Lung Tumors

1. Lung Tumors

2. malignant lung tumors • Lung cancer is the leading cause of cancer deaths in both women and men • about 2% of those diagnosed with lung cancer that has spread to other areas of the body are alive five years after the diagnosis • Most lung tumors are malignant • Primary or metastatic

3. Picture of the Lungs

4. Lung Cancer in the US • According to 2004 statistics, there were 173,770 new cases and 160,440 deaths yearly • More deaths from lung cancer than prostate, breast and colorectal cancers combined • Decreasing incidence and deaths in men; continued increase in women

5. malignant lung tumors two main types: • small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) non-small cell lung cancer(NSCLC): • Adenocarcinoma • Squamous cell carcinoma • Large cell cancer

6. malignant lung tumors • Adenocarcinoma (an NSCLC) is the most common type of lung cancer, making up 30%-40% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonia-like appearance on chest x-rays. • Squamous cell carcinoma (an NSCLC) is the second most common type of lung cancer, making up about 30% of all lung cancers. • Large cell cancer (another NSCLC) makes up 10% of all cases. • SCLC makes up 20% of all cases.

7. malignant lung tumors Lung Cancer Causes • Cigarette smoking • Passive smoking • Radiation Exposure • Air pollution from motor vehicles • Asbestos • Lung diseases, such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD),

8. Smoking Facts • Tobacco use is the leading cause of lung cancer • 87% of lung cancers are related to smoking • Risk related to: • age of smoking onset • amount smoked • gender • product smoked • depth of inhalation

9. Symptoms • cough • dyspnea • hemoptysis • recurrent infections • chest pain

10. Syndromes/Symptoms secondary to regional metastases: • Esophageal compression dysphagia • Laryngeal nerve paralysis  hoarseness • Symptomatic nerve paralysis  Horner’s syndrome • Lymphatic obstruction  pleural effusion • Vascular obstruction  SVC syndrome • Pericardial/cardiac extension  effusion, tamponade

11. Diagnosis • History and Physical exam • Diagnostic tests • Chest x-ray • Biopsy (bronchoscopy, needle biopsy, surgery) • Staging tests • CT chest/abdomen • Bone scan • Bone marrow aspiration

12. Where does it travel? • Lymph Nodes, Brain, Liver, Adrenal, Gland, Bones • 40% of metastasis occurs in the Adrenal Gland

13. malignant lung tumors Lung Cancer Treatment depend on: • SCLC or NSCLC • tumor stage • general physical condition

14. malignant lung tumors • Surgery • Chemotherapy and radiation therapy: • cure in a small number of patients • relieving symptoms • Inoperable NSCL

15. malignant lung tumors • Surgery • preferred treatment for patients with early stage NSCLC • 60%-80% of all patients who have advanced or metastatic disease are not suitable for surgery • The extent of removal depends on the size of the tumor, its location, and how far it has spread. • Surgery is not widely used in SCLC. Because SCLC spreads widely and rapidly through the body, removing it all by surgery usually is impossible.

16. Treatment and StagingNSCLC

17. Benign lung tumors • bronchial adenomas • hamartomas • group of uncommon neoplasms (eg, chondromas, fibromas, lipomas, leiomyomas, hemangiomas, teratomas, pseudolymphomas, endometriosis).

18. Benign lung tumors • 2-5% of all primary lung tumors • Hamartomasare the most common type • Hamartomas can be easily enucleated, but wedge resection is also appropriate

19. Benign lung tumors Complications: • Pneumonia • atelectasis • hemoptysis • malignancy

20. Benign lung tumors • purpose of surgical intervention for benign lung tumors is to avoid missing potentially malignant lesions • remove benign lung tumors when they are symptomatic, which indicates the presence of complications such as pneumonia, atelectasis, and/or hemoptysis. • minimally invasive technique or bronchoscopic resection

21. Benign lung tumors Workup: • Chest radiograph • computed tomography (CT) scan • Fiberopticbronchoscopy: • Percutaneous biopsy/guided transthoracic needle aspiration biopsy • Video-assisted thoracoscopy • Open biopsy

22. malignant lung tumors

23. Benign lung tumors Treatment: • solitary nodule in a young nonsmoking patient can be monitored with serial radiographs as long as the solitary nodule does not double in size in less than a year and it does not significantly increase in the pattern of calcification and shape consistent with a malignancy.

24. extent of surgery : • simple endoscopic resection, • thoracotomy with bronchotomy/local excision, • segmental resection, • lobectomy, • pneumonectomy

25. Diaphragm • major muscle of respiration and the second most important muscle after the heart

26. Diaphragm

27. Diaphragm • Spontaneous breathing relies primarily on diaphragmatic excursion to produce negative intrathoracic pressure.  

28. Diaphragmatic diseases • Diaphragmatic hernia • Eventration • Tumors • paralysis

29. Diaphragmatic hernia divided into 2 categories: • congenital defects • acquired defects:Blunt trauma accounts for 75% of ruptures, and penetrating trauma accounts for the rest.

30. Diaphragmatic RUPTURE • Left-sided rupture is more common

31. Clinical findings include : • (1) marked respiratory distress, • (2) decreased breath sounds on the affected side, • (3) palpation of abdominal contents upon insertion of a chest tube, • (4) auscultation of bowel sounds in the chest, • (5) paradoxical movement of the abdomen with breathing, and/or • (6) diffuse abdominal pain.

32. DX • Chest radiography :Abdominal contents in the thorax • Nasogastric tube seen in the thorax • Elevated hemidiaphragm (>4 cm higher on left vs right)

35. TREATMENT • surgical intervention whether the patient presents • high incidence of concomitant intra-abdominal injuries dictates the need for emergency abdominal exploration in

36. Congenital diaphragmatic hernia (CDH • absence of the diaphragm, or a hole in the diaphragm. • most common on the left.

37. There are two types of diaphragmatic hernia: • Bochdalek hernia: This type involves an opening on the back side of the diaphragm. The stomach, intestines and liver or spleen usually move up into the chest cavity. • Morgagni hernia: This type is rare and involves an opening in the front of the diaphragm, just behind the breast bone. The liver or intestines may move up into the chest cavity.

38. Presentation • difficulty breathing • fast breathing • fast heart rate • cyanosis (blue color of the skin) • abnormal chest development, with one side being larger than the other • abdomen that appears caved in (concave).

39. Tx:surgery

40. Eventration of the diaphragm • all or part of the diaphragmatic muscle is replaced by fibroelastic tissue • diaphragm retains its continuity and attachments to the costal margin • congenital or acquired • partial or diffuse

42. Diaphragmatic tumors • The diaphragm is commonly involved with malignant pleural disease or malignant peritoneal disease. • Only rarely, however, is the diaphragm the source of either benign or malignant processes.

43. Diaphragmatic tumors • Primary tumors of the diaphragm are very rare • Benign tumors are most common:lipomas and cystic masses • Most malignant tumors are sarcomas

44. Tumors of the diaphragm are not associated with any characteristic symptom. • 50% of patients were asymptomatic and were found incidentally. • If any symptom is characteristic, it is that lower chest discomfort, heaviness and referred pain to the top of the shoulder.