LUNG TUMOR

DR.SAEED MANA ALMAIDAMAH

• The lung carcinoma , is a malignant lung
tumor
characterized by uncontrolled cell growth in
tissues
of the lung .

• If left untreated , this growth can spread

beyond the
lung by the process of metastasis into nearby
tissue
or other parts of the body .
 Bronchogenic carcenoma :
• Commonest cause of cancer related
death in male
• The rate of increase is declining in male
but is accelerating in female
• Majority are related to smoking
• Bad prognesis ( 5 years survival for all
stages of lung cancer combined <15%(
• If localized to lung 5yr survival is 45%
●Lung cancer is the most common cause of death .

●causing 1.59 million deaths per year .

●Tobacco use is the major preventable cause.

.
●Just as tobacco use and cancer rates are falling in
some developed countries,
●both smoking and lung cancer are rising in Eastern
Europe and in many developing countries.
●The great majority of tumours in the lung are
primary lung cancers
●The prognosis remains poor, with fewer than 30%
of patients surviving at 1 year and 6–8% at 5 years.
 Types of lung carcinoma
■Small cell lung cancer (SCLC)
●Small cell carcinoma

■Nonsmall cell lung carcinoma ( NSCLC)

●Squamous cell carcinoma
●Adenocarcinoma
●Large cell carcinoma
●Squamous cell carcinoma
was the most common type
but has recently been
replaced by adenocarcinoma .

●Adenocarcinoma most
common type in female ,
nonsmoKers and patients < 45
years
■Lung cancers arise from the bronchial
epithelium or mucous glands.
■The common cell types in lung cancer are :
●Adenocarcinoma 35–40%
●Squamous 25–30%
●Small-cell 15%
●Large-cell 10–15%
■ When the tumour occurs in a large
bronchus, symptoms arise early
■When the tumours originate in a peripheral
bronchus ,symptoms arise late ,resulting in
delayed diagnosis.
■Lung cancer may involve the pleura directly or by
lymphatic spread .

■It may extend into the chest wall, invading the

intercostal nerves or the brachial plexus and causing
pain.

■Lymphatic spread to mediastinal and

supraclavicular lymph nodes often occurs before
diagnosis.

■Blood-borne metastases occur most commonly in

 Clinical features
■Lung cancer presents in many different
ways,● reflecting local, ●metastatic or
●paraneoplastic tumour effects.
■Cough :●the most common early symptom.
●often dry ●secondary infection may cause
purulent sputum .
■Haemoptysis is common, especially with
central bronchial tumours.
■ Breathlessness may be caused by ●collapse
or ●pneumonia, or ●by tumour causing a
large pleural effusion or● compressing a
■Pain and nerve entrapment :●Pleural pain
may indicate malignant pleural invasion.
●Intercostal nerve involvement causes pain in
the distribution of a thoracic dermatome.
●Cancer in the lung apex may cause Horner’s
syndrome (ipsilateral partial ptosis,
enophthalmos, miosis and hypohidrosis of the
face; due to involvement of the sympathetic
nerves to the eye.
●Pancoast’s syndrome (pain in the inner
aspect of the arm, sometimes with small
muscle wasting in the hand) indicates
malignant destruction of the T1 and C8 roots
■Mediastinal spread
●The oesophagus •dysphagia.
● The pericardium , arrhythmia or
pericardial effusion may occur.
●Superior vena cava obstruction by
malignant nodes • suffusion and swelling
of the neck and face, conjunctival
oedema, headache and dilated veins on
the chest wall
● The left recurrent laryngeal nerve
•vocal cord paralysis, •voice alteration
■Metastatic spread focal neurological
defects, epileptic seizures, personality
change, jaundice, bone pain or skin nodules.
Lassitude, anorexia and weight loss usually
indicate metastatic spread.
■Finger clubbing Overgrowth of the soft
tissue of the terminal phalanx, leading to
increased nail curvature and nail bed
fluctuation, is often seen
■Hypertrophic pulmonary
osteoarthropathy (HPOA) This is a painful
periostitis of the distal tibia, fibula, radius
Non-metastatic extrapulmonary manifestations of
lungcancer ■Endocrine
• Inappropriate antidiuretic hormone (ADH,
vasopressin) secretion, causing hyponatraemia
• Ectopic adrenocorticotrophic hormone secretion
• Hypercalcaemia due to secretion of parathyroid
hormone-related peptides • Carcinoid syndrome
• Gynaecomastia
■Neurological
• Polyneuropathy • Myelopathy • Cerebellar
degeneration
• Myasthenia (Lambert–Eaton syndrome, )
■Other • Digital clubbing • Hypertrophic
pulmonary osteoarthropathy • Nephrotic
 Investigations
■Imaging
■ chest X-ray,
●lobar collapse ● mass lesions,
●effusion ●malignant rib destruction .
■ CT
● may reveal mediastinal or metastatic spread
and is helpful for planning biopsy procedures, (
percutaneous CT-guided biopsy.)
■Biopsy and histopathology
●Over half of primary lung tumours can be
visualised and sampled directly by biopsy and
brushing using a fexible bronchoscope.
●For tumours that are too peripheral percutaneous
needle biopsy under CT or ultrasound guidance is a more
reliable way to obtain a histological diagnosis.
●sputum cytology may reveal malignant cells .
●In patients with pleural effusions, pleural
aspiration and biopsy is the preferred
investigation.
●In patients with metastatic disease, the diagnosis
can often be confirmed by needle aspiration or
biopsy of affected lymph nodes, skin lesions, liver
■Staging to guide treatment
●The propensity of small-cell lung cancer to
metastasise early means these patients are
usually not suitable for surgical intervention.

