6 Basics of Lung CA.pptx
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Lung cancer is the leading cause of cancer death worldwide. In India, one-third of all cancer cases and deaths are due to lung cancer. The majority of lung cancers are non-small cell lung cancer (NSCLC), which is usually diagnosed at late stages. Diagnosis involves ruling out tuberculosis through pathological or cytological confirmation of lung cancer. Staging workup includes CT scans and PET scans to determine if the cancer has spread. Treatment depends on stage and type but may include surgery, chemotherapy, and targeted therapy.
![Geographical Diversity (India)
Study East North West South
No of cases 607 654 489 258
Mean age (yrs) 58.9 (11.5) [M] 58.1 (10.8) 56 (11.9) 56.0 (10.1)
Males 80.6% 83.3% 77.7% 77.5%
Smokers 73.1% 76.9% 47.9% 60.4%
• SqCC
• ADC
• SCLC
• NSCLC-NOS
35.1%
30.8%
16.5%
11.7%
38.1%
27.5%
20.5%
10.9%
24.1%
40.3%
8.0%
18.0%
15.9%
42.6%
13.2%
19.0%
• I-II
• IIIA
• IIIB
• IV
53.9% (I-IIIA)
28.2% (IIIB)
27.0% (IV)
3.1% (I-II)
13.1% (IIIA)
35.4% (IIIB)
48.5% (IV)
15.5% (I-II)
46.6% (III)
37.9% (IV)
11.2% (I-
II)
35.7% (III)
53.1% (IV)
Singh N, et al. J Thorac Dis 2012;4:474-84
Dey A, et al. Indian J Cancer 2012;49:89-95
Noronha V, et al. Indian J Cancer 2012;49:74-81
Krishnamurthy A, et al. Indian J Cancer 2012;49:82-8](https://image.slidesharecdn.com/6basicsoflungca-220809130722-0dfe55c0/85/6-Basics-of-Lung-CA-pptx-10-320.jpg)
![Epidemiology: Summary
The leading cause of cancer death among men
and women
Begins when cells in the lung grow out of
control and form a tumor
There are two main types of lung cancer:
Non-small cell lung cancer [NSCLC]
Constitutes 80% of which 65% are Stage
III/IV
Small cell lung cancer [ SCLC]
Constitutes 20% of total cases](https://image.slidesharecdn.com/6basicsoflungca-220809130722-0dfe55c0/85/6-Basics-of-Lung-CA-pptx-17-320.jpg)
6 Basics of Lung CA.pptx
- 1. Lung Cancer
- 2. Epidemiology Lung cancer has been estimated as the most common cancer in the world combined sexes for several decades accounting for 23.1 in 2012. More than half (55%) of the cases occurred in the developing world. Globocon 2012 The death toll due to lung cancer is projected to rise to ten million by 2030 with 7 out of 10 deaths in the developing world.
- 5. ASR - 6.9 % 6.9/lac
- 6. Lung Cancer Indian Scenario New Cases 67% ROW 33% India One-third of total cases in INDIA Seen not in elderly but also in middle aged persons. Most of the patients have advanced disease at diagnosis and 51.8% have evidence of metastases. The commonest presentation has been a mass lesion with or without collapse Squamous cell & adeno carcinoma have been the most common type Prevailing Cases 67% ROW 33% India
- 7. Lung Cancer Indian Scenario – Rising incidence Smoking smoker to nonsmoker ratio was 2.7 to 20 :1. Radiation Exposure Environmental/ Occupational Exposure Asbestos Radon Passive smoke
- 8. Lung cancer Symptoms & Diagnosis Symptoms often confused with TB fever, cough, expectoration, hemoptysis, weight loss and anorexia Age of the patient, smoking history, mediastinal symptoms such as hoarseness of voice, SVC obstruction and dysphagia favour the diagnosis Diagnosis with categorisation of the cell type is required before treatment 70-90% diagnosed by cytopathological examination Any mass lesion on radiology is subjected to bronchoscopy or transthoracic FNAC biopsy
- 9. Lung cancer - Types Lung Cancer CANCERS OF LUNG Secondary Cancer Others Primary Cancer Bronchgenic carcinoma Small-cell lung cancer Non-small lung cancer Large cell carcinoma Squamous cell carcinoma Adeno- carcinoma
- 10. Geographical Diversity (India) Study East North West South No of cases 607 654 489 258 Mean age (yrs) 58.9 (11.5) [M] 58.1 (10.8) 56 (11.9) 56.0 (10.1) Males 80.6% 83.3% 77.7% 77.5% Smokers 73.1% 76.9% 47.9% 60.4% • SqCC • ADC • SCLC • NSCLC-NOS 35.1% 30.8% 16.5% 11.7% 38.1% 27.5% 20.5% 10.9% 24.1% 40.3% 8.0% 18.0% 15.9% 42.6% 13.2% 19.0% • I-II • IIIA • IIIB • IV 53.9% (I-IIIA) 28.2% (IIIB) 27.0% (IV) 3.1% (I-II) 13.1% (IIIA) 35.4% (IIIB) 48.5% (IV) 15.5% (I-II) 46.6% (III) 37.9% (IV) 11.2% (I- II) 35.7% (III) 53.1% (IV) Singh N, et al. J Thorac Dis 2012;4:474-84 Dey A, et al. Indian J Cancer 2012;49:89-95 Noronha V, et al. Indian J Cancer 2012;49:74-81 Krishnamurthy A, et al. Indian J Cancer 2012;49:82-8
- 11. Features of non-small cell lung cancer (NSCLC) Lung Cancer Adenocarcinoma (40%) •Accounts for approximately 40% of all lung cancers diagnosed in the U.S. •Usually located in peripheral regions of the lung. •Frequently spreads to lymph nodes and distant organs. •Most common type of NSCLC in non- smokers. •High percentage in women.
