Lung Cancer

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Cancer : 

Cancer The uncontrolled, abnormal growth of cells Cancer may spread to other parts of the body

Definition : 

Definition Lung cancer is a solid tumor originating from bronchial epithelial cells. An estimated 219,440 people diagnosed in the United States in 2009 The leading cause of cancer death among men and women

Functions of the Lung : 

Functions of the Lung The lungs consist of five lobes, three in the right lung and two in the left lung Most cells in the lung are epithelial cells, which line the airways and produce mucus, which lubricates and protects the lungs The main function of the lungs is to allow oxygen from the air to enter the bloodstream for delivery to the rest of the body

Lung Cancer : 

Lung Cancer 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 and small cell

Risk Factors for Lung Cancer : 

Risk Factors for Lung Cancer Cigarette smoking is responsible for about 83% of lung cancer cases Exposure to Asbestos, chloromethyl ethers, heavy metals, polycyclic aromatic hydrocarbons Radon gas has also been implicated.

Pathophysiology : 

Pathophysiology Lung carcinomas arise from pluripotent epithelial cells after exposure to carcinogens, which cause chronic inflammation that leads to genetic and cytologic changes and ultimately to carcinoma. Activation of proto-oncogenes, inhibition or mutation of tumor suppressor genes, and production of autocrine growth factors contribute to cellular proliferation and malignant transformation.

Symptoms of Lung Cancer : 

Symptoms of Lung Cancer Fatigue (tiredness) dyspnea Cough Chest pain Loss of appetite Sputum production Hemoptysis (coughing up blood) If cancer has spread, symptoms include bone pain, difficulty breathing, abdominal or back pain, headache, weakness, and speech difficulties

Diagnosis : 

Diagnosis Because almost all patients will have a tumor in the lung, a chest x-ray or CT scan of the chest is performed The diagnosis must be confirmed with a biopsy The location(s) of all sites of cancer is determined by additional CT scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging) It is important to find out if cancer started in the lung or somewhere else in the body. Cancer arising in other parts of the body can spread to the lung as well

Lung Cancer Staging : 

Lung Cancer Staging Staging is a way of describing a cancer, such as the size of a tumor and if or where it has spread Staging is the most important tool doctors have to determine in patient’s prognosis The type of treatment a person receives depends on the stage of the cancer Staging is differentiate for non-small cell lung cancer and small cell lung cancer Recurrent cancer is cancer that comes back after treatment

Stage I Non-Small Cell Lung Cancer : 

Stage I Non-Small Cell Lung Cancer Cancer is found only in the lung Surgical removal recommended Radiation therapy and/or chemotherapy may also be used

Slide 13: 

The term "non-small cell lung cancer" applies to the various types of bronchogenic carcinomas (those arising from the lining of the bronchi) which include adenocarcinoma, squamous cell carcinoma, and large cell undifferentiated carcinoma

Stage II Non-Small Cell Lung Cancer : 

Stage II Non-Small Cell Lung Cancer The cancer has spread to lymph nodes in the lung Treatment is surgery to remove the tumor and nearby lymph nodes Chemotherapy recommended; radiation therapy sometimes given after chemotherapy

Stage III Non-Small Cell Lung Cancer : 

Stage III Non-Small Cell Lung Cancer The cancer has spread to the lymph nodes located in the center of the chest, outside the lung Stage IIIA cancer has spread to lymph nodes in the chest, on the same side where the cancer originated Stage IIIB cancer has spread to lymph nodes on the opposite side of the chest, under the collarbone, or the pleura (lining of the chest cavity) Surgery or radiation therapy with chemotherapy recommended for stage IIIA Chemotherapy and sometimes radiation therapy recommended for stage IIIB

Stage IV Non-Small Cell Lung Cancer : 

Stage IV Non-Small Cell Lung Cancer The cancer has spread to different lobes of the lung or to other organs, such as the brain, bones, and liver Stage IV non-small cell lung cancer is treated with chemotherapy

Small Cell Lung Cancer: All Stages : 

Small Cell Lung Cancer: All Stages Classified as Limited stage (confined to one area of the chest) or Extensive stage (not confined to one area of the chest) Patients with limited stage small cell lung cancer are best treated with simultaneous radiation therapy and chemotherapy Patients with extensive stage small cell lung cancer are treated with chemotherapy In patients whose tumors have shrunk after chemotherapy, preventive radiation therapy to the head cuts the risk that the cancer will spread to the brain and extends patients’ the lives.

