Lung Cancer Medicine II PDF

MINDANAO STATE UNIVERSITY GENERAL SANTOS CITY COLLEGE OF MEDICINE MEDICINE II 09.26.24 LUNG CANCER GROUP #1...

MINDANAO STATE UNIVERSITY GENERAL SANTOS CITY COLLEGE OF MEDICINE MEDICINE II 09.26.24 LUNG CANCER GROUP #1 ABUBACAR I ABOSOPIAN | ABU-AMEN I ADZAR I AGAKHAN I ALAWI EPIDEMIOLOGY Lung cancer remains one of the most common cancer, particularly in men. It is ranked as the second most common cancer in the Philippines Global Cancer Observatory (2021, March). Philippine Population Fact Sheets. https://gco.iarc.who.int/media/globocan/factsheets/populations/608-philippines-fact-sheet.pdf EPIDEMIOLOGY Lung cancer is uncommon below age 40, with rates increasing until age 80, after which the rate tapers off. The projected lifetime probability of developing lung cancer is estimated to be ∼8% among males and ∼6% among females. (Loscalzo, 2022) EPIDEMIOLOGY Lung cancer has a high mortality rate due to late-stage diagnosis. It is one of the leading causes of cancer deaths in the Philippines. Male Female Both Sexes Global Cancer Observatory (2021, March). Philippine Population Fact Sheets. https://gco.iarc.who.int/media/globocan/factsheets/populations/608-philippines-fact-sheet.pdf RISK FACTORS Cigarette smokers have a 10-fold or greater increased risk of developing lung cancer Occupational exposure Smoking cessation ○ Promote 4abstinence ○ Stopping tobacco use before middle age avoids >90% of the lung cancer risk Inherited predisposition to lung cancer (Loscalzo, 2022) PATHOLOGY Epithelial Lung Cancers: Small-cell carcinoma-associated with smoking. Non-small cell carcinoma ○ Adenocarcinoma-most common lung cancer in lifetime never smokers or former light smokers (95% of patients with SCLC. (Loscalzo, 2022) CLINICAL MANIFESTATIONS PARANEOPLASTIC SYNDROME - common in patients with small cell lung cancer (SCLC). - first sign of recurrence Systemic Symptoms ○ Anorexia, Cachexia, Weight loss (bad prognostic sign), Fever, Immunosuppression Endocrine Syndromes ○ Hypercalcemia, SIADH, Cushing's Syndrome Skeletal-Connective Tissue Syndromes ○ Clubbing - seen in non-small cell lung cancer (NSCLC). ○ Hypertrophic Osteoarthropathy - common in adenocarcinomas, presents with bone pain. (Loscalzo, 2022) CLINICAL MANIFESTATIONS Neurologic Syndromes ○ Eaton-Lambert Syndrome - Proximal muscle weakness (lower extremities), autonomic dysfunction. ○ Paraneoplastic Cerebellar Degeneration and Encephalomyelitis Thrombotic or Hematologic Syndromes ○ Trousseau’s syndrome (migratory thrombophlebitis) ○ Nonbacterial thrombotic endocarditis ○ Disseminated intravascular coagulation (DIC). Rare Manifestations Dermatomyositis, Acanthosis nigricans Nephrotic syndrome, Glomerulonephritis Adrenal Metastases (Loscalzo, 2022) DIFFERENTIAL DIAGNOSIS Differential Diagnosis Rule in Rule out Chronic Obstructive Chronic cough, Progressive, non-malignant, Pulmonary Disease (COPD) wheezing, emphysema/bronchitis on dyspnea, imaging, PFT shows airflow history of smoking limitation. Pulmonary Tuberculosis (TB) Cough, TB skin test or IGRA positive, weight loss, cavitary lesions on chest X-ray, night sweats, sputum culture positive for Fever, Mycobacterium tuberculosis hemoptysis Pneumonia Acute fever productive, Infectious, acute onset, responds cough, to antibiotics, consolidation on pleuritic chest pain chest X-ray or CT Bhatt, M., Kant, S., & Bhaskar, R. (2012). Pulmonary tuberculosis as differential diagnosis of lung cancer. South Asian Journal of Cancer, 01(01), 36–42. (Author, Year) https://doi.org/10.4103/2278-330x.96507 