Lung Cancer
By,
Nazneen Chougle
Neha Bhatkal
Nilekha Kalyankar
Nirali Bavaria
Namrata Gaokar
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Contents
Introduction
Signs and Symptoms
Pathophysiology
Statistics
Diagnosis
Treatment
Recent Clinical Trials
Palliative Care and Case Study
Ethical Considerations
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Tumors
o Benign tumors
 They are not cancer.
 Do not spread to other
parts of the body and are
not a threat to life.
o Malignant tumors
 They are cancer.
 Can invade and damage
tissues and organs near
the tumor
 The spread of cancer is
Called metastasis
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Lung Cancer: Defined
Uncontrolled growth of malignant cells in one or both
lungs and tracheo-bronchial tree.
 A result of repeated carcinogenic irritation causing
increased rates of cell replication.
Proliferation of abnormal cells leads to hyperplasia,
dysplasia or carcinoma in situ.
90%-95% of cancers of the lung arise from the epithelial
.4
cells, the cells lining the larger and smaller airways
Two Types Of Lung Cancer Cells
 Non Small Cell Lung Cancer (NSCLC)
― Most common type
― Grows and spreads more slowly
than small cell lung cancer
― Three main types
•
•
•
Adenocarcinoma
Squamous Cell Carcinoma
(epidermoid carcinoma)
Large Cell Carcinoma
 Small Cell Lung Cancer (SCLC)
― Called oat cell cancer
― Less common
― Grows more quickly
― Spread to other organs in the body
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Where D oes it Come From?
Smoking
Passive smoking
Radon gas
Familial predisposition
Lung diseases
Prior history of lung cancer
Air pollution
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Signs and symptoms
 No symptoms in up to 25% of people
 Symptoms related to the cancer
– cough
– dyspnea
– hemoptysis
– recurrent infections
– chest pain
 Symptoms related to metastasis
 Paraneoplastic symptoms.
 Nonspecific symptoms.
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Deaths Due to Lung Cancer
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DIAGNOSIS
 H ISTOR Y AN D PH YSICAL E XAMINATION
 Cyanosis
 Chest x- ray
 CT (computerized tomography, computerized
axial tomography, or CAT) scans
 L OW- DOSE
HELICAL CT SCAN (or spiral CT scan)
 MAGNETIC RESONANCE IMAGING(MRI).
 P OSITRON EMISSION TOMOGRAPHY (PET)
 BLOOD TESTS
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DIAGNOSIS
 BONE SCANS: These are used to create images of
bones on a computer screen or on film. Doctors may
order a bone scan to determine whether a lung cancer
has metastasized to the bones.
 SPUTUM CYTOLOGY : If a tumor is centrally located
and has invaded the airways, this procedure, known as
a sputum cytology examination, may allow visualization
of tumor cells for diagnosis
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DIAGNOSIS
 BRONCHOSCOPY: Examination of the airways by bronchoscopy
(visualizing the airways through a thin, fiberoptic probe inserted through
the nose or mouth) may reveal areas of tumor that can be sampled
(biopsied) for diagnosis by a pathologist.
 NEEDLE BIOPSY: Fine needle aspiration (FNA) through the skin,
most commonly performed with radiological imaging for guidance, may
be useful in retrieving cells for diagnosis from tumor nodules in the
lungs.
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DIAGNOSIS
DIAGNOSIS
 T HORACENTESIS: Aspiration of a sample of this fluid with a thin
needle (thoracentesis) may reveal the cancer cells and establish the
diagnosis.
 MAJOR SURGICAL PROCEDURES