How is Lung Cancer Treated? : 

How is Lung Cancer Treated? Treatment depends on the stage and type of lung cancer Surgery Radiation therapy Chemotherapy (options include a combination of drugs) Targeted therapy Lung cancer is usually treated with a combination of therapies

Cancer Treatment: Surgery : 

Cancer Treatment: Surgery The tumor and the nearby lymph nodes in the chest are typically removed to offer the best chance for cure For non-small cell lung cancer, a lobectomy (removal of the entire lobe where the tumor is located), has shown to be most effective Surgery may not be possible in some patients

Cancer Treatment: Adjuvant Therapy : 

Cancer Treatment: Adjuvant Therapy Treatment given after surgery to lower the risk of the cancer returning May include chemotherapy, radiation therapy, and targeted therapy

Cancer Treatment: Radiation Therapy : 

Cancer Treatment: Radiation Therapy The use of high-energy x-rays to destroy cancer cells Side effects include fatigue, malaise (feeling unwell), loss of appetite, and skin irritation at the treatment site Radiation pneumonitis is the irritation and inflammation of the lung; occurs in 15% of patients It is important that the radiation treatments avoid the healthy parts of the lung

Cancer Treatment: Chemotherapy : 

Cancer Treatment: Chemotherapy Use of drugs to kill cancer cells A combination of medications is often used May be prescribed before or after surgery, or before, during, or after radiation therapy Can improve survival and lessen lung cancer symptoms in all patients, even those with widespread lung cancer

Drugs used : 

Drugs used The most widely used and recommended regimens include cisplatin or carboplatin combined with etoposide was considered to be the most active regimen for advanced NSCLC. The most frequently used regimen is a platinum combined with etopside or , less frequently, irinotecan. For SCLC.

Common chemotherapy regimens for nsclc. : 

Common chemotherapy regimens for nsclc. PE : CISPLATIN : 60mg/m2 IV on DAY1 ETOPOSIDE: 120mg/m2 IV on days1-3. CAP : CYCLOPHOSPHAMIDE : 400mg/m2 IV on day1 DOXORUBICIN(ADRIAMYCIN) :40mg/m2IV day1 CISPLATIN: 40mg/m2 IV on day1. Repeat cycle every 4 weeks. CARBO/ VP-16 CARBOPLATIN : 300mg/m2 IV on day1. ETOPOSIDE: 100mg/m2 IV on days 1-3 repeat cycle every 3-4 weeks.

Chemotherapy regimens for sclc : 

Chemotherapy regimens for sclc Cisplatin based: EP ETOPOSIDE : 100mg/m2 IV on days 1-3. CISPLATIN : 25mg/m2 IV on days 1-3 repeat cycle every 3-4 weeks. CARBOPLATIN BASED: CARBOPLATIN: 100mg/m2 IV on days 1-3 ETOPOSIDE:120mg/m2 IV on days 1-3. Repeat cycle every 3-4 weeks. ADRIAMYCIN BASED: CAV CYCLOPHOSPHAMIDE: 1000mg/m2 IV on day1 DOXORUBICIN: 45-50 mg/m2 IV on day1 VINCRISTINE: 1.4mg/m2 IV on day1.

Cancer Treatment: Targeted Therapy : 

Cancer Treatment: Targeted Therapy Treats lung cancer by stopping the action of abnormal proteins that cause cells to grow and divide out of control Bevacizumab prevents the formation of new blood vessels, which help feed the growth and spread of a tumor; given with chemotherapy Erlotinib approved for locally advanced and metastatic non-small cell lung cancer Cetuximab may be given with chemotherapy in situations where bevacizumab may be unsafe

Coping with Side Effects : 

Coping with Side Effects Side effects are treatable; Fatigue is a common, treatable side effect Pain is treatable; non-narcotic pain-relievers are available Antiemetic drugs can reduce or prevent nausea and vomiting Medications and extra oxygen can improve breathing Radiation therapy or surgery can be used to treat metastases that are causing pain or other symptoms

After Treatment : 

After Treatment Patients with lung cancer face the risk of cancer growing back or the development of a new lung cancer. All patients must follow up with their doctors for regular x-rays, scans, and check-ups Many survivors are at high risk for heart disease, stroke, emphysema, and chronic bronchitis; some cancer treatments increase this risk Walking for 15 to 30 minutes each day can improve lung and heart functioning

Slide 29: 

Quitting smoking helps recovery and health. Patients who have developed lung cancer who then stop live longer. It is never too late to stop smoking.

Thank you……… : 

Thank you………

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