LUNG CANCER

Andreana Crucillo, Kyra Dela Cruz, Ciara Malagonio, Katrina Monsanto, Daniel Ong,
Jeremiah Vytiaco
ETIOLOGY

Smoking
-the single biggest risk factor for lung cancer (90% of all cases)
-contains more than 60 different toxic substances
-risk increases according to the duration of smoking and the number of cigarettes
smoked per day.
-other types of tobacco products that also increase your risk of developing lung
cancer and other types of cancer:

cigars

pipe tobacco

snuff (a powdered form of tobacco)

chewing tobacco
-Smoking cannabis has also been linked to an increased risk of lung cancer. Most
cannabis smokers mix their cannabis with tobacco. While they tend to smoke less
than tobacco smokers, they usually inhale more deeply and hold the smoke in their
lungs for longer.
-Even smoking cannabis without mixing it with tobacco is potentially dangerous
because cannabis also contains substances that can cause cancer.
Passive smoking
-research has found that non-smoking women who share their house with a smoking
partner are 25% more likely to develop lung cancer than non-smoking women who
live with a non-smoking partner.
Radon
-Radon is a naturally occurring radioactive gas that comes from tiny amounts of
uranium present in all rocks and soils. It can sometimes build up in buildings.
Occupational exposure and pollution
Exposure to certain chemicals and substances that are used in several occupations
and industries has been linked to a slightly higher risk of developing lung cancer:

arsenic, asbestos, beryllium, cadmium, coal and coke fumes, silica and
nickel.

large amounts of diesel fumes for many years may increase your risk of
developing lung cancer by up to 50%.

risk of developing lung cancer increases by about a third if you live in an

area with high levels of nitrogen oxide gases (mostly produced by cars and
other vehicles).
Types of lung cancer
Doctors divide lung cancer into two major types based on the appearance of lung
cancer cells under the microscope:

Small cell lung cancer. Small cell lung cancer occurs almost
exclusively in heavy smokers and is less common than non-small cell
lung cancer.
Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for
several types of lung cancers that behave in a similar way. Non-small cell lung
cancers include squamous cell carcinoma, adenocarcinoma and large cell
carcinoma.

NOTE:
Pack-year a unit for measuring the amount a person has smoked over a long
period of time (1 pack = 20 cigarettes smoked per day for 1 year); one pack-year is
the equivalent of 365.24 packs of cigarettes or 7305 cigarettes
PATHOPHYSIOL
OGY

Latency Period: 15-35 years

Note: It starts after exposure to asbestos and co-carcinogens such as cigrettes
Prodrome:
Lung cancer typically doesnt cause signs and symptoms in its early stages. They
occur when the disease is advanced.

EPIDEMIOLOGY

SIGNS AND
SYMPTOMS

DIAGNOSTIC
TECHINIQUES

chronic cough with blood

shortness of breath

chest pain

wheezing

hoarseness

significant weight loss

headache
Globally:

largest contributor to new cancer diagnoses

o 1,350,000 new cases
o 12.4% of total new cancer cases

largest contributor to death from cancer

o 1,180,000 deaths
o 17.6% of total cancer deaths

Male > Female

Philippines:

Diagnosed
o 11458 cases
o 14% of total cancer cases

Deaths
o 9184 cases
o 18% of total cancer deaths

Male > Female

persistent coughing

chest pain

hoarseness and shortness of breath

recurrent lung infections (e.g bronchitis and pneumonia)

loss of appetite and weight loss

diaphragm paralysis

pleural effusion

hypercalcemia

grey/white firm neoplastic tissue

focal areas of hemorrhage or necrosis may appear to prodice red/yellow

molting

tumor cells which are fragile and often show fragmentation and crush
artifact in small biopsy specimens

nuclear molding
To determine which tests, the doctor checks for
1. Medical History

2.
3.