Mediastinoscopy

Thoracotomy
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Recent Advances
Biomarkers
Fluorescent in-situ hybridization techniques
(FISH)
Super Dimension(R)/Bronchus System (SDBS)
Computer-aided detection (CAD)
Breath tests
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Contd….
Auto fluorescence bronchoscopy (AFB)
Endobronchial ultrasound (EBUS)
Coherence tomography (OCT)
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CHEMOTHERAPY
 Used for both NSCLC and SCLC
 Used in combination with radiation therapy and
surgical therapy.
 Platinum based drugs most effective- Cisplatin
 May be given as pills, as an intravenous infusion, or
as a combination of the two.
 Second-line chemotherapy is used to treat recurrent
cancers that have previously been treated with
chemotherapy.
 Side effects- Nausea, Vomiting, weight loss, hair
loss, mouth sores, etc
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RADIATION THERAPY
 Curative therapy, palliative therapy or as
adjuvant therapy in combination with surgery
or chemotherapy.
 Used for both NSCLC and SCLC
 Uses high energy X-rays to kill dividing cells.
 Brachytherapy
 Shrinks a tumor or limits its growth when
given as a sole therapy
 Simulation is necessary prior to treatment.
 Side effects- fatigue, lack of energy, reduced
WBC count and blood platelet levels,
irritation of skin, nausea , Vomiting,
diarrhoea.
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SURGERY
 Generally performed for limited-stage (stage I or
sometimes stage II) NSCLC.
 Surgery may not be possible if the cancer is too
close to the trachea.
 Depends upon the size and location of the tumor.
 Could require lobectomy (removal of one lobe)
pneumonectomy (removal of an entire lung) or
lymphadenectomy (removal of lymph nodes).
 If a recurrent cancer is confined to one site in the
lung.
 Side effects-difficulty breathing, shortness of
breath, pain, and weakness.
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PHARMACOTHERAPY
 Erlotinib (Tarceva), is used in patients with NSCLC who are no longer
responding to chemotherapy. Also called as “The Targeted Drug”
because it targets a protein called the Epidermal Growth Factor Receptor
(EGFR) that is important in promoting the division of cells.
 Iressa (Gefitinib)
 Antiangiogenesis drugs- Bevacizumab (Avastin)
 Vadimezan – Disrupts Blood Vessels within tumors.
 Bisphosphonates.
 ARQ 197
Tragedy
 Exubera –inhaled Insulin ,manufactured by Pfizer had promised of letting
diabetics avoid needle sticks but actually increased the cases of lung
cancer in diabetic patients.
 Drug has been withdrawn.
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OTHER IMPORTANT DRUGS
NON SMALL CELLED LUNG CANCER
SMALL CELLED LUNG CANCER
Alimta
Erlotinib
Docetaxel
Etoposide
Gemzar
Hyacamtin
Navelbine
Tarceva
Onxol
Topotecan
Paclitaxel
VePesid
Photofrin
Taxol
Taxotere
Vinorelbine
Gemcitabine
Pemetrexed
Porfimer
Gefitinib
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Other Newer Therapies
 PHOTODYNAMIC THERAPY (PDT)
 RA DIO FREQUENCY ABLATI O N

o
CHINESE MEDICINES

CRYOSURGERY
Ligustrum lucidim Ait. (Tree Pivet), Astragalus membranaceous
Suppress tumor angiogenesis, promote dormancy of cancerous cells,
induce re-differentiation of cancer cell, directly kill cancerous cells，
and it is effective against recurrence and metastases of cancer.
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IMMUNOTHERAPIES







