PATOLOGI KANKER PARU UPAYA DIAGNOSTIK - Website …staff.ui.ac.id/system/files/users/sutjahjo.endardjo/material/lung... · Primary carcinoma of the lung Most common primary malignant

LUNG CANCER

Sutjahjo EndardjoDepartemen Medik Patologi Anatomik

FKUI/RS Cipto Mangunkusumo

Primary carcinoma of the lung Most common primary malignant tumor

in the world Directly related to cigarette smoking

(95% of patients related to smoking) Associated with occupational exposure

to carcinogens Overall 5-year survival rate of 4-7%

Estimated new cases and deaths (US 2008)

New cases: 215,020Deaths: 161,840

Pathological conditions which are associated with development of malignancy

Malignant transformation of benign tumors: adenoma -> colonic ca

Chronic inflammatory conditions: ulcerative colitis -> cancer, tuberculoma-> lung cancer

Intraepithelial neoplasia: metaplasia, dysplasia, carcinoma in situ

CARCINOGENESIS Chemicals: industrial – aniline dyes;

asbestos, social habits - cigarette smoking, diet – aflatoxin. Radiation Viruses: HPV, Hepatitis B, EBV

Pathogenesis SCC

SYMPTOMS a cough that gets worse or does not go away breathing trouble, such as shortness of

breath constant chest pain coughing up blood a hoarse voice frequent lung infections, such as pneumonia feeling very tired all the time weight loss with no known cause

SYMPTOMS

SYMPTOMS

SYMPTOMS

Epithelial lining of the LUNG

HISTOLOGICAL Classification (WHO, 1999) Squamous cell carcinoma(SCC) Adenocarcinoma(Adeno) Large cell carcinoma(LCC) Small cell carcinoma(SCLC)

Neuroendocrine(carcinoid) Other

Squamous cell Ca (SCC) Histologi

Sitologi

Adenocarcinoma(Adeno) Histologi

Sitologi

Large cell Ca (LCC) Histologi

Sitologi

Small cell lung Ca (SCLC) Histologi

Sitologi

Carcinoid typical atypic

Perspectives in lung cancer 1.Estimated 1.3 million new cases will be

diagnosed annually2.Adenocarcinoma is the major histological

subtype3.Increasing the incidence of typical & atypical

carcinoid and large cell neuroendocrine tumors

4.Decreasing the incidence of small cell carcinoma

Hansen: 2nd International Chicago Symposium on Malignacies of Chest and Head & Neck, October 2001

SPECIMENS for DIAGNOSIS Histopathology

- surgical specimen- biopsied specimen

Cytology- sputum, bronchial washing / brushing- transthoracal needle aspiration(TTNA)- transbronchial needle aspiration

- pleural fluid

Processing specimen Histopathology Frozen section

- hematoxilin eosin- histokimia- immunohistology

Fixation- 10% formaline- fresh

Cytology- papanicolaou- giemsa- diff-quick- sitokimia- immunocytology

Fixation- 95% alcohol

- dry

CYTOLOGY of LUNG Cancer inRSUP Persahabatan 2000-2001

Type N %

Adeno 172 76

SCC 52 23

LCC 3 1

SCLC - -

Carcinoid - -

Positivity of specimensRSUP Persahabatan 2000-2001

Specimen Total Malignant %Surgical 138 36 26

TTB 459 135 29

Wash/Brus 834 91 11S.Endardjo, 2001

Positivity of sputum cytologyCara

periksaDirect

%Inhalation

%Saccomano

%

Endardjo1990

5.2

Astowo1995

16 26

Titin M S2002

4.3 18.3

Collecting sputum Sputum early morning No dental-brushing Deep cough, can be induced Collect in a clean tray Send to PathLab as soon as possible/

smear on glass object and fix into alcohol 95% or put into saccomano solution

Para-neoplastic symptoms

Para-neoplastic symptoms

Para-neoplastic symptoms

Stages of Small Cell Lung Cancerusing two stages:

Limited stage: Cancer is found only in one lung and its nearby tissues.

Extensive stage: Cancer is found in tissues of the chest outside of the lung in which it began. Or cancer is found in distant organs.

Stages of Non-Small Cell Lung Cancer.

Stage 0: Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A Stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.

Stage IA: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than 3 centimeters across (less than 1 ¼ inches).

Stage IB: The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes. .

Stage IIA: The lung tumor is no more than 3 centimeters across. Cancer cells are found in nearby lymph nodes.

Stage IIB: The tumor is one of the following: Cancer cells are not found in nearby lymph nodes, but the tumor has invaded the chest wall, diaphragm, pleura, main bronchus, or tissue

that surrounds the heart (see the picture of the diaphragm).

Stage IIIA: The tumor may be any size. Cancer cells are found in the lymph nodes near the lungs and bronchi, and in the lymph nodes between the lungs but on the same side of the chest as the lung tumor.

Stage IIIB: The tumor may be any size. Cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumor may have invaded nearby organs, such as the heart, esophagus, or trachea. More than one malignant growth may be found within the same lobe of the lung.

The doctor may find cancer cells in the pleural fluid.

Stage IV: Malignant growths may be found in more than one lobe of the same lung or in the other lung. Or cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver, or bone.

Important points (lung ca) 5-year survival rate is very low Incidence increasing Screening is expensive Related to cigarettes smoking and other

carcinogens Adenocarcinoma type increasing Need a certain diagnostic

ability/approach