>educational:

>other:

>administrative:

>contact us:

>resp notes:

>downloads:

>go back to:

Lung Cancer

Introduction

Incidence: Lung cancer is the most common cancer in the world with 1.3 million new cases diagnosed every year. The vast majority of lung cancers are caused by cigarette smoking.

[Return to top]

---

Classification

Benign:
- adenoma
- carcinoid (rarely malignant)
- hamartoma

Malignant (1^o):
25 % = Small cell (SCLC, oat cell carcinoma)

Non-small cell (NSCLC):
50 % = squamous cell
15 % = adenocarcinoma
10 % = large cell
bronchoalveolar

Malignant (2^o):
- carcinoma (breast, kidney)
- sarcoma (bone)
- melanoma

[Return to top]

---

Risk Factors

Environmental
- smoking (80%)*: NOT adenocarcinoma
- passive smoking
- radon (5%)

Occupational
- asbestos
- silica
- nickel

Predisposing conditions
- pulmonary fibrosis

Social
- low socioeconomic status
­ - smoking

* risk decreases by 50% every 5 years after stopping smoking

[Return to top]

---

Prognosis

5 year survival:

- overall (UK) = 6%
- resected (T2,N0,M0 NSCLC) = 60%
- SCLC, median survival = 2–3 months

[Return to top]

---

Investigation

Aim is to get histological diagnosis in order to guide management.

Imaging
- CXR
- lateral CXR

Tissue biopsy for histology
- Central tumour: bronchoscopy (biopsy, washings, brushings)
- Peripheral tumour: percutaneous FNAC (fine needle aspiration cytology), can be CT/US guided
- Other cytology: sputum, pleural fluid
- On-table: mediastinoscopy, VATS

[Return to top]

---

Staging & Function

Standard
- CT chest / upper abdomen (inc. liver & adrenals)
- CT head
- bone scan

Experimental
- PET (positron emission tomography)scan: mediastinal staging

Functional
- Risk factors: surgery CId if: FEV1 <1.5L or transfer factor <50%

SCLC
- limited stage disease = 30 %
- extensive stage disease = 70 %

Treatable if:
- disease confined to one hemithorax...
- or without ipsilateral supraclavicular node involvement
- that can be encompassed within a tolerable direct-beam radiotherapy field

NSCLC
- TNM staging

[Return to top]

---

Management of Lung Cancer: NSCLC

Surgery
- wedge resection ± VATS:* 50% local recurrence

- lobectomy: 3% mortality
- pneumonectomy: 6% mortality
- if… predicted post-surgical FEV1 >40% Normal

DXR (radiotherapy)
- radical: multiple daily doses (CHART **)
- palliative: local symptoms, brain mets (? steroids)

(Chemotherapy)
- only for advanced disease
- 30% objective response, 60% symptom relief

* VATS = video assisted thoracoscopic surgery
** CHART = continuous hyperfractionated accelerated radiotherapy

[Return to top]

---

Management of Lung Cancer: SCLC

Chemotherapy
- 80% response rates:­ survival 4-6months (extensive stage), 6–12months (limited stage)

Limited stage disease
- consolidation DXR: decreases recurrence by 50 %

[Return to top]

---

Palliative measures SCLC

Endobronchial
- stents / laser / cryotherapy

Systemic
- opiods: for pain & shortness of breath
- steroids: fornon-specific symptoms & appetite

[Return to top]

---