- 12. Lung Cancer •Usually located in the central regions of the lung. •Often causes bronchial obstruction. •Tends to be slow growing. •Spreads commonly to regional lymphnodes Squamous Cell Carcinoma Features of non-small cell lung cancer (NSCLC)
- 13. Lung Cancer •Accounts for approximately 15% of all lung cancers diagnosed in the U.S. •Usually appears as a larger lesion. •Occurs in the peripheral regions of the lung. •Characteristically aggressive, and rapidly fatal. •Tends to spread to lymph nodes and distant organs. Large Cell Carcinoma Features of non-small cell lung cancer (NSCLC)
- 14. Features of small - cell lung cancer (SCLC) Lung Cancer •Highly malignant •Closely associated with smoking •Most common type of lung cancer which produces endocrine type paraneoplastic syndrome •at the time of diagnosis metastasis is commonly observed
- 15. Lung Cancer..growing concern! Incidence Mortality Lung Ca 18.7% 22.3% Prostate Ca 4.1% 2.5% Incidence Mortality Lung Ca 10.9% 13% Prostate Ca 3.4% 3.2% ASIA INDIA GLOBOCAN 2008 (IARC) Section of Cancer Information (29/8/2013)
- 16. The India We Don't Know World’s 2nd largest tobacco consuming nation 275 million tobacco users Rising tobacco use Prevalence of tobacco use in India (2009-10)1 % of Tobacco users Total population Adult males Adult females 100% 35% 48% 20%
- 17. Epidemiology: Summary The leading cause of cancer death among men and women Begins when cells in the lung grow out of control and form a tumor There are two main types of lung cancer: Non-small cell lung cancer [NSCLC] Constitutes 80% of which 65% are Stage III/IV Small cell lung cancer [ SCLC] Constitutes 20% of total cases
- 18. Diagnosis and staging Differentiating Lung Ca from TB: May not be possible on the basis of clinical or imaging features alone Cytological/pathological confirmation of diagnosis of LC mandatory prior to initiation of Rx RNTCP - Guidelines
- 19. Diagnostic workup History and Physical exam Diagnostic tests Chest x-ray Biopsy (bronchoscopy, needle biopsy, surgery) Staging tests CT chest/abdomen Bone scan PET scan Lung Cancer
- 20. Diagnosis of Lung CA This chest radiograph shows complete collapse of the left lower lobe (left), which was found to be an endobronchial tumor on CT (right). Chest radiographs may sometimes only reveal secondary signs of an underlying mass. Opacities on chest radiographs may require follow-up imaging to document resolution of either atelectasis or infection and ensure no underlying mass lesion is present.
- 21. ≤
- 22. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2013;266:304-317.
- 23. NSCLC Treatment Treatment depends on the stage and type of lung cancer Surgery / Radiation therapy Local therapy for early-stage lung cancer Chemotherapy Inoperable or advanced cases treated with Combination regimens Targeted therapy successful for EGFR mutated pts Lung cancer is usually treated with a combination of therapies
- 24. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2013;266:304-317.
- 25. CR indicates complete response; EGFR, epidermal growth factor receptor; PR, partial response, PS, performance score; SD, stable disease. Adapted from Bunn PA. Current status of advanced lung cancer. Presented at:14th International Lung Cancer Congress; July 25-27, 2013; Huntington Beach, CA.
- 26. OncoLog, October 2011, Vol. 56, No. 10
- 27. Platinum-based regimen Bevacizumab with carboplatin / paclitaxel Cisplatin with vinblastine / mitomycin Cisplatin / vinorelbine Cisplatin or Carboplatin / paclitaxel Cisplatin / gemcitabine Nonplatinum based regimen Pts not tolerating cisplatin based regimen ie. elderly or with PS of 2 EGFR TKIs for EGFR mutations Stage IV International recommendations
- 28. Recurrent or Progressive Stage IV# International recommendations Second-line therapy Docetaxel Pemetrexed Erlotinib after failure of both platinum-based and docetaxel chemotherapies # advanced or metastatic NSCLC with adequate performance status who have progressed on 1st-line platinum-based therapy