Lung Cancer: A Presentation by Dr. Ola Negm (2023)

LUNG CANCER DR OLA NEGM [email protected] • Describe the 4 main types of lung cancer: aetiology, pathology, staging, treatment and prognosis. • Distinguish small cell carcinoma from non-small cell carcinoma. • Outline the evidence linking smoking and lung cancer. – Most common cause of...

LUNG CANCER DR OLA NEGM [email protected] • Describe the 4 main types of lung cancer: aetiology, pathology, staging, treatment and prognosis. • Distinguish small cell carcinoma from non-small cell carcinoma. • Outline the evidence linking smoking and lung cancer. – Most common cause of death from cancer in both male and female. – 40-79yrs; Peak incidence 50-60; Lung Cancer Risk Factors Age Ionising Radiation (0.5% radon) Smoking 86% of lung cancers in the UK are linked to tobacco smoking (esp SCLC) 83% active smoking, 3% due to environmental tobacco smoke exposure in non-smokers Occupational exposures eg asbestos, Silica, Diesel engine exhaust, paint fumes, arsenic and inorganic arsenic compounds Air Pollution Family History Symptoms of lung cancer: o Coughing, o Weight loss, o Shortness of breath, o Chest pain, o Hemoptysis (coughing up blood, or sputum that is streaked with blood), and other non-specific symptoms including: fever, weakness, and lethargy. o Rarely, patients may present with difficulty swallowing or wheezing. • Up to 12% of patients • Most endocrine are related to SCLC: – Cushings syndrome (ectopic adrenocorticotropic hormone ACTH) – Inappropriate ADH secretion (low Na) • Hypercalcaemia (PTH) -squamous chest x-ray: o Solitary pulmonary nodule or mass. o Up to 80% of solitary pulmonary nodules (<4cm diameter) in the over-50 age group are cancer. o Chest x-ray may also be used to evaluate the size of the tumour and possible involvement of lymph nodes in the chest. CT scan: • Particularly useful in identification of lymph node involvement. o The NLST (US National Lung Screening Trial) showed a 20% reduction in lung cancer mortality in high-risk participants (smoking history of ≥30 pack-years) aged 55 to 74 years who were randomly assigned to screening with low-dose computed tomography (LDCT) versus those assigned to chest radiography. - Early CDT-Lung is a blood test enabling the early detection of lung cancer. - The test is currently in clinical use and has already shown that within high risk populations that cancers can be detected early whilst they are still treatable with the potential for increased patient survival and indeed in some cases cure. Stage 1A Lung Cancer – curable! Lung cancer Diagnosis (Biopsy) o Lung biopsy usually performed when clinical symptoms or findings on a chest x-ray or CT scan suggest lung cancer. o Biopsy sample then sent to pathologist for confirmation, and then "staging" is necessary to determine how far the cancer has spread. Bronchoscopy o This information will guide treatment for the cancer and determine the patient's prognosis. o Lung Cancer Small Cell Lung Cancer Small cell carcinoma Non-Small Cell Lung Cancer NSCLC Squamous carcinoma Adeno-carcinoma Large cell carcinoma Non Small Cell Lung Cancer staging https://www.youtube.com/watch?v=IWOzzqA3l7c TNM Small Cell Lung Cancer staging https://www.youtube.com/watch?v=o_E3NvE7wDo SCLC often staged more simply - Limited and Extensive Using TNM more – 30% presenting with symptoms of metastatic disease eg: fracture (bone), CNS symptoms (brain), jaundice (liver). – Local spread to nodes characterised by clinical syndromes: • SVC syndrome (compression from paratrachial nodes) https://www.youtube.com/watch?v=HSgdkmZGQgA • Horners syndrome (cervical sympathetic chain) etc. https://www.youtube.com/watch?v=9XKj95DBscM Horner’s syndrome – Most have metastasised to distant sites (70%) on presentation (brain, liver, bone, adrenal). – 25% have regional lymph node involvement on diagnosis – Most are inoperable (75% NSCLC, age is a factor) – 1 year survival rate = ~30% – 5 year survival overall ~9% – 5yr survival for localised lung lesion 45% – Most common cause of death from cancer in both male and female. – Smoking is the main risk factor. – Prognosis is better if it is discovered early.