carcinoma of lungs

1. LUNG CARCINOMA
Definition – Lung Carcinoma is a malignant lung tumor characterized by
uncontrolled cell growth in tissue of the lung.
If left untreated this growth can spread beyond the lung by the process of
Metastasis into nearby tissue or the other parts of the body.

2. Types of Lung Cancer
• 1.Small Cell Lung Cancer (SCLC)
• 2.Non Small Scale Lung Cancer (NSCLC)
• NSCLC Is Divided In Three Types
• A. Large Cell Carcinoma
• B. Adenocarcinoma
• C. Squamous Cell Carcinoma

3. • A. Non small cell lung cancer (NSCLC)
• - Most common type
• - About 80-85℅ are NSCLC
• - Grows more slowly
• It is further classified into the following
• # Epidermoid carcinoma Or Squamous cell CA
• - 30-35℅ of lung cancer
• - Arise from bronchial epithelium
• - Cavitation may also occur
• - Slow growth, metastasis not common
• #Adenocarcinoma – Very common in mostly smokers
• - 25-30 ℅ of lung cancer
• - Arise from bronchial mucus gland
• - Slow metastasis may occur to kidney, liver and adrenals
• - May not located centrally, mid lung or peripherally

4. LUNG CA
# Slow Growth
- Rarely cavity
- Strongly linked to cigarette smoking
- # Large cell carcinoma
- 10-20℅ of lung cancer
- Cavitations common
- Slow metastasis may occur to kidney, liver and adrenals gland
- May be located centrally ,mid lung peripherally
- # Small cell carcinoma
- It generally starts in one of the larger breathing tubes grows fairly rapidly and is likely to
be large by the time of diagnosis
- Spreads more quickly and aggressively
- Accounts for 15℅ of cases
- Found mostly in heavy smokers

5. ETIOLOGY
• Tobacco Smoke
• - About 80℅ of lung cancer deaths are thought to result from smoking
• EXPOSURE TO OTHER CANCER CAUSING AGENTS IN THE WORK PLACE
• - Radioactive such as Uranium
• - Inhaled chemicals such as Beryllium, Silica, Coal products, Mustard gas
• CERTAIN DIETARY SUPPLEMENTS
• - 2 Large studies found that smokers who took beta carotene supplements
actually had an increased risk of CA lung
• EXPOSURE TO ASBESTOS
• - People who work with asbestos ( such as in mines, mills, textiles plants
places )

6. PATHOPHYSIOLOGY
• Due to etiological factors
• Damage to the cell
• Carcinogen bind to damaged cell DNA
• Cellular changes
• Passed to the daughter cell
• Eventually malignant cell develops
• Malignant transform from normal epithelium
• CARCINOMA

7. SIGN AND SYMPTOMS
• A cough that gets worse day by day
• Sputum ( Spit of Phlegm )
• Chest pain that is often worse with deep breathing, coughing, or
laughing, coughing up blood
• Hoarseness of voice if trachea involved
• Weight loss and loss of eppetite
• Shortness of breath
• Feeling tired or weak
• Infections such as bronchitis and pnuemonia

8. Sign and symptoms
• Bone pain
• Nervous system changes
• Yellowing of the skin and eyes
• Horners syndrome
• Horner syndrome
• Superior vena cava syndrome
• Paraneoplastic syndrome

9. Sign and Symptoms
1. A cough that gets worse day by day
2. Sputum (Spit or Phlegm)
3. Chest pain that is often worse with deep breathing, coughing or laughing
4. Coughing up blood
5. Hoarseness of voice if trachia is involved
6. Weight loss and loss of appetite
7. Shortness of breath
8. Feeling tired or weak
9. Infections such as bronchitis and pneumonia
10. Bone Pain like pain in back or hips

10. • Nervous system changes such as headache, weakness, dizziness,
balance problem or seizures, from cancer spread to the brain or
spinal cord.
• Yellowing of the skin and eyes (Jaundice) from cancer spread to the
liver
• Horner’s Syndrome – Cancer of the top part of the lungs, sometimes
called Pancoast Tumours, sometimes can affect certain nerves of the
eyes and part of the face, causing a group of syndrome called
Horner’s Syndrome.
• Dropping or weakness of one eyelid

11. • Reduced or absent sweating on the same side of the face sometimes cause
severe shoulder pain.
• Superior Vena Cava Syndrome – Tumours in this area can press on the SVC,
which can cause the blood to back up in the veins. This can lead to swelling
in the face, neck, arms, and upper chest.
• Paraneoplastic Syndrome – Some lung cancer can make hormone like
substances that can enter the blood stream and cause problems with
distant tissue and organs, even though the cancer has not spread to those
tissues or organs. These problems are called Paraneoplastic Syndrome.
• Excess growth/ Thickening of certain bones, especially those in the finger
tips.
• Excess breast growth in men ( Gynecomastia ) .

