LUNG CARCINOMA

PREPARED BY;
FATIN NOOR FARZANA BT MOHD SHAIFULBAHRI
KALPPENA NAIDU A/P RAJA GOPAL
MUHD FAIZ BIN ATIQUR RAHMAN
NURUL ZULAIKHA BINTI MD HARIS
Introduction & Definition of
Lung Cancer
BY FATIN NOOR FARZANA BT MOHD SHAIFULBAHRI
 Introduction

Lung Cancer = Cancer that

forms in tissues of the lung,
usually in the cells lining air
passages.
• The two main types are small
cell lung cancer and non-
small cell lung cancer.
• These types are diagnosed
based on how the cells look
under a microscope.
 Pathophysiology of
Lung Cancer
BY FATIN NOOR FARZANA BT MOHD SHAIFULBAHRI
 Pathogenesis
• Multistep process.
• Before becoming invasive, lung epithelium may undergo morphological changes
that include :
1. Hyperplasia.
2. Metaplasia.
3. Dysplasia.
4. Carcinoma in situ.
• 3 types of recognized precursor lesions:
Squamous dysplasia and carcinoma: precursor lesion for squamous-cell carcinoma.
Adenomatous hyperplasia: precursor lesion for bronchioalveolar carcinoma, a form of
adenocarcinoma.
Idiopathic pulmonary neuroendocrine cell hyperplasia: precursor for pulmonary carcinoids.
• Cigarette smoking is the leading cause of lung cancer
• Risk for lung cancer increases with the duration,
intensity and depth of smoke inhalation.
• Cigarettes contain multiple carcinogens (more than 60)
that have been shown to induce cancers in laboratory
setting
1. Polycyclic aromatic hydrocarbons (PAH) such as benzo[α]pyrene
produce mutations in the p53 gene
2. N-nitroso compounds are a major group of chemicals found in
tobacco smoke, several of which are potent animal carcinogens.
3. Nicotine a promoter for carcinogenesis.
• Increased risk of lung cancer among first-degree
relatives,
Small Cell Lung carcinoma – mutations in MYC,
BCL2, c-KIT, p53, and RB,
Non SCLC - mutations in EGFR, KRAS, CD44, and
p16.
Aetiology and Epidemiology of
Lung Cancer
BY KALPPENA NAIDU A/P RAJA GOPAL
• Incidence.
Second most common cancer after breast cancer in
women and prostate cancer in men.
Is a leading cause of cancer death worldwide.

• Age
Peak incidence at 65-75 years

• Sex
Male > Female
The Malaysian national cancer registry shows that the
age-standardised incidence of lung cancer for the Chinese
is more than twice that of the Malays and Indians for both
sexes.
• Causes are;

Tobacco smoking
Approximately 90% of lung cancers
Weaker association with lung adenocarcinoma which more common
among women and non-smokers.
Occupational and environmental exposure to carcinogen
Passive smoking
Radon (second leading cause of lung cancer)and uranium (radioactively
decays into radon)
Asbestos
Occupational carcinogens like arsenic,chromium,nickel,beryllium and
silica,
Family history of similar disease
Sign and Symptoms of Lung
Carcinoma
BY NURUL ZULAIKHA MD HARIS
Complication of Lung Carcinoma
BY NURUL ZULAIKHA MD HARIS
Investigation and Management
By MUHD FAIZ BIN ATIQUR RAHMAN
Non-Invasive Investigations
• Imaging
• Chest X ray
• Computerised tomography (CT) scan of the thorax – this test is able to visualize the lungs in a three
dimensional setting. It  can also measure the size of the cancer, detect spread of the cancer to other
organs thus giving a clue as to the stage of the cancer.
• Positron Emission Tomography (PET) scan is done to detect cancer and metastases
• Bone scan is not routinely done nowadays with the availability of the above investigations

• Laboratory investigations
• Blood investigations
• Sputum examination
• Lung function tests
• Molecular testing
Invasive investigations
• Bronchoscopy. This procedure involves a flexible tube which is connected to a video camera. It
allows the doctor to visualize the airways and if there is a presence of an abnormality, a biopsy will
be taken to confirm the type of lung cancer
• Pleuroscopy. This procedure is done when there is excessive fluid in the pleural cavity which can be
caused by the cancer, whether it is a primary or secondary/metastatic. Pleuroscope is a tube which is
connected to a camera. Apart from removing excessive fluid for diagnostic purposes, biopsies can
also be done to confirm the type of cancer
• Mediastinoscopy is sometimes used for diagnosis and staging. However, it is an invasive procedure
• Fine needle aspiration (FNA): the lesion is approached via a fine needle under the guidance of a
radiological facility (ultrasound or CT). The aspirated material is tested for malignancy under
microscope
• Open biopsy: this is performed in operation setting. This approach is usually good for lesions that
can’t be approached by FNA, and for localized tumors that may be totally removed by surgery
(tumors localized to single lobe, with no metastasis).
Management of Lung Cancer
• Treatment depends on:
• Type of cancer
• Stage of cancer
• Functional status and lung function of the patient
SCLC Staging
• Limited stage
• Limited stage means that the cancer is only in 1 part of the chest and
radiation therapy could be a treatment option. About 1 out of 3 people with
SCLC have limited stage disease when first diagnosed.

