron emission tomography (PET) Positron emission tomography (PET) detects increased glucose uptake by detects increased glucose uptake by malignant tissues using a glucose analog, malignant tissues using a glucose analog, [2-18F]fluoro-2-deoxy-D-glucose (DFG). It [2-18F]fluoro-2-deoxy-D-glucose (DFG). It provides a highly accurate and non-provides a highly accurate and non-invasive method for detecting malignant invasive method for detecting malignant lung tumors. lung tumors.

AdenocarcinomaAdenocarcinoma Adenocarcinoma is also the most common cell type seen in women and Adenocarcinoma is also the most common cell type seen in women and

nonsmokers.nonsmokers. Adenocarcinoma is sometimes associated with other concomitant lung Adenocarcinoma is sometimes associated with other concomitant lung

diseases including diffuse fibrotic interstitial lung diseases, tuberculosis, diseases including diffuse fibrotic interstitial lung diseases, tuberculosis, and pulmonary infarction. 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 The typical radiologic manifestation of adenocarcinoma is a solitary

pulmonary nodule with well-defined, lobulated, irregular, or poorly defined pulmonary nodule with well-defined, lobulated, irregular, or poorly defined borders. It may be quite difficult to see on plain radiolgraphy.borders. It may be quite difficult to see on plain radiolgraphy.

Thin-section CT of small peripheral carcinomas may demonstrate air Thin-section CT of small peripheral carcinomas may demonstrate air bronchograms or air bronchiolograms in 65% of cases. Peripheral bronchograms or air bronchiolograms in 65% of cases. Peripheral adenocarcinomas may directly invade the pleura and grow in pleural adenocarcinomas may directly invade the pleura and grow in pleural space. The lesion may be spiculated space. The lesion may be spiculated

Adenocarcinoma has been reported to occur in close relation to Adenocarcinoma has been reported to occur in close relation to preexisting bulla and may manifest as a nodular opacity within the preexisting bulla and may manifest as a nodular opacity within the bulla, thickening of the bulla wall, change in the size of bulla, or bulla, thickening of the bulla wall, change in the size of bulla, or spontaneous pneumothorax spontaneous pneumothorax

                    

             

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.

adenocarcinoma

adeno

Bronchioloalveolar carcinomaBronchioloalveolar carcinoma Bronchioloalveolar carcinoma is a subtype of Bronchioloalveolar carcinoma is a subtype of

adenocarcinoma and represents 2-6% of all lung cancers.It adenocarcinoma and represents 2-6% of all lung cancers.It typically arises distal to the terminal bronchioles and typically arises distal to the terminal bronchioles and spreads along the preexisting alveolar septa without spreads along the preexisting alveolar septa without causing significant amounts of lung destructioncausing significant amounts of lung destruction

The cells secrete mucin and surfactant apoprotein-- can The cells secrete mucin and surfactant apoprotein-- can lead to bronchorrhealead to bronchorrhea

Bronchioloalveolar carcinoma can manifest as a single Bronchioloalveolar carcinoma can manifest as a single peripheral nodule or mass usually in the upper lung.Most peripheral nodule or mass usually in the upper lung.Most commonly, this nodule is well-circumscribed commonly, this nodule is well-circumscribed

Squamous cell carcinomaSquamous cell carcinoma Squamous cell carcinoma is a common form of lung cancer, Squamous cell carcinoma is a common form of lung cancer,

accounting for approximately one-third of all cases of accounting for approximately one-third of all cases of bronchogenic carcinomas.bronchogenic carcinomas.

Unlike adenocarcinoma, it is strongly linked with a history of Unlike adenocarcinoma, it is strongly linked with a history of cigarette smoking.cigarette smoking.

Most squamous cell carcinomas arise centrally from either the Most squamous cell carcinomas arise centrally from either the main, lobar or segmental bronchi and ulcerate through the main, lobar or segmental bronchi and ulcerate through the mucosa into the surrounding lung parenchyma.mucosa into the surrounding lung parenchyma.

Their central location also tends to produces symptoms at an Their central location also tends to produces symptoms at an earlier stage than tumors located peripherally.earlier stage than tumors located peripherally.

Although symptoms tend not to be specific, most commonly a Although symptoms tend not to be specific, most commonly a non-productive cough, they stem from the involvement of vital non-productive cough, they stem from the involvement of vital structures at the hilar area of the lung structures at the hilar area of the lung

They are the most common cause of the Pancoast or superior They are the most common cause of the Pancoast or superior sulcus syndrome. sulcus syndrome.

