Neoplasms of Lung.pptx

lung tumors

1. Neoplasms of Lung - Dr Aziz

2. Primary Lung Cancer CONTENTS Introduction Risk Factors Relevance with Smoking Clinical presentation Classification Investigation Treatment

3. Introduction Lung cancer is one of the most common cancers throughout the world. From the time of diagnosis, 80% of patients are dead within 1 year and only 5% survive 5 years, making lung cancer the most common cause of cancer death. More deaths by lung cancer than the next four combined (colorectal, breast, prostate and pancreas)

4. Risk factors Smoking Gender Age Genetic preposition Occupational exposure

5. Gender prediliction Male predominant but raoidky changing Increase in Women smokers In 2007 55% Men 45% Women

6. Lung Cancer and Smoking ~90% of lung cancers attributed to smoking Risk directly linked to “pack-years” Pack years : the number of packs smoked per day multiplied by the number of years of exposure.

7. Occupational exposures Proven Arsenic Asbestos Chromium Mustard gases Nickel Bischloromethyl ether Polycyclic aromatic hydrocarbons Suspected Acrylonitrile Beryllium Vinyl chloride Silica Iron ore Wood dust

8. Asbestosis and Lung Cancer Prolonged heavy exposure has relative risk Peak incidence 15 - 24 years after exposure Fiber type is important - Chrysotile and Crocidolite > Anthophyllite.

9. Asbestosis and Lung Cancer Risk multiplied if smoking also present Mortality Ratio: - Non smoking asbestos worker : 5.17 - Smoker : 10.85 - Smoker & Asbestos worker : 53.24

10. Pathological classification

11. TNM STAGING

12. TNM STAGING

13. TNM STAGING

14. T1 tumour T1 tumor – A typical T1 tumor in the left lower lobe, completely surrounded by pulmonary parenchyma.

15. T2 tumour T2 tumor - A typical T2 tumor with atelectasis/pneumonitis of the left lower lobe up to the hilum, due to involvement of the left main bronchus.

16. T3 tumor T3 tumor - A typical T3 tumor in the right upper lobe with invasion of the chest wall.

17. T4 tumor T4 tumor – A typical T4 tumor in the right upper lobe with invasion of the mediastinum.

18. Pancoast tumor A Pancoast tumor is a tumor of the superior pulmonary sulcus characterized by pain due to invasion of the brachial plexus, Horner's syndrome and destruction of bone due to chest wall invasion. MR is superior to CT for local staging.

19. Clinical features Clinical features of lung carcinoma depend on : site of the lesion; invasion of neighbouring structures extent of metastases.

20. Clinical features persistent cough weight loss dyspnoea non-specific chest pain Haemoptysis Clubbing pleural effusion hypertrophic pulmonary osteoarthropathy

21. Investigations Diagnostic tests Chest Xray Bronchoscopy Ultrasound Guided Biopsy CT guided biopsy Staging tests CT scan- Chest,Brain,Abdomen PET SCAN Bone Scintigraphy Mediastinoscopy Bone marrow biopsy

22. Chest Xray

23. Fiberoptic Bronchoscopy

24. USG GUIDED BIOPSY

25. CT guided biopsy

26. Medistinoscopy The mediastinoscope slides down immediately in front of the trachea, behind the aortic arch, and behind and between the great vessels of the head and neck.

27. Treatment Thoracotomy : Incision used posterolateral A double-lumen endotracheal tube is used to allow ventilation of one lung while the other is collapsed

28. Video Assisted Thoracoscopic Surgery (VATS) Helps to gain access through smaller incision and complete hilar dissection can be achieved The technique avoids rib-spreading and appears to reduce postoperative pain and length of stay, and aids a speedier recovery.

29. Surgical management The principle of surgery is to remove all cancer (the primary and the regional lymph nodes) but to conserve as much lung as possible. Surgery with curative intent is offered to patients with early stage lung cancer (T1–3, N0–1)

30. Radiation therapy Treatment of stage I and stage II NSCLC radiation therapy is considered alone reduces local failures in completed resected (stages II and IIIA)NSCLC

31. Chemotherapy

32. THANK YOU