● In non-small-cell lung cancer (NSCLC),

treatment and prognosis are determined by
disease extent, so careful staging is required.

●CT is used early to detect obvious local or

distant spread.
• Division is for therapeutic purposes
• Virtually all SCLC have metastasized by
time of diagnosis – treated by
chemotherapy+/- radiotherapy
• NSCLC better treated by surgary
• Genetic differences :
• SCLC : RB gene mutation
• NSCLC :P16/CDKN2A gene inactivation
• KRAS & EGFR oncogene mutation
 Management
Treatment with the aim of cure is not possible or is■
.inappropriate due to extensive spread or comorbidity

Surgical treatment■
Accurate pre-operative staging, coupled with●
.improvements in surgical and post-operative care

Radiotherapy■
,It is much less effective than surgery ●
Radical radiotherapy can offer long-term survival in●
.selected patients with localised disease
Radical radiotherapy is usually combined with●
. chemotherapy

The greatest value of radiotherapy, however, is in●

the palliation of distressing complications, such as
,superior vena cava obstruction •
,recurrent haemoptysis •
pain caused by chest wall invasion or •
skeletal metastatic deposits •
■Chemotherapy
●The treatment of small-cell carcinoma with
combinations of cytotoxic drugs, sometimes with
radiotherapy,.
●Regular cycles of therapy, including combinations
of intravenous cyclophosphamide, doxorubicin and
vincristine or intravenous cisplatin and etoposide,
are commonly used.
●In NSCLC chemotherapy is less effective, though
platinum based chemotherapy regimens offer 30%
response rates .

Laser therapy and stenting

•
Secondary tumours of the lung
■Blood-borne metastatic deposits in the
lungs may be derived from many primary
carcinomas,
■• breast, •kidney, •uterus, •ovary, •testes
•thyroid,•osteogenic and •other sarcomas
■usually multiple and bilateral.
■ no respiratory symptoms
■ the diagnosis is incidental on X-ray.
■Breathlessness may occur if a considerable
amount of lung tissue has been replaced by
metastatictumour.
■Lymphatic infiltration may develop in
carcinoma of the breast, stomach, bowel,
pancreas or bronchus.
■‘Lymphangitic carcinomatosis’ causes
severe, rapidly progressive breathlessness
with marked hypoxaemia.
■The chest X-ray shows diffuse pulmonary
shadowing radiating from the hilar regions,
often with septal lines,
■CT shows characteristic polygonal
thickened interlobular septa.