LUNG CANCER
(Bronchogenic Carcinoma)
BIO 218 Human Anatomy
Summary: What is Lung Cancer?
• Lung Cancer is the growth of abnormal tissue characterized by the progressive,
uncontrolled multiplication of cells. This abnormal growth of new cells does not
develop into healthy lung tissue but rather manifest into a tumor or also called a
neoplasm.
• As tumors become larger and more numerous, they inhibit the lung’s ability to
provide the blood stream with oxygen.
• Lung Cancer arises from the epithelium of the tracheobronchial tree.
• As a tumor enlarges, the surrounding bronchial airways and alveoli become
irritated, inflamed, and swollen. The adjacent alveoli may fill with fluid or
become consolidated and collapse.
• As the tumor protrudes into the tracheobronchial tree, excessive mucous
production and airway obstruction develop.
Summary: (cont.)
• Major Pathological changes in lung cancer:
Inflammation, swelling, and destruction of the bronchial airways and alveoli
Excessive mucous production
Tracheobronchial mucous accumulation and plugging
Airway obstruction (either from blood, from mucous accumulation, or from a
tumor projecting into a bronchus)
Atelectasis (collapse of part or all of the lung)
Alveolar consolidation (liquid-filled alveolar space)
Cavity formation
Pleural effusion (buildup of fluid between the layers of tissue
that line the lungs and chest cavity)
Summary: (cont.)
• Benign Tumors
2 Different types of tumors
• Malignant Tumors
• Remain in one place and do not
appear to spread.
• Do not endanger life unless they
interfere with the normal
functions of other organs or
affect a vital organ.
• They grow slowly and push aside
normal tissue but do not invade
it.
• Not invasive or metastatic.
• Composed of embryonic, primitive, or
poorly differentiated cells.
• They grow in a disorganized manner and
so rapidly that the nutrition of the cells
becomes a problem.
• Invade surrounding tissues and may be
metastatic (cancer spreading beyond its
site of origin to other parts of the body).
• Malignant changes may develop in any
portion of the lung, they most commonly
originate in the mucosa of the
tracheobronchial tree.
Types of Lung Cancer: How is Lung Cancer
Classified?
Lung Cancer can be classified into 2 main types, based on the histological
appearance of the cancer under a microscope.
• Non-small cell
• Small cell lung
lung carcinoma
carcinoma
(NSCLC) 80% of all
(SCLC) 20% of
lung cancer in the
all lung cancer
U.S.
in the U.S.
 Squamous cell
carcinoma 30%
 Adenocarcinoma
35%-40%
 Large cell
carcinoma
(Undifferentiated)
10%-15%
 Small cell (or
oat cell
carcinoma)
14%
Adenocarcinoma
(high magnification)
Oat cell carcinoma
Etiology & Epidemiology: What are the
causes and risks of Lung Cancer?
 Lung cancer is the leading cause of cancer deaths in the U.S.
 According to the American cancer Society 2008 surveillance report, it is estimated that more than 214,000 new cases of
lung cancer are reported in the U.S. annually.
 114,000 in males
 100,000 in females
• Cigarette smoking is the most common cause of lung cancer.
• It is estimated that cigarette smoke contains more than 4,000 different chemicals, many of which have proved to be carcinogens
(class of substances that are directly responsible for damaging DNA, promoting or aiding cancer).
• A genetic predisposition toward developing lung cancer also plays a role in the incidence of lung cancer.
• Environmental or occupational risk factors for lung cancer include the following:
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•
•
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Benzopyrene and radon particles associated w/ uranium
Radiation and nuclear fallout
Polycyclic aromatic hydrocarbons and arsenicals
•
Asbestos fibers
•
Diesel exhaust
•
Nitrogen mustard gases
•
Nickel
Silica
mining
Vinyl chloride
Chloromethyl methyl ether
Air pollution
Coal and iron mining
Symptoms of Lung Cancer
•
•
•
•
•
•
•
•
•
•
•
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Persistent or intense coughing
Pain in the chest, shoulder, or back from coughing
Hoarseness of the voice
Harsh sounds while breathing (stridor)
Difficulty breathing and swallowing
Chronic bronchitis or pneumonia
Sputum production (mucus coughed up from the lower airways)
Changes in color of the sputum
Coughing up blood or blood in the sputum (hemoptysis)
Increased respiratory rate (tachypnea)
Increased heart rate and blood pressure (tachycardia)
Cyanosis (blue or purple coloration of the skin)
Screening and Diagnosis
•
•
•
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Chest X-ray (most common screening test)
Computed tomography (CT) scan
Positron emission tomography (PET) scan
A definitive diagnosis, however, can be made only by viewing a tissue sample
(biopsy) under a microscope. Procedures to obtain a tissue biopsy include:
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•
•
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Bronchoscopy
Thoracoscopy
Mediastinoscopy
Transbronchial needle (open lung) biopsy
• Sputum cytology
• Thoracentesis
• Videothoracoscopy
Staging of Lung Cancer
• Non-Small Cell Lung Carcinoma
• Stage 0: The cancer is limited to the lining of the bronchial airways. There is no involvement of the lung
tissue or distant metastasis. Cancer is usually found during bronchoscopy. When found and treated early,
cancers at this stage can often be cured.
