lung cancer
DESCRIPTION
Lung Cancer. Lung Cancer. The most common cancer worldwide, and the deadliest 1.37 million deaths worldwide (WHO 2008) 203,000 people diagnosed in the US each year, 158,000 deaths (CDC 2007). Risk Factors. Cigarette smoking Smokers are 10-20 times more likely to get lung cancer - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/1.jpg)
Lung Cancer
![Page 2: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/2.jpg)
Lung Cancer
The most common cancer worldwide, and the deadliest
1.37 million deaths worldwide (WHO 2008) 203,000 people diagnosed in the US each
year, 158,000 deaths (CDC 2007)
![Page 3: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/3.jpg)
Risk Factors
Cigarette smoking Smokers are 10-20 times more likely to get
lung cancer85-90% of deaths from lung cancer are
smoking relatedRisk is dose dependent: the more a person
smokes, the higher the riskQuitting decreases a person's risk
![Page 4: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/4.jpg)
Risk Factors
Radon accounts for 21,000 lung cancer deaths (EPA 2003)
Industrial exposures: Asbestos, coal tar fumes, nickel, chromium, arsenic, etc
Family historyHigh cholesterol diet? Alcohol?Beta carotene (Vitamin A) supplements in
heavy smokers
![Page 5: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/5.jpg)
Prevention
QUIT SMOKING (or failing that, cut down)Decrease exposure to second hand smokeDecrease exposure to radon, asbestos and
other industrial carcinogensHealthy dietPhysical activity
![Page 6: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/6.jpg)
National Lung Cancer Screening Trial
53,454 participants: 55-74 y/o> 30 pack year hx of cigarette smokingQuit smoking < 15 yrs prior if a former smokerNo hx lung ca or other life-threatening cancersNo sx's of hemoptysis or wt lossNo chest CT prior 18 mo
![Page 7: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/7.jpg)
NLST
Participants randomized to low dose chest CT vs PA chest x-ray annually for 3 years
LDCT arm showed a 20% reduction in lung cancer deaths compared to the CXR arm (p=0.004)
NEJM 2011 Aug 4;365(5):395-409
![Page 8: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/8.jpg)
Screening and Diagnosis
Chest x-rays have not been shown to be a good screening tool for lung cancers
NCCN guidelines for LDCT screening:55-74 y/o and> 30 pack years of smoking andSmoking cessation < 15 yrsOr > 50 y/o and > 20 pack year hx of smoking
and one additional risk factor (not second hand smoke)
![Page 9: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/9.jpg)
Symptoms
About 25% of people with lung cancer have no symptoms
Central tumors: obstructive sx's, cough, dyspnea, atelectasis, postobstructive pneumonia, wheezing, hemoptysis
Peripheral tumors: pleural effusion, pain if invading pleura or chest wall
![Page 10: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/10.jpg)
Symptoms
Pancoast tumor: tumor in the superior sulcus– Shoulder pain– Low brachial plexopathy– Horner's syndrome (ptosis, miosis,
anhidrosis)
![Page 11: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/11.jpg)
Diagnosis
![Page 12: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/12.jpg)
NCCN Guidelines
• Nodule < 8 mm: radiologic surveillance• Nodule > 8 mm, solid, non-calcified:
consider PET, bx or excise if suspicious• <10 mm non-solid or part-solid nodule:
radiologic surveillance• >10 mm non-solid or part-solid nodule:
LDCT in 3-6 mo
![Page 13: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/13.jpg)
![Page 14: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/14.jpg)
Beyond IHC
• Molecular analysis of certain mutations has become increasingly important for determining therapy
• EGFR mutations are a target for TKI's• KRAS mutations indicate a resistance to
TKI's• ALK mutations provide a target for ALK
inhibitors (crizotinib)
![Page 15: Lung Cancer](https://reader031.vdocuments.site/reader031/viewer/2022020117/5681680f550346895ddd9ba6/html5/thumbnails/15.jpg)
Further Work Up
PET scan, MRI of the brainBronchoscopyMediastinoscopy/USPFT's Lab tests: CBC, electrolytes