1 / 15

Lung Cancer

Lung Cancer. Lung Cancer. The most common cancer worldwide, and the deadliest 1.37 million deaths worldwide (WHO 2008) 203,000 people diagnosed in the US each year, 158,000 deaths (CDC 2007). Risk Factors. Cigarette smoking Smokers are 10-20 times more likely to get lung cancer

ajaxe
Download Presentation

Lung Cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lung Cancer

  2. Lung Cancer The most common cancer worldwide, and the deadliest 1.37 million deaths worldwide (WHO 2008) 203,000 people diagnosed in the US each year, 158,000 deaths (CDC 2007)

  3. Risk Factors Cigarette smoking Smokers are 10-20 times more likely to get lung cancer 85-90% of deaths from lung cancer are smoking related Risk is dose dependent: the more a person smokes, the higher the risk Quitting decreases a person's risk

  4. Risk Factors Radon accounts for 21,000 lung cancer deaths (EPA 2003) Industrial exposures: Asbestos, coal tar fumes, nickel, chromium, arsenic, etc Family history High cholesterol diet? Alcohol? Beta carotene (Vitamin A) supplements in heavy smokers

  5. Prevention QUIT SMOKING (or failing that, cut down) Decrease exposure to second hand smoke Decrease exposure to radon, asbestos and other industrial carcinogens Healthy diet Physical activity

  6. National Lung Cancer Screening Trial 53,454 participants: 55-74 y/o > 30 pack year hx of cigarette smoking Quit smoking < 15 yrs prior if a former smoker No hx lung ca or other life-threatening cancers No sx's of hemoptysis or wt loss No chest CT prior 18 mo

  7. NLST Participants randomized to low dose chest CT vs PA chest x-ray annually for 3 years LDCT arm showed a 20% reduction in lung cancer deaths compared to the CXR arm (p=0.004) NEJM 2011 Aug 4;365(5):395-409

  8. Screening and Diagnosis Chest x-rays have not been shown to be a good screening tool for lung cancers NCCN guidelines for LDCT screening: 55-74 y/o and > 30 pack years of smoking and Smoking cessation < 15 yrs Or > 50 y/o and > 20 pack year hx of smoking and one additional risk factor (not second hand smoke)

  9. Symptoms About 25% of people with lung cancer have no symptoms Central tumors: obstructive sx's, cough, dyspnea, atelectasis, postobstructive pneumonia, wheezing, hemoptysis Peripheral tumors: pleural effusion, pain if invading pleura or chest wall

  10. Symptoms Pancoast tumor: tumor in the superior sulcus Shoulder pain Low brachial plexopathy Horner's syndrome (ptosis, miosis, anhidrosis)

  11. Diagnosis

  12. NCCN Guidelines Nodule < 8 mm: radiologic surveillance Nodule > 8 mm, solid, non-calcified: consider PET, bx or excise if suspicious <10 mm non-solid or part-solid nodule: radiologic surveillance >10 mm non-solid or part-solid nodule: LDCT in 3-6 mo

  13. Beyond IHC Molecular analysis of certain mutations has become increasingly important for determining therapy EGFR mutations are a target for TKI's KRAS mutations indicate a resistance to TKI's ALK mutations provide a target for ALK inhibitors (crizotinib)

  14. Further Work Up PET scan, MRI of the brain Bronchoscopy Mediastinoscopy/US PFT's Lab tests: CBC, electrolytes

More Related