Lung Cancer. By, Nazneen Chougle Neha Bhatkal Nilekha Kalyankar Nirali Bavaria Namrata Gaokar. Contents. Introduction Signs and Symptoms Pathophysiology Statistics Diagnosis Treatment Recent Clinical Trials Palliative Care and Case Study Ethical Considerations. Tumors. - PowerPoint PPT Presentation
Text of Lung Cancer
By, Nazneen Chougle
IntroductionSigns and SymptomsPathophysiologyStatisticsDiagnosisTreatmentRecent Clinical TrialsPalliative Care and Case StudyEthical Considerations
Tumorso 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
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 cells, the cells lining the larger and smaller airways .4
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
Where D oes it Come From?
SmokingPassive smokingRadon gasFamilial predispositionLung diseasesPrior history of lung cancerAir pollution
Signs and symptoms
No symptoms in up to 25% of peopleSymptoms related to the cancer
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.
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.
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.
Antiangiogenesis drugs- Bevacizumab (Avastin)
Vadimezan – Disrupts Blood Vessels within tumors.
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.
OTHER IMPORTANT DRUGSNON SMALL CELLED LUNG CANCER SMALL CELLED LUNG CANCER
Other Newer Therapies PHOTODYNAMIC THERAPY (PDT)
RA DIO FREQUENCY ABLATI O N
CHINESE MEDICINESo 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.
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.
Clinical trials for lung cancer
oA 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.
Clinical trials for lung cancer- ongoing
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
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.
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
Palliative Care in Lung CancerSymptom Palliative Recommendations
1) Pain Mild : Acetaminophen or NSAIDsSevere : 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 TherapyAdjunct Therapy : Dexamethasone (60mg)
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
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
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.
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.
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