DIAGNOSTIC WORK UP CHEST X-RAY Often the first imaging test performed if lung cancer is suspected. Provides a basic image of the lungs and surrounding structures. It can detect large tumors, lung collapse, or fluid accumulation in the lungs. (Author, Year) DIAGNOSTIC WORK UP CT SCAN It provides precise information about tumor size, location, and involvement of nearby tissues or lymph nodes. All patients with NSCLC should undergo initial radiographic imaging with CT scan to identify sites of malignancy. (Author, Year) DIAGNOSTIC WORK UP CT PET SCAN It is mostly used for staging and detection of metastases in lung cancer and in the detection of nodules >15 mm in diameter. Often combined with a CT scan (PET-CT) for more precise localization and staging. Gold standard for staging and identifying metastasis. (Author, Year) DIAGNOSTIC WORK UP SPUTUM CYTOLOGY Simple, non-invasive test that may detect cancer cells in sputum. Examination of sputum (mucus coughed up from the lungs) or fluid samples (from the chest) for cancerous cells. (Author, Year) DIAGNOSTIC WORK UP BIOPSY Biopsy of the tumor tissue is essential for definitive diagnosis. Pathologists study the tissue under a microscope to determine the type of lung cancer (small cell vs. non-small cell) and its characteristics. is the gold standard in lung cancer diagnosis. (Author, Year) DIAGNOSTIC WORK UP BRONCHOSCOPY THORACENTESIS (Author, Year) PRINCIPLES OF TREATMENT Overview Staging and Diagnosis: Accurate staging using the TNM system is essential for determining the appropriate treatment strategy. For full details, refer to the reference table in Harrison's Principles of Internal Medicine (20th edition, 2018) on page 546 by Loscalzo et al. (Author, Year) PRINCIPLES OF TREATMENT Non-Small-Cell Lung Cancer (NSCLC) Staging and Treatment: ○ Stage I and II: Surgery: Preferred treatment, typically lobectomy. Adjuvant Therapy: Postoperative chemotherapy for stage II and IIIA. ○ Stage III: Concurrent Chemoradiotherapy: Standard for unresectable stage III. ○ Stage IV: Systemic Therapy: Includes chemotherapy, targeted therapy, and immunotherapy based on genetic mutations (Refer to Table 74-1). Treatment Algorithm (Refer to Figure 74-3): ○ Stage IA: Surgery alone. ○ Stage IB-II: Surgery followed by adjuvant chemotherapy. ○ Stage III: Combined chemoradiotherapy. ○ Stage IV: Systemic therapy and palliative care. (Author, Year) PRINCIPLES OF TREATMENT Small-Cell Lung Cancer (SCLC) 1. Staging and Treatment: ○ Limited Stage: Concurrent chemoradiotherapy. ○ Extensive Stage: Combination chemotherapy, with prophylactic cranial irradiation (PCI) for responders. 2. Treatment Algorithm (Author, Year) PRINCIPLES OF TREATMENT Molecular and Targeted Therapy Targeted Agents: Treatments based on genetic mutations such as EGFR and ALK. (Author, Year) OTHER INFORMATION Palliative Care Symptom Management: Focus on alleviating pain, dyspnea, and cough. Supportive Measures: Provide nutritional and psychological support, and manage side effects. (Author, Year) PRINCIPLES OF TREATMENT Important Considerations for Primary Care MDs Smoking Cessation: Advise and support cessation to reduce risk and improve outcomes. Coordination of Care: Facilitate referrals and ensure multidisciplinary collaboration. Follow-Up: Regular monitoring for recurrence and managing chronic symptoms. (Author, Year) REFERENCES Loscalzo, J., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Jameson, J. L. (2022). Harrison's principles of internal medicine. (No Title).