Lung Cancer

The BIG Kahuna among Tumors

Why is Lung Cancer the BIG Kahuna?

• Number 1 cause of cancer deaths in both men and women now

• Only major cancer that continues to show an increase in rates of new cases

• Has an overall 5-year survival rate of less than 50% (approximately 44%)

• One of the most preventable but least treatable of cancers

Major Types of Lung Tumors

• 99% of all lung cancers arise from the epithelial cells of lung tissue and are therefore Bronchogenic Carcinomas

• Approximately 1% arise from lymphoid tissue or other supporting structures within the lung; these are mostly Mesotheliomas

Bronchogenic Carcinomas

• Two Types– Small Cell (SCLC)– Non-small Cell (NSCLC)

• Important to differentiate– Small Cell are more aggressive and respond

better to chemotherapy and radiation– Non-small Cell are best treated with surgery

(unless advanced); chemotherapy not as useful

Non-small cell lung cancer3 types

• Squamous Cell (also called epidermoid) – cancer of the cells that line the bronchi or small and large airways – the most common

• Adenocarcinoma - cancer of the mucus producing or gland cells within the lung

• Giant Cell - cancer of the cells that make up the walls of the air sacks

Small Cell Lung Cancer

• Also called Oat Cell

• Cancer involving the small cells that resemble lymphocytes and line the walls of the bronchi and alveoli (air sacks) as infection fighters

Risk Factors

• SMOKING!!!!!• Secondary smoke• Environmental

– Occupational exposure to radiation or inhaled carcinogens

– Air pollution

• Immuno-suppressed states• Diet

Smoking

• Smoking markedly increases risk for ALL forms of lung cancer

• The risk appears to be non-linear; the more a person has smoked, and the longer they have smoked combines to accelerate risk as they get older

• Even after smoking cessation of 15-20 years, former smokers still have a greater risk than people who have never smoked

Secondary Smoke

• The Environmental Protection Agency has declared secondary smoke a major carcinogen

• The risk to persons from secondary smoke may in fact be higher for the same amount of exposure as for the smoker, because secondary smoke is NOT filtered through the cigarette

Environmental Exposures

• Environmental Radiation, especially radon

• Occupational radiation exposure as seen in uranium, coal, and iron miners

• Medical radiation, especially adjuvant radiation for breast cancer treatment, Hodgekins Disease or lymphomas

• Asbestos – the primary risk for mesotheliomas and sarcomas of the lung

Immuno-suppressed States

• HIV/AIDS patients

• Transplant patients on anti-rejection drugs

• Persons with certain auto-immune diseases such as Rheumatoid Arthritis or Ankylosing Spondylitis

• Persons with other forms of cancer

Diet

• Dietary deficiencies in Vitamin E and Beta Carotene are associated with increased incidence of lung cancer among already high risk smokers

• Vitamin A in significant doses has been shown to reduce the incidence of lung cancer and retard its progression

ALL of the other risk factors in lung cancer are adversely affected by

SMOKING!!!

It is important to note that lung cancer does NOT have a large hereditary factor, so you can’t

blame this cancer on not choosing your parents well!

Prevention

• NEVER start smoking– Should note that marijuana is even more toxic

to the lungs that tobacco with a higher risk

• Smokers need to QUIT

• Avoid second-hand smoke, especially children and young people because effects are cumulative

Prevention (continued)

• Pay attention to air quality indices and warnings

• Avoid exposures to other airborne carcinogens whenever possible

• Wear approved and properly fitted respirators in hazardous occupations like coal mining and fire fighting

• Avoid exposure to radiation when possible

Hazardous Radiation

• Most common airborne radiation exposure is radon which is found naturally around concrete

• If you have a concrete basement, have it checked for radon levels; if high, insulate it and/or ventilate it

• Don’t ask for or insist on x-rays that you might not need; avoid excessive CT scans

Detection

• Single most common symptom of lung cancer is a persistent cough without the presence of infection, especially a cough that changes or becomes bloody

• Definitive study is usually a chest x-ray; questionable cases may need a CT scan of the chest or an MRI

• Absolute diagnosis needs a tissue sample from a biopsy or bronchoscopy

More on Detection

• Hoarseness without presence of infection or another obvious cause is another disturbing symptom, usually caused by tumor invading or wrapping itself around the nerve to the vocal cords, or direct invasion of the cords

Staging

• Lung cancer is staged by looking at three things– The size and location of the tumor– The presence of lymph nodes with tumor in

them– The presence or absence of metastases

The higher the number in each of these categories: T, N, M, the worse the disease

Treatment - NSCLC

• Non-small cell tumors with no metastases and few or no positive lymph nodes are best treated with complete surgical excision of the segment or lobe of the lung involved

• If lymph nodes are positive or if there has been local spread, radiation and chemotherapy may be added

• If metastases are present, chemotherapy is usually essential

Treatment - SCLC

• The hallmark of small cell lung cancer treatment is chemotherapy as many of these cancers are exquisitely sensitive to the newer chemotherapy regimens

• Radiation can be used as an adjunct or in some cases as the primary therapy

Prognosis

• The overall prognosis in lung cancer is not good – that’s why prevention is SO IMPORTANT – STOP SMOKING!!!

• In early NSCLC disease 5 year cure rates may be as high as 85%

• Stage 4 disease with metastases is dismal, less than 1% with survival of less than 6 months being the rule

Prognosis (continued)

• Intermediate disease is becoming more amenable to treatment as newer regimens of chemotherapy are being discovered and surgical techniques are improving

• Even in non-operable terminal disease, palliative radiation and chemotherapy can improve quality of life frequently

Recurrent Disease

• The incidence of a new primary tumor, frequently in the other lung, is very common in post-lung cancer patients, so frequent surveillance and follow up is essential

• IF YOU DON’T SMOKE, DON’T START, IF YOU DO, QUIT NOW!

THE GREAT AMERICAN SMOKEOUT

• The Great American Smokeout is this month

• Contact your local chapter of the American Cancer Society for more information or call 1800 227-2345

• Or go to www.cancer.org

QUESTIONS?