Lung and Liver Cancer

Gayathri.M,BTB-11-009

Cancer

New cells form when the body doesn't need them and old or damaged cells don't die as they should.

The buildup of extra cells often forms a

mass of tissue called a growth, nodule, or tumor.

The growth can be benign or malignant.

Benign tumour Malignant tumour

rarely a threat to life may be a threat to life

can be removed and usually don't grow back

sometimes can be removed but can grow back

don't invade the tissues around them

can invade and damage nearby tissues and organs

don't spread to other parts of the body

can spread to other parts of the body

Liver Cancer

Liver

Largest organ

What does Liver do???It removes harmful substances from the blood.It makes enzymes and bile that help digest

food.It also converts food into substances needed

for life and growth.

Liver Cancer

Primarily liver cancer begins in hepatocytes.

Known as hepatocellular carcinoma.

Risk FactorsInfection with hepatitis B virus (HBV) or

hepatitis C virus (HCV)Heavy alcohol useAflatoxinIron storage diseaseCirrhosisObesity and diabetes

SymptomsPain in the upper abdomen on the right sideA lump or a feeling of heaviness in the

upper abdomenSwollen abdomen (bloating)Loss of appetite and feelings of fullnessWeight lossWeakness or feeling very tiredNausea and vomitingYellow skin and eyes, pale stools, and dark

urine from jaundiceFever

DiagnosisPhysical exam Check the liver, spleen and other nearby

organs for any lumps or changes in their shape or size.

Check for ascites, an abnormal buildup of fluid in the abdomen.

Also, your skin and eyes may be checked for signs of jaundice.

Blood testsBlood test detects alpha-fetoprotein (AFP).High AFP levels could be a sign of liver

cancer.

CT scanMRIUltrasound testBiopsyA biopsy usually is not needed to diagnose

liver cancer, but in some cases, the doctor may remove a sample of tissue.

A pathologist uses a microscope to look for cancer cells in the tissue.

Tissues are obtained by1. A needle through the skin2. Laparoscopic surgery3. Open surgery

Staging Staging is an attempt to find out whether

the cancer has spread, and if so, to what parts of the body.

When liver cancer spreads, the cancer cells may be found in the lungs.

Cancer cells also may be found in the bones and in lymph nodes near the liver.

Metastatic Liver CancerTests done for Diagnosis:1. CT scan of the chest2. Bone scan3. PET scan

Treatment1. Surgery

2. Ablation

3. Embolization

4. Targeted Therapy

5. Radiation Therapy

6. Chemotherapy

SurgerySurgery is an option for people with an

early stage of liver cancer. The surgeon may remove the whole liver

or only the part that has cancer. If the whole liver is removed, it's replaced

with healthy liver tissue from a donor and is known as total hepatectomy.

Removal of part of the liver is known partial hepatectomy.

Liver transplantDone when tumours are small, the disease has not spread outside the liver, and suitable donor liver tissue can be found.

AblationTreatments to control liver cancer and

extend life.Surgery to remove the tumor may not be

possible because of cirrhosis or other conditions that cause poor liver function, the location of the tumor within the liver, or other health problems.

Radiofrequency ablationUse of special probe that contains tiny

electrodes to kill the cancer cells with heat.Ultrasound, CT, or MRI may be used to

guide the probe to the tumor.It is a hyperthermia therapy.Percutaneous ethanol injectionUltrasound is used to guide a thin needle

into the liver tumor.Alcohol (ethanol) is injected directly into

the tumor and kills cancer cells.The procedure may be performed once or

twice a week.

EmbolizationFor those who can’t have surgery or a liver

transplant, embolization or chemoembolization may be an option.

A tiny catheter with sponge or other particles is inserted into an artery in your leg and is moved into the hepatic artery.

The particles block the flow of blood through the artery which results in the death of tumour.

Targeted TherapyPeople with liver cancer who can’t have

surgery or a liver transplant may receive a drug called targeted therapy.

Targeted therapy slows the growth of liver tumors.

It also reduces their blood supply. The drug is taken by mouth.Side effects include nausea, vomiting, mouth

sores, and loss of appetite.Sometimes, a person may have chest pain,

bleeding problems, or blisters on the hands or feet.

The drug can also cause high blood pressure.

Radiation TherapyRadiation therapy uses high-energy rays

to kill cancer cells. It may be an option for a few people who

can’t have surgery. Sometimes it is used with other

approaches. Radiation therapy also may be used to

help relieve pain from liver cancer that has spread to the bones.

Two types: External radiation therapy Internal radiation therapy

ChemotherapyThe use of chemicals to kill tumours.The drugs are given intravenously.The side effects mainly depend on how

much and what kind of drug is given.Common side effects include nausea,

vomitting, loss of appetite, fever and chills, and weakness.

Lung Cancer

Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs.

Primary and secondary lung cancer

Primary lung cancer starts in lungs.

Lung is the secondary site of infection for some other cancer.