Symptoms
Findings in Physical Examination

Imaging Tests
o Chest X-Ray

Usually the first to use for diagnosis

o CT Scan

Next to X-Ray

uses X-rays and a computer to create detailed images of the

inside of your body.
o PET Scan

Carried out if the CT Scan indicates early stages of cancer

Shows where the active cancer cells are

o Bone Scan
Tissue Testing (further test anything suspicious about the tissue)
o Without needles

Bronchoscopy

Procedure which allows the doctor or nurse to take a

sample of cells in the lungs
Uses bronchoscope

With Needles with general anesthesia

Thoracoscopy

Two or three small cuts are made in the chest to

pass a tube with a video camera

Can be used as part of treatment to remove part of a

lung in some early-stage lung cancer
Mediastinoscopy

Examination of the area between the lungs and

center chest

Makes a small cut at the bottom of your neck to

insert a thin tube with a camera at the end

Takes sample of cells and lymph nodes

o
*lymph nodes- usually the first place where
cancer spreads
Thoracocentesis

used to check whether fluid around the lungs is

caused by cancer or by other medical problem

needle placed in between ribs to drain the fluid

Sputum Cytology

Sample of mucus coughed up from the lungs

(sputum or phlegm) investigated under microscope
Fine needle Biopsy

Long, thin fine needle used to remove a sample of

cells from the area

Ultrasound

Endobronchial Ultrasound

Bronchoscope is fitted with an ultrasound device at

its tip
Passed down into windpipe to look at near by lymph

nodes
Endoscopic Esophageal Ultrasound

MANAGEMENT

Same as endobronchial but uses endoscope

Passed down the throat and into esophagus

Stages
I. Non-small-cell lung cancer

The most common that spreads slowly than small-cell lung cancer

Types
o Adenocarcinoma
o Squamous cell carcinoma
o Large cell carcinoma
II. Small cell lung cancer

Less common whose cancer cell are smaller than the non-small-cell lung
cancer

Types
o Small cell carcinoma (oat cell cancer)
o Combined small cell carcinoma
Stages

Within the lung and not spread to nearby lymph nodes

Stage A: Less than 3 cm in size (1.2 inches)

Stage B: Size: 3-5 cm (1.2-2 inches)

Two
o A

5-7 cm

Less t han 5 cam and cancerous cell have spread t o nearby

lymph nodes
o B

Larger than 7 cm

Has spread to

Nearby lymph nodes

Surrounding muscle or tissue

Main airways (bronchus)

Cause the lung to collapse

Multiple tumors in the lung

Three
o A

Has spread to

Lymph nodes in the middle of the chest

Into surrounding tissue

o Covering of the lung
o The chest wall
o The middle of the chest
o Other lymph nodes near the affected lung
o B

Lymph nodes on either side of the chest, above the

collarbones

Gullet (oesophagus)

Windpipe (trachea)

Heart or into a main blood vessel

Four
o Spread to both lungs or another part of the body (brain, liver, or
brain)
o Cancer has caused fluid- containing cancer cells to build up around
heart or lungs

Surgery

Removal of tumor
Removal of lymph nodes from chest to check for signs of cancer
Risk:

Bleeding

Infection

Shortness of breath
o Recommendation of respiratory therapist may be recommended
after surgery
Chemotherapy
o Use of drugs to kill cancer cells
o May be injected into the vein or taken orally
o May be used before surgery to shrink tumors
o May be used to relieve pain and other symptoms
o Some common drugs:

Carboplatin (Paraplatin) or cisplatin (Platinol)

Docetaxel (Docefrez, Taxotere)

Gemcitabine (Gemzar)

Nab-paclitaxel (Abraxane)

Paclitaxel (Taxol)

Pemetrexed (Alimta)

Vinorelbine (Navelbine)
Radiation therapy
o Use of high powered energy beams from x-rays and protons to kill
cancer cells
o Can be directed at lung cancer from outside the body (external
beam radiation) or it can be put inside needle, seeds, or catheter to
be placed near the cancer (brachytherapy)
o Can be used after surgery to kill remaining cancer cells
o May be used to relieve pain and other symptoms
Targeted drug therapy
o Often used in combination with chemotherapy drugs

Afatinib (Gilotrif)

Bevacizumab (Avastin)

Ceritinib (Zykadia)

Crizotinib (Xalkori)

Erlotinib (Tarceva)

Nivolumab (Opdivo)

Ramucirumab (Cyramza)
o Some targeted therapies only work on cancer cells that have certain
genetic mutations
Clinical trials
o Studies of experimental lung cancer treatment
o May be latest innovations but dont guarantee cure
Palliative care
o Supportive care
o Working with a doctor to minimize signs and symptoms
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