PCCSOM Medicine 2 M.09 Lung Cancer PDF

PCC SOM 2026 MEDICINE 2 M.09 LUNG CANCER One genetic mutation is induced for every 15 MEDICINE LECTURE...

PCC SOM 2026 MEDICINE 2 M.09 LUNG CANCER One genetic mutation is induced for every 15 MEDICINE LECTURE cigarettes smoked LECTURER: Dr. Jezreline Marie Cacanindin-Rimando Risk is lower among person who quit smoking DATE: October 14, 2024 o The size of the lung cancer risk reduction increases with the length of time the person TOPIC OUTLINE has quit smoking INTRODUCTION - Environmental tobacco smoking (ETS) or second- EPIDEMIOLOGY hand smoke RISK FACTORS Risk is less from active smoking (about 20-30% Smoking cessation increase in lung cancer among never smokers Inherited predisposition married for many years to smokers) PATHOLOGY - E-cigarettes or vaping - undefined FOUR MAJOR CELL TYPES: EVALI (E-cigarette or vaping-associated lung 1. Small-cell lung cancer (SCLC) injury) emerging phenomenon that poses risks 2. Adenocarcinoma that may counterbalance the potential benefit in 3. Squamous cell carcinoma helping patients reduce traditional cigarette 4. Large-cell carcinoma consumption and lung cancer risk Non-small cell carcinoma (NSCLC) - Occupational exposure to asbestos, arsenic, IMMUNOHISTOCHEMISTRY bischloromethyl ether, hexavalent chromium, MOLECULAR PATHOGENESIS mustard gas, nickel, polycylic aromatic hydrocarbons EARLY DETECTION AND SCREENING - Ionizing radiation CLINICAL MANIFESTATIONS - Prior lung diseases - chronic bronchitis, emphysema, DIAGNOSING LUNG CANCER tuberculosis STAGING LUNG CANCER - Risk appears to be higher among individuals with low fruit and vegetable intake during adulthood Anatomic staging Staging system SMOKING CESSATION TREATMENT - Stopping tobacco use before middle age avoids more Non-small-cell lung CA than 90% of the lung cancer risk attributable to Stage I & II NSCLC tobacco Stage III NSCLC - Beneficial in individuals with lung cancer - improved Metastatic disease survival, fewer side effects from therapy, and overall Small-cell lung CA☺ improvement in quality of life INTRODUCTION INHERITED PREDISPOSITION - Disease of modern man - Certain genetic polymorphisms of the P450 enzyme - Number 1 cause of cancer-related mortality system -CYP1A1, and chromosome fragility. - Decline in lung cancer deaths has emerged - First-degree relatives of lung cancer probands — two improvements in testing and therapeutic strategies, to three-fold excess risk of lung cancer and other decline in tobacco use cancers - Tobacco consumption - primary cause of lung cancer - Rare germline mutation (T790M) involving the - 60% - former smokers (smoked 100 cigarettes per epidermal growth factor receptor (EGFR) — maybe lifetime, quit 1 year) linked to lung cancer susceptibility in never-smokers EPIDEMIOLOGY - GLOBOCAN 2000 (Philippines): PATHOLOGY 2nd most common cancer - Small Cell Lung Cancer (SCLC) - neuroendocrine Most common cause of cancer death among markers CD56, neural cell adhesion molecule men and women (NCAM), synaptophysin chromogranin - Not common below 40 years old, with rates - Adenocarcinoma glandular differentiation or mucin increasing until 80 years of age, then tapers off production and may show acinar, papillary, lepidic, or RISK FACTORS solid features. - Cigarette smokers - 10-fold or greater increased risk - Squamous cell carcinoma tumors show keratinization of developing lung cancer compared to those who and/or intercellular bridges that arise from bronchial never smoked. epithelium. - Squamous cell and Small-Cell Lung CA – most commonly associated with tobacco use NOTE TAKER: BALAO-AS | BASTIAN | CUTAY | DOMINGO | FERRER | GARCIA | PADAYAO Page 1 | 13  PCC SOM 2026- MEDICINE 2 M.09 LUNG CANCER Adenocarcinoma in lifetime never smokers or former - Small subset of the cells within a tumor (i.e. stem light smokers (95% investigation for lung cancer even in the face of a of patients with SCLC normal CXR - One-third of patients present with symptoms as a - A persistent pneumonia without constitutional result of distant metastasis symptoms and unresponsive to repeated courses of - Site of metastatic involvement largely determines antibiotics also should prompt an evaluation for the other symptoms underlying cause - Paraneoplastic syndromes are common – often - Lung cancer arising in a lifetime never smoker: more relieved with successful treatment of the tumor common in women and East Asians; younger patients Systemic symptoms of anorexia, cachexia, weight - Central or endobronchial growth of the primary loss, fever and suppressed immunity - tumor: cough, hemoptysis, wheeze, stridor, dyspnea paraneoplastic syndromes of unknown etiology or post obstructive pneumonia - Endocrine syndromes are seen in 12% of patients Hypercalcemia from ectopic production of parathyroid hormone (PTH) or PTH-related NOTE TAKER: BALAO-AS | BASTIAN | CUTAY | DOMINGO | FERRER | GARCIA | PADAYAO Page 3 | 13  PCC SOM 2026 MEDICINE 2 peptide: most common life-threatening M.09 LUNG CANCER STAGING metabolic complication of malignancy, primarily 2 PARTS: occurring with squamous cell lung carcinoma. - Determination of the location of the tumor and o Nausea, vomiting, abdominal pain, possible metastatic sites (anatomic staging) constipation, polyuria, thirst and altered - Assessment of a patient’s ability to withstand various mental status antitumor treatments (physiologic staging) Hyponatremia - may be caused by SIADH - It is important to get complete history, physical (Syndrome of Inappropriate Secretion of examination, with evaluation of all medical problems, Antidiuretic Hormone) or by atrial natriuretic determination of performance status, and history of peptide (ANP) weight loss o Resolves within 1-4 weeks of initiating chemotherapy ANATOMIC STAGING o Serum sodium can be managed and - Accurate staging is essential for determining the maintained above 128mEq/L via fluid appropriate treatment in patients with resectable restriction disease and for avoiding unnecessary surgical procedures in patients with advanced disease DIAGNOSIS - ALL patients should undergo initial radiographic - Tissue sampling is required to confirm a diagnosis in imaging with CT scan, positron emission tomography all patients with suspected lung cancer (PET), or preferably CT-PET - Suspected metastatic disease: biopsy of a distant site - PET scanning attempts to identify sites of malignancy of disease is preferred for tissue confirmation based on glucose metabolism by measuring the - Core biopsy: preferred to ensure adequate tissue for uptake of F-fluorodeoxyglucose (FDG) analysis Rapidly dividing cells - take up the F-FDG and - Tumor tissue may be obtained by minimally invasive appear as a ‘hot spot’ techniques: Used for staging and detection of metastases in Bronchial or transbronchial biopsy during lung cancer and in the detection of nodules fiberoptic bronchoscopy >15mm in diameter Fine needle aspiration (FNA) - PET scanning Percutaneous biopsy using image (UTZ-CT A standardized uptake value (SUV) of >2.5, a guided) highly suspicious for malignancy guidance False negatives: diabetes, in lesions