MONOCLONAL ANTIBODIES
“ Humanized” antibodies- Trastuzumab
ANTIGEN SPECIFIC VACCINES
Incorporating cytokines into anti-tumor vaccines
Biomarkers
Radioactive agents
By cutting off a key gene,14-3-3zeta, lung cancer tumour cells
are left 'homeless‘ and they can't survive on their own.
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Clinical trials for lung cancer
o A Study to Diagnose Lung Cancer by Sputum Cytology.
o FR901228 in Treating Patients With Refractory or Progressive
Small Cell Lung Cancer or Non-Small Cell Lung Cancer.
o INS316 in Diagnosing Lung Cancer in Patients With Untreated
Lung Cancer
o Prevention of Tumour Spread Due to Lung Cancer Surgery.
o Vaccine Therapy in Treating Patients With Colon, Pancreatic, or
Lung Cancer.
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Clinical trials for lung cancerongoing
oBiomarkers for Early Detection of Lung Cancer in Patients With
Lung Cancer, Participants at High-Risk for Developing Lung
Cancer, or Healthy Volunteers
oA Clinical Trial to Validate Molecular Targets of Vorinostat in
Patients With Stage I-III Non-Small Cell Lung Cancer
oDNA Analysis in Predicting Lung Cancer Risk
oPhase II Study of Dichloroacetate (DCA) in Patients With
Previously Treated Metastatic Breast or NSCL Cancer
oSputum Cytology in Screening Heavy Smokers For Lung
Cancer
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Recent research
oTumor Growth Pattern May Predict Survival in Non-Small Cell
Lung Cancer
oNewer techniques to combact with non-small cell lung cancer
and small cell lung cancer.
oHormone with anti cancer effects.
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Quality of life
 Means how lung cancer survivors feel about different
aspects of life, including physical health, emotional
health, and ability to carry out daily activities. opinions about
their quality of life, as well as the factors that affect their
quality of life.
 Helps to develop new services for lung cancer survivors.
 Behavioral Questionnaires or Telephonic Interviews are
conducted.
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Palliative Care in Lung Cancer
Symptom
Palliative Recommendations
1) Pain
Mild : Acetaminophen or NSAIDs
Severe : Opioids
2) Dyspnea
Oxygen, Bronchodilators, Corticosteroids,
Antibiotics, Opioids
3) Cough
Non opioid cough suppressants,
Bronchodilators, Corticosteroids, Opioids
4) Bone Metastases
External Radiation Therapy + Systemic
Corticosteroids (Prednisone 20 to 40 mg)
5) Brain Metastases
Dexamethasone (20mg) for 4 weeks
6) Spinal cord
Compression
High Dose Steroids + Radiation Therapy
Adjunct Therapy : Dexamethasone (60mg)
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Palliative Care Centers
1) Fox Phase Cancer Centre, Philadelphia, USA
2) Barbara Ann Karmanos Cancer Hospice, Southfield, USA
3) John Taylor Hospice, Birmingham, England
4) The Prince of Wales Hospice, Yorkshire, England
5) St. Luke’s Hospice, Plymouth, England
6) Primrose Hospice, Worcestershire, England
7) St. Francis Hospice, Ireland
8) Royal Perth Hospital, Australia
9) Shanti Avedna Ashram
10) Chittaranjan National Cancer Institute
11) Christian Medical Association of India
12) Cipla Foundation's Cancer Palliative Care Centre
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Ethical Considerations
 Should terminally ill cancer patients be allowed to
try new therapies with no clinical trials?
 Should they worry about the side effects?
 Personal Autonomy v/s Justice.
 Imposing the truth on an unprepared patient.
 Cultural Sensitivity and Cultural Competence.
 Special aspects of truth telling in pediatric and geriatric
oncology.
 Euthanasia and Physician-assisted Suicide
Lung Cancer Awareness
 November is Lung Cancer Awareness Month.
 The colour of lung cancer
awareness is Pearl White.
 ‘Can Support’ organized
walkathon called “Walk for Life”
on 7th Feb 2010 in New Delhi to
create awareness about
Lung Cancer.
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Case Study
 In March 2004, 46 yr old non-smoker, Caucasian female, presented
with flu-like symptoms, persistent cough and constant fatigue.
 Biopsy and CT scan revealed NSCL cancer in the right lung.
 Surgery was scheduled a month later to remove the nodular mass
and the entire right middle lobe of the right lung.
 In May 2005, additional nodules appeared in the mediastinal area
and a biopsy and mediastinoscopy revealed mucin- producing
adenocarcinoma in stage II B.
 PET scan done in May 2006 revealed liver and right pleural space
metastasis.
 The patient received chemoradiation therapy consisting of weekly
Carboplatin (Platinol) plus Paclitaxol (Taxol), concurrent with
radiation therapy.
 Experimental Phase I/II clinical trial with oral Tarceva (Erlotinib) and
oral Vorino stat. Brachytherapy to the trachea.
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Some Interesting Facts
 Most common form of cancer worldwide.
 1.2 million new cases of lung cancer worldwide every
year.
 Responsible for 17.8% of all cancer deaths annually.
 Kills about 9,00,000 men and
3,30,000 women annually
 In Men smoking causes more than
80% of lung cancer cases.
 In Women it causes 45% of all
lung cancer cases.
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Summary
 Lung cancer is the leading cancer-related cause of death.
 It has become the subject of a great
amount of research.
 The best way to prevent it is to
quit (or never start) smoking.
 Treatment depends on the cancer's
specific cell type, how far it has spread
and patient's performance status.
 It also depends on the stage, or how
advanced it is.
 Treatment includes chemotherapy,
radiation and surgery.
 In recent years, various molecular
targeted therapies have been developed
as treatments.
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REFERENCES




www.cancer.gov/cancertopics/types/lung
www.daviddarling.info/encyclopedia/L/lung_cancer_treatment.html
www.merck.com/mmhe/sec04/ch057/ch057a.html
www.clinicaltrials.gov
 Medscape,clin lung cancer 2009-10,
By, Everrete and E.Vokes
 PNAS journal Volume 100, July 8th, number 14
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T HANK YOU
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