LUNG CANCER (Treatment (NSCLC (Metastatic NSCLC (stage IV) (Targeted
- NSCLC is less sensitive to chemotherapy and/or radiation, so surgery is the treatment of choice in these tumors
- SCLC, initially responds well to chemotherapy and/or radiation, but has usually metastases widely by the time it is discovered, making surgery ineffective.
1.High dose radiotherapy
- Paliative techniques
take home messages
Advanced (stage IV)
- Incurable disease
- Some patients may benefit from chemotherapy or targeted therapy
- Majority will necessitate palliative therapy
Early (operable) disease (stage I, II, selected IIIA)
- The mainstay of treatment: pulmonary resection (lobectomy or pneumonectomy)
- Long-term survival after surgery in 40% of patients
- No defined role of pre- or postoperative radiotherapy
- The role of preoperative chemotherapy debatable
- Postoperative chemotherapy recommended in selected patients
Loss of appetite
due to local compress
- Chest pain 25-35%
- Bone pain
- Superior vena cava syndrome commonly occurs with SCLC
- Horner’s syndrome
- Irregular heartbeat
- Cardiac tamponade
- Thoracic outlet syndrome
- Wheezing, Hoarseness
Coughing (most common) >50%
Recurring pneumonia 15-20%
- disease or symptom that is the consequence of cancer in the body but, unlike mass effect, is not due to the local presence of cancer cells.
- These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune responce against the tumor.
Lambert-Eaton myasthenic syndromemost common in SCLC
Paraneoplastic cerebellar degeneration
Trousseau sign (associated with venous thrombosis and hypercoagulability)
Disseminated intravascular coagulation
- combination of:
Droping of the eyelid (ptosis)
Constriction of the pupil (miosis)
- rare and malignant cancer caused by asbestos.
- form in the pleura.
- Symptoms: As the disease mostly affects the lungs, the primary symptoms affect the respiratory system, such as shortness of breath, or the thoracic cavity, such as chest pain.
Pleural effusion is the most common presentation (blood)
- Treatment: surgery, which includes removal of some or all of the pleura and possibly part of the lung, combined with chemotherapy and/or radiation.
- Survival: The prognosis is poor, with a median survival time of about 1 year.
- Relatively uncommon tumor
- Incresing incidence
- Average age at diagnosis: 60 years
- Long latency period (20-40 years)
- Men constitute 70–80% of cases
pleura (>90%), peritoneum, pericardium, tunica testis
Tumor growth: Slow
Type of growth: Mainly loco- regional
Sensitivity to chemotherapy: Low/moderate
Main treatment modality: Surgery
Tumor growth: Rapid
Type of growth: Rapid dissemination
Sensitivity to chemotherapy: High
Main treatment modality: Chemotherapy
magnetic resonance imaging
positron emission tomography
- Bronchoscopy for pat with Central tumor
- Transthoracic fine needle biopsy for pat with Peripheral tumor
- CT chest and upper abdomen for All patients
- Bone scan If symptoms present
- Brain (CT) or MRI Advisable in high risk groups
- PET/CT In patients considered for radical surgery or radiotherapy
- General status, Lung signs
- Aching pain associated with bone invasion (rib, vertebrae...)
- Tamponade (pericardium),
hoarseness (recurrent laryngeal nerve), Horner’s syndrome...
- Superior vena cava syndrome
- Enlarged nodes (cervical, supraclavicular...)
- Liver enlargement...
- Clinical history (smoking, symptoms, weight loss, performance status...)
- Clinical examination
- Chest radiography
- Main aim: establishing the presence of extrathoracic spread (limited vs. extensive disease)
- History and clinical examination, Pathology, Chest X-ray.
- CT chest and abdomen, Bone scan, Brain CT or MRI (As soon as ED is demonstrated, stop further investigations)
- CBC, platelets, Electr., liver function tests, Ca, LDH, urea, creat.
- PET (optional)
- Limited disease (LD) (limited to one hemithorax)
- Extensive disease (ED) (distant metastases)
1.Cigarette smoking (90%), Passive smoking (33%)
pre-existing lung disease such as pulmonary fibrosis;
- situated at the top of lung.
- can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve,vagus nerve, or, characteristically , characteristically, compression of a sympathetic ganglion resulting in a range of symptoms known as Horner’s syndrome (Droping of the eyelid (ptosis), Constriction of the pupil (miosis), Endophthalmos).
- the most common cancer in terms of both incidence and mortality.
- 90% of patients who develop lung cancer will die of the disease
1.Epithelial tumours: malignant, bening