The lung windows CT demonstrates a mass in the lumen of the right main stem bronchus and narrowing of the pulmonary artery. A bronchoscopic view also shows the tumor in the right main stem bronchus

Malignant mesotheliomaMalignant mesothelioma Malignant mesothelioma is an uncommon neoplasm yet it is Malignant mesothelioma is an uncommon neoplasm yet it is

the most common primary malignancy of the pleurathe most common primary malignancy of the pleura most significant etiological factor for the development of most significant etiological factor for the development of

malignant mesothelioma is asbestos exposuremalignant mesothelioma is asbestos exposure Radiological Findings Radiological Findings

• Chest x-ray may show pleural effusions or pleural Chest x-ray may show pleural effusions or pleural thickening on the affected side. thickening on the affected side.

• Computed tomography (CT) may also show pleural Computed tomography (CT) may also show pleural effusions or pleural thickening with irregular nodularity. effusions or pleural thickening with irregular nodularity. CT may be helpful to evaluate local invasion of the chest CT may be helpful to evaluate local invasion of the chest wall, pericardium, diaphragm, as well as wall, pericardium, diaphragm, as well as mediastinal/great vessel invasion and nodal mediastinal/great vessel invasion and nodal involvement. involvement.

CT image demonstrates pleural thickening posteriomedially in the right hemithorax

Large cell carcinomaLarge cell carcinoma

Large cell carcinoma represents 10-Large cell carcinoma represents 10-20% of bronchogenic tumors. 20% of bronchogenic tumors.

They tend to grow rapidly, They tend to grow rapidly, metastasize early, and are strongly metastasize early, and are strongly associated with smoking. associated with smoking.

Small cell carcinomaSmall cell carcinoma Small cell carcinoma accounts for approximately 20% of all Small cell carcinoma accounts for approximately 20% of all

lung cancers.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 Small cell carcinoma causes a number of paraneoplastic

syndromes.Small cell carcinoma is the most common type syndromes.Small cell carcinoma is the most common type of cancer to cause clinical hormone syndromes.The tumor of cancer to cause clinical hormone syndromes.The tumor cells may produce ectopic adrenocorticotropic hormone cells may produce ectopic adrenocorticotropic hormone (ACTH), resulting in Cushing's syndrome. The symptoms of (ACTH), resulting in Cushing's syndrome. The symptoms of Cushing's syndrome are nonspecific and are often Cushing's syndrome are nonspecific and are often attributed to other factors. Another paraneoplastic hormone attributed to other factors. Another paraneoplastic hormone syndrome that commonly occurs is the syndrome of syndrome that commonly occurs is the syndrome of inappropriate anti-diuretic hormone (SIADH). This is caused inappropriate anti-diuretic hormone (SIADH). This is caused bysecretion of ADH from the tumor. Symptoms are related bysecretion of ADH from the tumor. Symptoms are related to the plasma hypotonicity that is secondary to water to the plasma hypotonicity that is secondary to water retention. retention.

Over 90% of small cell tumors are found in a central Over 90% of small cell tumors are found in a central location. location.

Met’sMet’s Metastatic tumors in the lungs are malignancies (cancers) Metastatic tumors in the lungs are malignancies (cancers)

that developed at other sites and spread via the blood that developed at other sites and spread via the blood stream to the lungs. Common tumors that metastasize to stream to the lungs. Common tumors that metastasize to the lungs include the lungs include breast cancerbreast cancer, , colon cancercolon cancer, , prostate cancerprostate cancer, sarcoma, , sarcoma, bladder cancerbladder cancer, , neuroblastomaneuroblastoma, , and and Wilm´sWilm´s tumor tumor. However, almost any cancer has the . However, almost any cancer has the capacity to spread to the lungs.capacity to spread to the lungs.

Pulmonary metastases occur predominantly in the lower Pulmonary metastases occur predominantly in the lower lobeslobes

Cavitation is uncommon and occurs more frequently in Cavitation is uncommon and occurs more frequently in upper lobe lesions.upper lobe lesions.

Mets FactsMets Facts

Cannon Ball MetsCannon Ball Mets• Head and Neck Cancer, Testicular and Head and Neck Cancer, Testicular and

Ovarian, Breast, Renal and ColonOvarian, Breast, Renal and Colon Ca+ MetsCa+ Mets

• Osteosarcoma and Chondrosarcoma Osteosarcoma and Chondrosarcoma ( these are Bone cancer mets)( these are Bone cancer mets)

• Mucinous Mets: ovarian, thyroid, Mucinous Mets: ovarian, thyroid, pancreas, colon and stomachpancreas, colon and stomach

Breast