12. STAGES OF CANCER - American joint committee on
cancer AJCC TNM system which is based on
SR No STAGES FEATURES
The size of the main
i tumor (T)
T There is no evidence
of a primary tumor
T¹ The tumor is no
larger than 3 CM not
reached plenera

13. T² The tumor has 1 or
more larger than 3 CM
across but not larger
than 7 cm
T³ The tumor has1 or
more of the following
features,It is 7 cm
across chest wall
T⁴ The cancer has 1 or
more, A tumor of any
size has grown into the
space between the

14. Whether the cancer
has spread to nearby
egional lymphnodes
N There is no spread to
nearby lymph nodes
N¹ The cancer has spread
to lymphnodes within
the lung, bronchus
enter the lung
N² The cancer has spread
to lymphnodes around
the carina,
mediastinum

15. M categories for lung
cancer
M No spread to distant
organor areas. This
includes the other lung,
lymphnodes
M1a The cancer has spread
to the other lung.
Cancer cells are found
in the fluid around the
lung
M1b The cancer has spread
to distant lymphnodes
or to other organs.

16. Diagnostic evaluation
• Medical history and physical exam
• Blood test
• CBC
• IMAGING TEST
• X-RAY
• CT-SCAN
• CT- GUIDED NEEDLE BIOPSY
• POSITION EMMISION TOMOGRAPHY ( PET SCAN )
• NEEDLE BIOPSY
• BRONCHOSCOPY

17. Diagnostic Evaluation
1. Medical History and physical examination
2. Blood Tests
• CBC
• Blood chemistry test can help spot abnormalities in some of patient
organs, such as the liver or kidneys, e.g. Increased level of LDH
• Imaging Test
1. Chest X-Ray
2. CT-SCAN

18. Imaging Tests
• CT – guided needle biopsy – If a suspected area of cancer is deep
within patient body a CT-SCAN can be used to guide a biopsy needle
into the suspected area.
• Positron emission tomography (PET SCAN) – {a} For this test a form of
radioactive sugar FDG is injected into the blood.
• {b} This radio activity can be seen with special camera PET/CT-SCAN.
• Needle Biopsy — Can often use a hollow needle to get a small sample
from a suspicious area ( Mass ), Fine needle biopsy FNA Biopsy, Core
Biopsy.

19. Laser therapy
• Used to threat very small tumors in the linings of airways
• Open up airways blocked by larger tumors to help people breathe
better

20. Pharmacological management
• CHEMOTHERAPY- For lung cancer chemotherapy is treatment with anti-cancer
drugs injected into a vein or taken by mouth. These drugs enter the
bloodstream and go throughout the body, making this treatment useful for
cancer anywhere in the body.
1. Cisplatin - 75-100 mg/m2 IV -4 WEEKS . Side effects – Hair loss
2. Carboplatin - 200 mg/m2 IV on Day 1 . Side effects – Mouth sores
3. Paclitaxel (Taxol) – 135 mg/m2 over 24 hr every 3 weeks. Side effect – Loss of
appetite
4. Albumin-b – 25 mg/m2 IV (5℅ or 25℅ soln). Side effects – Nausea and
vomiting
5. Docetaxel (Taxotere) – 75mg/m2 IV over 1 hr for 3 week. Side effects –
Diarrhoea

21. • 6. Vinorelbine ( Navelbine) – 25 mg/m2 4 week with IV Cisplatin 100
mg/m2 4 week. Side effect – Constipation
• 7. Vinblastin – 4 mg/ sq-meter 2 week. Side effect – Easy Brushing
(From having too few blood platelets) , Fatigue

22. Surgical Management
1. Lobectomy – In this surgery the entire love containing the tumor is
removed
2. Segmentectomy Or Wedge resection – In this surgery only part of a
love is remove.
3. Pneumonectomy – This surgery removes an entire lung. This might
be needed if the tumor is close to the center of the chest.
4. VATS ( Video assisted thoracic surgery)
5. Radio Frequency Ablation
6. Palliative procedure for lung cancer – Palliative or Supportive care,
is aimed at reliving symptoms and improving a persons quality.