lung cancer

Lung Cancer Done by: Rana Abdulnaser AL-Hakimi

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Lung cancer is an epidemical disease, annually there are 1.4 million deaths and about 1.6 million new cases. More people die of lung cancer than of colon, breast, and prostate cancers combined. Lung cancer mainly occurs in older people. About 2 out of 3 people diagnosed with lung cancer are older than 65. Fewer than 3% of all cases are found in people under the age of 45. The average age at the time of diagnosis is about 71. The chance that a man will develop lung cancer is about 1 in 13, for a woman, the risk is about 1 in 16, These numbers include both smokers and non-smokers. For smokers the risk is much higher, while for non-smokers the risk is lower. Lung cancer incidence rates were around twice as high in more developed countries compared with less developed countries

LUNG CANCER STATICAL IN THE WORLDE

LUNG CANCER IN THE ARAB WORLD

15/22 (68.1%) of the Arab countries have lung cancer as one of the most frequent five types of cancer, for both sexes.

In 2008 about 9,537 new cases was reported in ages below 65 for both sexes, and 7,059 cases for ages above 65.

Lung cancer are about 15 fold higher in Tunisia than in Sudan for men, and about 10 fold higher in Bahrain than in Yemen for females.

In 2020 there is expected to be 14,788 new lung cancer cases in the Arab countries for ages below 65, and 14,788 cases for ages above 65 in both males and females.

By the year 2025, 85% of the world’s smokers will live in less developed countries. It is estimated that by 2030 lung cancer will be the sixth most common cause of death, compared with its current ranking of ninth.

By 2030 it is expected that around 70% of all tobacco-related deaths (including lung cancer) will occur in the world’s poor and middle income nations, compared with the current estimate of 50%.31,109. .

LUNG CANCER IN THE FUTURE

.Lung cancer have 2 major types

Non-small cell lung cancer

small cell lung cancer

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Squamous cell (epidermoid) carcinoma: About 25% to 30% of all lung cancers It start in early versions of squamous cells, whichare flat cells that line the inside of the airways in the lungs. It often linked to a history of smoking It found in the middle of the lungs, near a bronchus

Adenocarcinoma: About 40% of lung cancersStart in early versions of the cells that would normally secrete substances such as mucus. Occurs mainly in people who smoke (or have smoked), it is also the most common type of lung cancer seen in non-smokers. It is more common in women than in menIt is more likely to occur in younger people than other types of lung cancer.

Non-small cell lung cancer

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Named for the small cells that make up these cancers. SCLC often starts in the bronchi near the center of the chest.It tends to spread widely through the body fairly early in the course of the disease. The cancer cells can multiply quickly and spread to lymph nodes and other organs, such as the bones, brain, adrenal glands, and liver. Sometimes the areas of cancer spread are seen as large tumors on x-rays and other imaging tests, but early on these areas may not be visible. SCLC spreads early, so removing the tumor in the lung rarely cures the cancer. This is why surgery is rarely used to treat SCLC . On the other hand, chemotherapy, which can reach cancer cells throughout the body, is the main treatment for small cell lung cancers.

Small cell lung cancer

Small cell lung cancer

Gene mutations

Chronic inflammatory lung diseases

Exposure to non-tobacco

carcinogensAir pollution

AsthmaCOPD(Chronic obstructive

pulmonary disease) Tuberculosis

Mutations in (RTKS)

Radon AsbestosChemical carcinogens

5% of all deaths due to air pollution.

Smoking is the most common etiological factor, accounting for nearly 85% of patients with lung cancer .

Heavy alcohol consumption increase lung cancer risk in

smokers

Vegetables and Fruit reduce lung cancer

risk in smokers

Primary tumor

Locoregional metastases

Distant metastases

Bone metastases

Brain metastasesHeadaches Dizziness,A change inconsciousness

Pain. loss of mobility. loss of skeletalFractures. Hypercalcaemia. Spinal cordcompression.

Malignant pleural effusion

Superior vena cava obstruction

DyspnoeaOrthopnoea Cough Chest discomfort Pain

Haemoptysis

Pain

Cough

Dysponea

Symptoms

T

N

M

The TNM staging system

Indicates the size of the main (primary) tumor and whether it has grown into nearby areas.

Describes the spread of cancer to nearby (regional) lymph nodes. Cancers often

spread to the lymph nodes before going to other parts of the body.

Indicates whether the cancer has spread (metastasized) to other organs of the body.

)The most common sites are the brain, bones, adrenal glands, liver, kidneys, and the

other lung(.

M: MetastasisT: Tumor N: Lymph nodes

Cancer cells are seen in a sample of sputum or other lung fluids, but the cancer isn't found with other tests, so its location can't be determined.