Risk FactorsAnything that we breathe in can affect the

health. The most important risk factor for lung

cancer is smoking tobacco.Other risk factors include:

1. Asbestos 2. Radon3. Industrial substances4. Radiation exposure5. Air pollution6. Tuberculosis7. Genetics

SymptomsSymptoms of lung cancer that are in the chest:Coughing, especially if it persists or becomes

intensePain in the chest, shoulder, or back unrelated to

pain from coughingA change in color or volume of sputumShortness of breathChanges in the voice or being hoarseHarsh sounds with each breath (stridor)Recurrent lung problems, such as bronchitis or

pneumoniaCoughing up phlegm or mucus, especially if it is

tinged with bloodCoughing up blood

Symptoms of lung cancer that may occur elsewhere

in the body:Loss of appetite or unexplained weight lossMuscle wasting (also known as cachexia)FatigueHeadaches, bone or joint painBone fractures not related to accidental injuryNeurological symptoms, such as unsteady

gait or memory lossNeck or facial swellingGeneral weaknessBleedingBlood clots

DiagnosisDiagnosis of lung cancer is usually done

by looking for symptoms.If it is suspected, a biopsy is done to

confirm the tumour.BronchoscopyA small tube is inserted through the mouth

or nose into the lungs.The tube, which has a light on the end,

allows the doctor to see inside the lungs and to remove a small tissue sample.

Types and Stages of Lung Cancer

Non-Small Cell Lung CancerNon-small cell lung cancer accounts

for about 85 percent of lung cancers.Stages of Non-Small Cell Lung CancerStage I: only in the lungs and has not

spread to any lymph nodes.Stage II: lung and nearby lymph

nodes.Stage III: lung and in the lymph nodes

in the middle of the chest.Locally advanced disease. Stage III has two subtypes:

Stage IIIA: cancer has spread only to lymph nodes on the same side of the chest where the cancer started.

Stage IIIB: cancer has spread to the lymph nodes on the opposite side of the chest, or above the collar bone.

Stage IV: This is the most advanced stage of lung cancer.

Advanced disease. Cancer has spread to both lungs, to

fluid in the areaaround the lungs, or to another part of

the body.

Small Cell Lung CancerSCLC accounts for remaining 15% of lung

cancer.

Stages of Small Cell Lung CancerLimited stage: In this stage, cancer is

found onone side of the chest, involving just one partof the lung and nearby lymph nodes.Extensive stage: In this stage, cancer has

spreadto other regions of the chest or other parts

ofthe body.

Small Cell and Non Small Cell Lung Cancer

Treatment

Non-Small Cell Lung Cancer1. Surgery, 2. Radiation, 3. Chemotherapy, and 4. Targeted treatmentsalone or in combination—are used to treat

lungcancer.

SurgeryMost stage I and stage II non-small cell lung

cancers are treated with surgery to remove the tumor.

For this procedure, a surgeon removes the lobe, or section, of the lung containing the tumor.

Chemotherapy and RadiationAdjuvant Chemotherapy for patients with

stage II and IIIA disease.For people with stage III lung cancer that

cannot be removed surgically chemotherapy in combination with definitive (high-dose) radiation treatments is recommended.

In stage IV lung cancer, chemotherapy is typically the main treatment and radiation is used only for palliation of symptoms.

Chemotherapy plan consists of combination of various drugs.

Neoadjuvant chemotherapyChemotherapy before radiation or surgery

causes shrinkage of tumor enough to make it easier to remove with surgery.

This increases the effectiveness of radiation and destroys hidden cancer cells at the earliest possible time.

Targeted TherapyTargeted therapies are designed specifically

to attack cancer cells by attaching to or blocking targets that appear on the surfaces of those cells.

People who have advanced lung cancer with certain molecular biomarkers may receive treatment with a targeted drug alone or in combination with chemotherapy.

Erlotinib - blocks Epidermal Growth Factor Receptor

Avastin – blocks Vascular Endothelial Growth Factor

Crizotinib – blocks Anaplastic lymphoma kinase

Small Cell Lung CancerChemotherapy and Radiation TherapyFor small cell lung cancer, regardless of

stage, chemotherapy is an essential part of treatment.

Radiation treatment may be used as well depending on the stage of cancer.

For limited-stage small cell lung cancer, combination chemotherapy plus radiation therapy at the same time is the recommended treatment.

Radiation therapy of the brain may be used before or after chemotherapy for some people whose cancer has spread to the brain.

Preventive Radiation Therapy to the BrainIn more than half of the people with small cell

lung cancer, the cancer also spreads to the brain.

Prophylactic Cranial Irradiation (PCI).This can benefit patient with both limited-

stage and extensive-stage small cell lung cancers.

SurgeryA very small percentage of people who have

limited-stage small cell lung cancer. No lymph node tumors may benefit from

surgery. After surgery adjuvant chemotherapy is

given.

Treatment Side EffectsBlood clotsBone issuesChemobrainDental issuesDiarrheaFatigueHair lossLymphedemaMouth soresNausea and vomitingNeuropathyPainWeight loss or gain

Referencehttp://www.lungcancer.org/find_informatio

n/publications/163-lung_cancer_101http://www.cancer.gov/cancertopics/types/

liverhttp://www.cancer.org/treatment/treatmen

tsandsideeffects/treatmenttypes/radiation/radiationtherapyprinciples/radiation-therapy-principles-types-of-radiation