Lung Cancer

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Lung Cancer

• Lung cancer is the leading cause of cancer deaths
  in both women and men in the United States
• Only about 14 of all people who develop lung
  cancer survive for 5 years.
• Most lung tumors are malignant.

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Lung Cancer

• Lung cancers are usually divided into 2 groups
  that account for about 95 of all cases.
• These two types are called simply small-cell lung
  cancer (SCLC) and nonsmall-cell lung cancer
  (NSCLC)
• SCLCs are less common, but they grow more quickly
  than NSCLCs and are more likely to metastasize.
  Often, they have already spread to other parts of
  the body when the disease is diagnosed.
• About 5 of lung cancers are of rare cell types
  such as carcinoid tumor, lymphoma, or metastatic
  (cancers from other parts of the body that spread
  to the lungs).

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Lung Cancer

• The specific types of primary lung cancers are as
  follows
• Adenocarcinoma (a NSCLC) is the most common type
  of lung cancer, making up 30-35 of all cases. A
  subtype of adenocarcinoma is called
  bronchoalveolar cell carcinoma, which creates a
  pneumonialike appearance on chest x-rays.

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Lung Cancer

• Squamous cell carcinoma (a NSCLC) is the second
  most common type, making up about 30 of all lung
  cancers.
• Large-cell cancer makes up 10 of all cases.
• SCLC makes up 20 of all cases.

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Lung Cancer

• Cigarette smoking is the most significant cause
  of lung cancer
• Cigar and pipe smoking increases your risk of
  lung cancer, but not as much as smoking
  cigarettes does
• Passive smoking, or sidestream smoke
• Air pollution from motor vehicles, factories
• Asbestos exposure increases the risk of lung
  cancer by 9 times. A combination of asbestos
  exposure and cigarette smoking compounds the risk
  by as much as 50 times.
• Radon exposure
• Symptoms of primary lung cancers include cough,
  coughing up blood, chest pain, and shortness of
  breath.

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Lung Cancer

• Lung cancer most often spreads to the liver, the
  adrenal glands, the bones, and the brain.
• Metastatic lung cancer in the adrenal glands also
  typically
• Metastasis to the bones is most common with
  small-cell type cancers but also occurs with
  other lung cancer types.
• Paraneoplastic syndromes are the remote, indirect
  effects of cancer not related to direct invasion
• A chest x-ray will most likely be done first to
  look for a cause of your respiratory symptoms.
• The x-ray may or may not show an abnormality
• Types of abnormalities seen in lung cancer
  include a small nodule(s) or a large mass
• Not all abnormalities are cancers,

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Lung Cancer

• NSCLCs that are inoperable are treated with
  chemotherapy or a combination of chemotherapy and
  radiation
• Chemotherapy is the first-line treatment for
  SCLC.
• Surgery is the most widely used treatment for
  NSCLC.

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• Location can suggest cell type
• Central lesion- squamous cell or small cell
• Peripheral lesion adenocarcinoma
• Positron emission tomography (PET) detects
  increased glucose uptake by malignant tissues
  using a glucose analog, 2-18Ffluoro-2-deoxy-D-gl
  ucose (DFG). It provides a highly accurate and
  non-invasive method for detecting malignant lung
  tumors.

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Adenocarcinoma

• Adenocarcinoma is also the most common cell type
  seen in women and nonsmokers.
• Adenocarcinoma is sometimes associated with other
  concomitant lung diseases including diffuse
  fibrotic interstitial lung diseases,
  tuberculosis, and pulmonary infarction.
• Bronchioloalveolar carcinoma represents a subtype
  of adenocarcinoma.
• The typical radiologic manifestation of
  adenocarcinoma is a solitary pulmonary nodule
  with well-defined, lobulated, irregular, or
  poorly defined borders. It may be quite difficult
  to see on plain radiolgraphy.
• Thin-section CT of small peripheral carcinomas
  may demonstrate air bronchograms or air
  bronchiolograms in 65 of cases. Peripheral
  adenocarcinomas may directly invade the pleura
  and grow in pleural space. The lesion may be
  spiculated
• Adenocarcinoma has been reported to occur in
  close relation to preexisting bulla and may
  manifest as a nodular opacity within the bulla,
  thickening of the bulla wall, change in the size
  of bulla, or spontaneous pneumothorax

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This chest X-ray shows adenocarcinoma of the
lung. There is a rounded light spot in the right
upper lung (left side of the picture) at the
level of the second rib. The light spot has
irregular and poorly defined borders and is not
uniform in density. Diseases that may cause this
type of X-ray result would be tuberculous or
fungal granuloma, and malignant or benign
tumors.