Stage 0Occult

cancer

The cancer is no larger than 3 cm acrossIt has not reached the membranes that surround the lungsIt does not affect the main branches of the bronchi. It has not spread to lymph nodes or distant sites

The main tumor is between 3 and 5 cm across.It has grown into a main bronchus , the visceral pleura ,and partially clogging the airways. The cancer has not spread to lymph nodes or distant sites.

Stage IAStage IA

Stage IBStage IB

The cancer is no larger than 3 cm

The main tumor is between 3 and 5

cm

The main tumor is between 5

and 7

A main bronchus It has not spread

Spread (but is not within 2 cm of the

carina )

Spread (but is not within 2 cm

of the (carina

Lymph nods within the lungs

Spread Spread It has not spread

Around area where the bronchi

enters the lung (hiler lymph nodes )

SpreadSpread It has not spread

The visceral pleura

It has not grown

Spread Spread

The airways It has not spread

partially cloggingpartially clogging

Distant sitesIt has not spread

It has not spread It has not spread

Distances Sites

Three combinations of categories make up

the IIA stage.

It has grown into a main bronchus. It has grown into the visceral pleura. Partially clogging the airways. It has spread to lymph nodes within the lung. It has spread around the area where the bronchus enters the lung . It has grown into the diaphram, the visceral pleura, the parietal Pericardium and it invades a main bronchus and is closer than 2 cm to the carina, but it does not involve the carina it self. It has grown into the airways enough to cause an entire lung to collapse or to cause pneumonia in the entire lung .Two or more separate tumor nodules are present in the same lobe of a lung .The cancer has not spread to lymph nodes or distant sites

The main tumor is between 5 and 7 cm

across.

It is larger than 7 cm across.

IIB STAGE

The main tumor can be any size.The cancer has spread only to lymph nodes around the carina or in the space between the lungs .

It is larger than 7 cm across. It has spread and grown in :the chest wall the diaphragm the mediastinal pleura the parietal pericardium. the airways a main bronchuslymph nodes within the lung Lymph nodes around the area where thebronchus enters the lung. These lymph nodes are on the same side as the cancer.Two or more separate tumor nodules are present in the same lobe of a lung.It has not spread to distant sites.

A tumor of any size has grown into: the mediastinum , the heart, the large blood vessels near the heart , the windpipe , esophagus, the backbone, or the carina, lymph nodes within the lung and/or around the area where the bronchus enters the lung. Any affected lymph nodes are on the same side as the cancer. It has not spread to distant sites.Two or more separate tumor nodules are present in different lobes of the same lung.

Nearby structures

Lung collapse

Caused pneumonia

Mediastinal

Lymph nodes

The cancer has not spread to distant sites.

Near the collarbone on either side

Hilar

Lymph nodes on the side opposite the primary tumor

The backbone

Mediastinum

The windpipe

The large blood vessels near the heart, the heart.

Near the collarbone on either side

Esophagus Lymph nodes on the side opposite the primary tumor

The carina and around the carina

The carina Two or more separate tumor nodules are present in different lobes of the same lung.

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Stage IV

The cancer can be any size It may or may not have grown into nearby structures or reached nearby lymph nodes.The cancer has spread to the other lung.Cancer cells are found in the fluid around the lung (called a malignant pleural effusion).Cancer cells are found in the fluid around the heart (called a malignant pericardial effusion).

The cancer can be any size It may or may not have grown into nearby structures or reached nearby lymph nodes. It has spread to distant lymph nodes or to other organs such as the liver, bones, or brain.

Diagnosis

Magnetic resonance imaging (MRI) scan

Chest x-ray

Computed tomography (CT) scan

Positron emission tomography (PET) scan

CT guided needle biopsy

Bone scan

Imaging tests

Bronchoscopy

Endoscopic esophageal ultrasound

Endobronchial ultrasound

Mediastinoscopy

Tests to diagnose lung cancer

Thoracentesis

Mediastinotomy

Thoracoscopy

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Sputum cytologyFine needle aspiration (FNA) biopsy

ImmunohistochemistryMolecular testsBlood testsPulmonary function tests

Sampling tissues and

cells

Lab tests of biopsy and

other samples

.Treatment

Chemo (sometimes along with radiation therapy) may be used to try to shrink a tumor Before surgery: This is known as neoadjuvant therapy. After surgery: to try to kill any cancer cells that may have been left behind..This is known as adjuvant therapy.For more advanced cancers or for some people who aren't healthy enough for surgery.

Surgery

Pneumonectomy

·LobectomySegmentectomy

)wedge resection(

External beam radiation therapy Brachytherapy (internal radiation therapy).Chemotherap

y

 Monoclonal antibodies tyrosine kinase inhibitors

Targeted therapy

Radiation therapy