Lung CA -symptoms
- coughing that gets worse or does not go away
- chest pain
- SOB
- wheezing
- coughing up blood
- feeling very tired all the time
- weight loss with unknown cause
- metastasis symptoms related to metastasis area
Lung CA- dx
-chest X-ray CT scan for smaller tumors - MRI, PET scan that look for metastasis to spine biopsy of lung tissue -CBC
Lung CA types:
- Non small cell Lung CA=85-90%, changes in oncogenes and tumor suppressor genes
- Small cell lung CA = 10-15%- dense cells in ovoid shape that usually arise from bronchial mucosa
Lung CA- pathogenesis
Two genetic lesions for NSCLC ( non sm. cell lung ca.)
- mutation of epidermal growth factor -> overexpression
- mutation of KRAS genes-> rapid cell proliferation
Bronchial precursor cell => sm cancer cell => large cell tumor which becomes adenocarcinoma or squamous cell tumor
Lung CA- staging
TNM: T- size
N- nodules in same or contralateral node
M- local vs extrathecal
Numeric:
I: confined to lung and No metastasis
II: tumors w hilar or peribronchial node involvement
III: locally advanced, mediastinal or cervical lymph node metastases and w/no extansion to chest wall
IV: tumor w distant metastases, malignant pleural or pericardial effusion
Lung CA:- metastases
-30% of newly diagnosed w CA have metastases
- spreads via Seeds and Soil theory:BV, Lymphatics and Direct extension
Common sites of metastasis: adrenal gland, brain, bone: 50% of all cases= long bone, ribs, spine, and Liver
LUNGS are the MOST FREQUENT site of metastases from other CAncer
Lung CA- bone metastases
osteoclast-makes bone weaker
osteoblast- lays down extra bone to make sclerosis of the bone
-symptoms: pain, fracture, spinal cord compression, hypercalcemia
Separate treatment based on symptoms: surgery, radiation, bisphosphanates
Lung CA- treatment NSCLC
St. I +II: radiation and chemo if have any lymph node disease
St.III: surgery usually non succesful bc of metastases, and is in combination w chemo radiation 20%
St.IV:- metastasis to spinal cord-> radiotherapy to spine
The goal is to interrupt cell growth w drugs to target epidermal growth factor or KRAS genes is under investigation and development
Lung CA - prognosis
NSCLC is better than SCLC Det. by: - stage at time of presentation - cell type treatment option - status of pt. Factors w poor prognosis: - weight loss of 10%BW in past 6 months, generalized weakness, male, >70 yo, prior chemotherapy, elevated CBC levels
Lung cancer risk factors
1 Cigarette smoking= linked to about 90% of lung CA
2. Redon
3. second hand smoke
Other: asbestos, arsenic, diesel exhaust, silica and chromium
personal or family history, radiation to chest and diet