• Stage I: The tumor is less than 3 cm and is located in lobar or distal airways. There is no lung tissue
involvement or distant metastasis.
• Stage II: Cancer has invaded neighboring lymph nodes or spread to the chest wall. There is no distant
metastasis.
• Stage IIIA: The tumor is any size. The tumor is in the main bronchus, or the tumor is accompanied by
atelectasis or obstructive pneumonitis (inflammation of lung tissue) of the entire lung. Local invasion involves
chest wall, diaphragm, mediastinum, pleural, or parietal pericardium.
• Stage IIIB: The cancer has spread locally to areas such as the mediastinum, heart, great vessels, trachea,
esophagus, vertebral body.
• Stage IV: The cancer is of any size, involves any of the lymph node groups, and has spread to other parts of
the body, such as the liver, bones, or brain.
• Small Cell Lung Carcinoma (harder to detect early)
• Limited: The cancer is confined to only one lung and to its neighboring lymph nodes.
• Extensive: The cancer has spread beyond one lung and nearby lymph nodes. It may have invaded both lungs,
more remote lymph nodes, or other organs.
Radiologic Findings
• Small oval or coin
lesion
• Large irregular mass
• Alveolar consolidation
Normal Chest X-ray
Chest x-ray of normal
appearance taken from
the back of an adult
male
Diagnostic Imaging
•
•
•
Atelectasis
Pleural effusion
Involvement of the
mediastinum or
diaphragm
Non-Small Cell Lung
Carcinoma
Non-Small Cell Lung
Carcinoma
Non-Small Cell Lung
Carcinoma
Large central lesion
diagnosed as non-small
cell carcinoma
A right lower lobe
squamous cell
carcinoma
Right upper lobe lesion
diagnosed as
adenocarcinoma
Diagnostic Imaging (cont.)
Small Cell Lung
Carcinoma
At the time of diagnosis
Small Cell Lung
Carcinoma
5 weeks later
Small Cell Lung
Carcinoma
2 months later
General Management of Lung Cancer
• Surgery
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
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Wedge resection: partial removal of a lung lobe
Segmentectomy: removal of a lung segment or segments of the lung
Lobectomy: removal of 1 lung lobe
Bilobectomy: removal of 2 lung lobes
Pneumonectomy: removal of whole right or left lung
• Respiratory Care Treatment Protocols
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Oxygen therapy protocol
Bronchopulmonary hygiene therapy protocol
Lung expansion therapy protocol
Aerosolized medication protocol
• Chemotherapy
• Radiation Therapy
• Comfort (Supportive) Care
Prognosis
5 Year Survival Rate
Stage
5-year
Survival
Rate
0
49%
I
45%
II
30%-31%
IIIA
14%
IIIB
5%
IV
1%
• The 5-year survival rate refers to the percentage of
patients who live at least 5 years after their cancer is
diagnosed.
• The numbers to the left are survival rates calculated from
the National Cancer Institute’s Surveillance,
Epidemiology, and End Results database, based on people
who were diagnosed with non-small cell lung carcinoma
between 1998 and 2000.
• The overall 5-year survival rate for stage 4 non-small cell
lung cancer is sadly less than 5%.
• The overall 5-year survival rate for extensive stage small
cell lung cancer is 6%. Average survival is 6 to 12 months
with treatment, but only 2 to 4 months without
treatment.
Conclusion
• Lung cancer is by far the leading cancer killer in both men and women in the United States.
• In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women.
• This cancer causes more deaths than the next three most common cancers combined (colon,
breast, and prostate).
• One important key to beating this disease is prevention in ways of avoiding or discontinuing
cigarette smoking and passive or second-hand smoking.
• Smoking, a main cause of small cell and non-small cell lung cancer, contributes to 80% and
90% of lung cancer deaths in women and men, respectively. Men who smoke are 23 times
more likely to develop lung cancer. Women are 13 times more likely, compared to nonsmokers.
• That said, there are reports of people who have survived and done well for many years who
had an early diagnosis and detection of lung cancer and received the necessary treatment
that best suits their particular circumstance.
Literature:
References
Jardins, Terry R., and George G. Burton. Clinical manifestations and assessment of
respiratory disease. 6th ed. Maryland Heights, Mo.: Mosby/Elsevier, 2011. Print.
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opsy.jpg
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