Lung cancer is the most common malignant disease and cause of cancer deaths. Smoking is the primary risk factor, with cigarette smokers 8-20 times more likely to develop lung cancer than non-smokers. Other occupational exposures like asbestos, radon, and chemicals used in mining and metal refining can also increase lung cancer risk. Symptoms often do not appear until the cancer has spread, with cough, breathlessness, and chest pain being common complaints at diagnosis. Treatment depends on the cancer type and stage but may involve surgery, chemotherapy, radiation therapy, or a combination of these. Prognosis is generally poor but prevention through smoking cessation can significantly reduce lung cancer risk.
2. Most common form of malignant diseases
40,000 new patients per year
8% male deaths and 4% of all female
deaths
Men > women, middle age
3. Tobacco smoking
Cigarette smokers are 8-20 times more
likely to develop lung cancer than life
long non smokers.
Squamous and small cell carcinoma
have clear association with smoking.
Adenocarcinoma is commonest
histological type in a non smoker
5. Asbestos – mining, processing, usage.
Radioactivity – metal ore mining, uranium
mining.
Nickel – refining.
Chromium salt – extraction, production,
usage.
Arsenic – metal refining, chemical industry,
insecticides.
6. Localised areas of pulmonary scarring
Diffuse pulmonary fibrosis
Cryptogenic fibrosing alveolitis is
associated with adenocarcinoma
Tuberculosis – scar carcinoma,
adenocarcinoma
Bronchioloalveolar carcinoma also occur
in areas of scarring
7. 1. Squamous cell carcinoma (epidermoid
carcinoma)
2. Small cell carcinoma
a. oat cell carcinoma
b. intermediate cell type
c. combined oat cell
carcinoma
8. 3. Adenocarcinoma
a. acinar
b. papillary adenocarcinoma
c. bronchioloalveolar
d. solid carcinoma with mucous
4. Large cell carcinoma
5. Adenosquamous carcinoma
9. 6. Carcinoid tumours
7. Bronchial gland carcinoma
a. adenoid cystic carcinoma
b. mucoepidermoid carcinoma
c. others
10. Polypeptides that take part in the control of
cell differentiation and proliferation
Bombesin/gastrin releasing peptide –
growth factor for small cell carcinoma
Non small cell carcinoma – few growth
factors are recognized, EGF, TGF
11. Loss of short arm of chromosome in small
cell carcinoma (p14, p23)
CDKN2 gene on chromosome 9 – Non
small cell lung carcinoma
13. Substances produced by tumour cells
that are released in to blood stream.
Neuron specific enolase, creatinine
phophokinase BB, CEA
14. Worsening of preexisting respiratory state.
No symptoms, detected by the chance
of finding an opacity.
Nonspecific symptoms of malignancy like
malaise, anorexia, and weight loss
Metastatic disease
15. Cough – most common symptom
New cough that persists longer than 2
weeks in a patient of 40 years who is a
smoker.
Hemoptysis – usually streaky
Breathlessness – due to central airway
narrowing, partial or total collapse of a
distal segment
Chest pain – deep chest discomfort, due
to peribronchial and perivascular nerve
involvement.
30. Non small cell lung carcinoma
Surgery – best result, but only a small
minority
Types of surgery
Pneumonectomy
Lobectomy
VATS – segmentectomy
5 year survival rate overall 35%
31. Radiotherapy
Stage I&II – inoperable due to medical
contraindications
Indications
Hemoptysis, pain, cough, dyspnoea due
to large bronchus obstruction,
mediastinal compression, symptoms due
to intracranial metastasis, symptoms due
to spinal cord compression.
36. Gynaecomastia – large cell and adeno
carcinoma
Eaton-Lambert syndrome,
polymyositis/dermatomyositis
Peripheral neuropathy
Cerebellar ataxia
37. Small cell carcinoma
Diagnosis – swelling of face and upper
torso and distension of veins across the
chest, upper arms and neck.
Treatment – chemotherapy,
radiotherapy and stenting
38. Pancoast
Pain in lower part of shoulder and
inner aspect of the arm (C8, T1 and T2)
Sympathetic ganglion involvement –
stellate
Diagnosis
Treatment - radiotherapy and surgery
40. Mediastinum lies centrally within the
chest and spans the region vertically
from the thoracic inlet to the
diaphragmatic hiatus, transversally
between the parietal pleura, and
coronally between the sternum and
vertebral column.
52. Adults
65% in Anterosuperior, 10% in the
middle and 25% in the posterior
compartments
Children
28% Anterosuperior, 10% in middle,
62% in the posterior compartment
53. • Noninvasive diagnostic procedures
• Computed tomography
• Magnetic resonance imaging
• Ultrasonography
• Radio nuclides
58. Less well established
Pancytopenia
Lambert-Eaton
Peripheral neuropathies
CNS changes
Multiple endocrine defects
Multiple rheumatologic disorders
Nephrotic syndrome
59. Thymoma is the most common primary
neoplasm of the mediastinum
15% of Thymic lesions
Equal frequency in male and female
40-60 years
75% in anterior mediastinum
More than 90% are visible on chest
radiograph
64. Constitute 70% of the lesions in children
and 60% in adults.
Contain multiple tissues that are foreign
to the part of the body in which they
develop.
Symptomatic only when infected
66. Bronchogenic cysts
Mediastinal cysts form 20% of
mediastinal tumours
60% of mediastinal cysts are
bronchogenic cyst
Oesophageal cysts
Neuroenteric cysts
Mesothelial cysts
Pericardial or pleuropericardial
cysts
Thoracic duct cyst
67. • Neurogenic tumours
• Most common malignancy in children
• In children 50% malignant, adults 10%
• Dumbbell tumours – intraspinal extension
• CT, MRI, myelography
Tumours of nerve sheath origin
› Benign – neurilemoma or neurofibroma
› Malignant tumours-incidence of
malignancy more in von
Recklinghausen’s disease
› Poor prognosis
Posterior mediastinal tumours
68. Tumours of autonomic nervous system
› Neuroblatoma, ganglioneuroblastoma
rare in adults