                                 
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adenocarcinoma
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adeno
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Bronchioloalveolar carcinoma

• Bronchioloalveolar carcinoma is a subtype of
  adenocarcinoma and represents 2-6 of all lung
  cancers.It typically arises distal to the
  terminal bronchioles and spreads along the
  preexisting alveolar septa without causing
  significant amounts of lung destruction
• The cells secrete mucin and surfactant
  apoprotein-- can lead to bronchorrhea
• Bronchioloalveolar carcinoma can manifest as a
  single peripheral nodule or mass usually in the
  upper lung.Most commonly, this nodule is
  well-circumscribed

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Squamous cell carcinoma

• Squamous cell carcinoma is a common form of lung
  cancer, accounting for approximately one-third of
  all cases of bronchogenic carcinomas.
• Unlike adenocarcinoma, it is strongly linked with
  a history of cigarette smoking.
• Most squamous cell carcinomas arise centrally
  from either the main, lobar or segmental bronchi
  and ulcerate through the mucosa into the
  surrounding lung parenchyma.
• Their central location also tends to produces
  symptoms at an earlier stage than tumors located
  peripherally.
• Although symptoms tend not to be specific, most
  commonly a non-productive cough, they stem from
  the involvement of vital structures at the hilar
  area of the lung
• They are the most common cause of the Pancoast or
  superior sulcus syndrome.

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The lung windows CT demonstrates a mass in the
lumen of the right main stem bronchus and
narrowing of the pulmonary artery. A
bronchoscopic view also shows the tumor in the
right main stem bronchus
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Malignant mesothelioma

• Malignant mesothelioma is an uncommon neoplasm
  yet it is the most common primary malignancy of
  the pleura
• most significant etiological factor for the
  development of malignant mesothelioma is asbestos
  exposure
• Radiological Findings
• Chest x-ray may show pleural effusions or pleural
  thickening on the affected side.
• Computed tomography (CT) may also show pleural
  effusions or pleural thickening with irregular
  nodularity. CT may be helpful to evaluate local
  invasion of the chest wall, pericardium,
  diaphragm, as well as mediastinal/great vessel
  invasion and nodal involvement.

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CT image demonstrates pleural thickening
posteriomedially in the right hemithorax
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Large cell carcinoma

• Large cell carcinoma represents 10-20 of
  bronchogenic tumors.
• They tend to grow rapidly, metastasize early, and
  are strongly associated with smoking.

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Small cell carcinoma

• Small cell carcinoma accounts for approximately
  20 of all lung cancers.
• It is characterized by itsorigin in large central
  airways
• Small cell carcinoma causes a number of
  paraneoplastic syndromes.Small cell carcinoma is
  the most common type of cancer to cause clinical
  hormone syndromes.The tumor cells may produce
  ectopic adrenocorticotropic hormone (ACTH),
  resulting in Cushing's syndrome. The symptoms of
  Cushing's syndrome are nonspecific and are often
  attributed to other factors. Another
  paraneoplastic hormone syndrome that commonly
  occurs is the syndrome of inappropriate
  anti-diuretic hormone (SIADH). This is caused
  bysecretion of ADH from the tumor. Symptoms are
  related to the plasma hypotonicity that is
  secondary to water retention.
• Over 90 of small cell tumors are found in a
  central location.

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Mets

• Metastatic tumors in the lungs are malignancies
  (cancers) that developed at other sites and
  spread via the blood stream to the lungs. Common
  tumors that metastasize to the lungs include
  breast cancer, colon cancer, prostate cancer,
  sarcoma, bladder cancer, neuroblastoma, and
  Wilms tumor. However, almost any cancer has the
  capacity to spread to the lungs.
• Pulmonary metastases occur predominantly in the
  lower lobes
• Cavitation is uncommon and occurs more frequently
  in upper lobe lesions.

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Mets Facts

• Cannon Ball Mets
• Head and Neck Cancer, Testicular and Ovarian,
  Breast, Renal and Colon
• Ca Mets
• Osteosarcoma and Chondrosarcoma ( these are Bone
  cancer mets)
• Mucinous Mets ovarian, thyroid, pancreas, colon
  and stomach

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Breast