• Extensive stage
• Extensive stage is used to describe SCLC that has spread to other parts of the
body such as the opposite lung, bone, brain, or bone marrow. Many doctors
consider SCLC that has spread to the fluid around the lung to be extensive
stage as well. About 2 out of 3 people with SCLC have extensive disease
when the cancer is first found.
TNM Staging in NSCLC and SCLC
• The staging system most often used for NSCLC is the American Joint
Committee on Cancer (AJCC) TNM system, which is based on 3 key
pieces of information:
• The size and extent of the main tumor (T)
• The spread to nearby lymph nodes (N)
• The spread (metastasis) to distant sites (M)
Management
• Non-pharmacological Management
• Smoking cessation
• Avoid to be passive smoker
• Avoid carcinogens and radon gas at workplace and
home.
• Radiotherapy
• Radiofrequency ablation may be used to treat non-
small-cell lung cancer at an early stage.The doctor
uses a CT scanner to guide a needle to the site of the
tumour. The needle is pressed into the tumour and
radio waves are sent through the needle. These waves
generate heat, which kills the cancer cells.
• Surgical procedures
• There are 4 types of lung cancer surgery:
• Lobectomy. The lungs have 5 lobes, 3 in the right lung and 2 in the left lung. A lobectomy is the
removal of an entire lobe of the lung. It is currently thought to be the most effective type of surgery,
even when the lung tumor is very small.
• A wedge resection. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove
the tumor, surrounded by a margin of healthy lung.
• Segmentectomy. This is another way to remove the cancer when an entire lobe of the lung cannot be
removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer
developed.
• Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the
entire lung.

• Palliative Treatment
• This consists of medical therapy or nursing care to reduce symptoms and morbidity and not to cure
the cancer. The main aim is to relieve symptoms. Palliative treatment includes:
• Reduce pain
• Reduce breathlessness
• Reduce anxiety
• Treat insomnia
• Treat depressive illness
• This palliative treatment is done so that lung cancer patients can have a good quality of life and are
able to do basic daily activities such as performing prayers, light activities etc so that the patient
does not feel left out from their relatives and community.
• Pharmacological Management

• Targeted therapy (for advanced-stage NSCLC)

• Targeted therapies are medicines designed to slow the spread of advanced non-small
cell lung cancer.
• NSCLC that is EGFR-positive: EGFR inhibitors (e.g., Osimertinib, Gefitinib,
Erlotinib)
• NSCLC that is ALK-positive: ALK tyrosine kinase inhibitors (e.g., Crizotinib)
• Immunotherapy
• Immunotherapy is a group of medicines that stimulate our immune system to target
and kill cancer cells. It can be used on its own or combined with chemotherapy.
• Pembrolizumab and Atezolizumab are types of immunotherapy used to treat lung
cancer.
• Chemotherapy
• Chemotherapy for NSCLC usually includes combination of drugs containing cisplatin
(or carboplatin). Other drugs used together with platinum include etoposide,
paclitaxel, vinorelbine or gemcitabine. Chemotherapy improve survival in metastatic
disease, as well as in locally advanced disease. Recently, clinical trails showed that the
use of chemotherapy after resection of lung cancer, improve the survival of patients.
Overall, chemotherapy (platinum based) have a role in treatment of lung cancer, but
the prognosis for the long term, remains disappointing.
References

• https://www.amboss.com/us/knowledge/Lung_cancer/
• https://www.healthline.com/health/lung-pet-scan
• https://www.mskcc.org/cancer-care/types/lung/diagnosis/biopsy/bronchoscopy
• https://www.cancer.net/cancer-types/lung-cancer-non-small-cell/types-treatment
• http://www.thebestoncologist.com/Cancer_Diseases/Lung_Cancer/How_Lung_Canc
er_is_Diagnosed.html
• https://www.cancer.net/cancer-types/lung-cancer-small-cell/stages
• http://www.myhealth.gov.my/en/lung-cancer/
• https://www.cancer.gov/publications/dictionaries/cancer-terms/def/lung-cancer