lung cancer overview - john w. davis, md facs
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Lung Cancer Overview
John W. Davis, M.D. FACS
February 16th, 2008
Overview
Epidemiology
Clinical Features
Diagnosis
Staging
Surgical Treatment
Lung Anatomy
Surgical Resections
Epidemiology
Definition
Science of identifying thedistribution/determinants of disease
Two study types Case control
Cohort
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Historical Perspectives
Rare in 19th century
20th Century increases Incidence in women 30 years later
Causes uncertain
Car exhaust/air pollution
50s case controls--tobacco
Epidemiology
Second most common cancer in the USA
Most lethal1/4 of all cancer deaths
Most common cause of cancer death inmen
Male:Female 1.2:1
Mortality rate for men is declining
Incidence continues to climb in women
Epidemiology Facts
Since 1987, more women have died of
lung cancer than breast cancer
African-American males have highes risk
Differences in socioeconomic status andsmoking behavior
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Etiology/Risk Factors
Cigarette Smoking 10-25 fold increase risk
Accounts for majority of lung cancer cases (85%)
Risk related to number of cigarettes, duration, age atinitiation, depth of inhalation, tar/nicotine content
More than 40 carcinogens have been identified
Filters/lower tar content help unless smokerscompensate smoking habits
Smoking cessation causes a gradual drop in risk
Passive smoke exposure/particularly children whothen smoke
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Tobacco as Carcinogen
Type
Cigarettes are #1 (British Doctor Cohort, 76) Pipe/Cigar lower risk
Tar/nicotine content
Amount Dose response
Duration Risk proportional to time (years)
Starting age important (15 yo)
Etiology/Risk factors
Inhalation of Asbestos fibers
Non-smokers 5X risk
20X risk with smoking
Dose Resonse
Radon exposure
COPD
Diet
Lung Cancer: Histology
Non-small cell
Adenocarcinoma
Squamous Cell Carcinoma
Bronchioalveolar Carcinoma
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Incidence/Mortality
Trends in Mortality in North America
Mendecreased since 1992 Women plateau 20 years later
International influence
Reflect more recent smokingprevalence/occupational hazards
China/Japan highest
Decreasing in Europe/NA
Clinical Features
Clinical Features
160,000 new cases anually
95% are symptomatic Primary tumor
Disseminated disease Nonspecific
Varied/Unpredictable Stage
Location
Histology
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Pulmonary Manifestations
Cough
Dyspnea Wheezing/Stridor
Hemoptysis
Pneumonic Symptoms
Lung Abscess
Nonpulmonary ThoracicManifestations
Chest wall
Diaphragm invasion
Mediastinal invasion
Superior vena cava syndrome
Pericardial effusions
Esophageal compression (dysphagia)
Vertebral body (severe back pain)
Paraneoplastic syndromes
Paraneoplastic Syndromes
Hypertrophic Pulmonary Osteoarthropathy
and Clubbing (HPO)
SIADH
Hypercalcemia
Ectopic Adrenocorticotropic Syndrome
Neurologic Paraneoplastic Syndromes
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Metastatic Symptoms
CNS
Bone
Hepatic
Adrenal
Skin/soft tissue
Nonspecific Symptoms
Diagnosis
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History and Physical
Age
Tobaccoism Bronchopulmonary symptoms
Chest wall pain/Mediastinal invasion
Bone/CNS involvement
Paraneoplastic Syndromes
Clubbing
Laboratory Evaluation
CBC/LFTs/Renal panel/Serum Calcium
Sputum cytology
Tumor Markers
NSE/CEA
Imaging Evaluation
Chest Xray
CT
MRI PET
Bone Scan
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Positron Emission Test (PET)
Now used commonly
Detects glucose metabolism Sensitive for inflammatory/malignant cells
High sensitivity/specificity with CT
Does NOT replace tissue diagnosis
Tissue Diagnosis
Bronchoscopy
Transthoracic needle biopsy
Mediastinoscopy
Thoracoscopy (VATS)
Lobectomy
Staging
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Treatment Options
Surgical Resection
Lobectomy Pneumonectomy
Segmentectomy
Wedge
Minimally invasive
Chemotherapy
Radiation
Surgical Treatment
Anatomic resection/MLND
Stage I and II
Select IIIA
Pneumonectomy higher risk
Segmentectomy lower risk/higherrecurrence
5 year survival 60-70%/40-55%
Surgical Treatment
Stage III
IIIA
Potentially resectable
Diverse group of patients
IIIB
Not resectable
Stage IV
Widespread disease
Median survival 4 months
Surgery for Palliation
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Anatomy
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Common Surgical Resections
Lobectomy
Pneumonectomy
Segmentectomy
Wedge
Mediastinoscopy
Sleeve Pneumonectomy
Thoracoscopic Procedures (VATS)
Solitary Pulmonary Nodule
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Thank You