Lung Cancer
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Transcript of Lung Cancer
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Lung Cancer
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Lung Cancer
The most common cancer worldwide, and the deadliest
1.37 million deaths worldwide (WHO 2008) 203,000 people diagnosed in the US each
year, 158,000 deaths (CDC 2007)
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Risk Factors
Cigarette smoking Smokers are 10-20 times more likely to get
lung cancer85-90% of deaths from lung cancer are
smoking relatedRisk is dose dependent: the more a person
smokes, the higher the riskQuitting decreases a person's risk
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Risk Factors
Radon accounts for 21,000 lung cancer deaths (EPA 2003)
Industrial exposures: Asbestos, coal tar fumes, nickel, chromium, arsenic, etc
Family historyHigh cholesterol diet? Alcohol?Beta carotene (Vitamin A) supplements in
heavy smokers
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Prevention
QUIT SMOKING (or failing that, cut down)Decrease exposure to second hand smokeDecrease exposure to radon, asbestos and
other industrial carcinogensHealthy dietPhysical activity
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National Lung Cancer Screening Trial
53,454 participants: 55-74 y/o> 30 pack year hx of cigarette smokingQuit smoking < 15 yrs prior if a former smokerNo hx lung ca or other life-threatening cancersNo sx's of hemoptysis or wt lossNo chest CT prior 18 mo
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NLST
Participants randomized to low dose chest CT vs PA chest x-ray annually for 3 years
LDCT arm showed a 20% reduction in lung cancer deaths compared to the CXR arm (p=0.004)
NEJM 2011 Aug 4;365(5):395-409
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Screening and Diagnosis
Chest x-rays have not been shown to be a good screening tool for lung cancers
NCCN guidelines for LDCT screening:55-74 y/o and> 30 pack years of smoking andSmoking cessation < 15 yrsOr > 50 y/o and > 20 pack year hx of smoking
and one additional risk factor (not second hand smoke)
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Symptoms
About 25% of people with lung cancer have no symptoms
Central tumors: obstructive sx's, cough, dyspnea, atelectasis, postobstructive pneumonia, wheezing, hemoptysis
Peripheral tumors: pleural effusion, pain if invading pleura or chest wall
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Symptoms
Pancoast tumor: tumor in the superior sulcus– Shoulder pain– Low brachial plexopathy– Horner's syndrome (ptosis, miosis,
anhidrosis)
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Diagnosis
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NCCN Guidelines
• Nodule < 8 mm: radiologic surveillance• Nodule > 8 mm, solid, non-calcified:
consider PET, bx or excise if suspicious• <10 mm non-solid or part-solid nodule:
radiologic surveillance• >10 mm non-solid or part-solid nodule:
LDCT in 3-6 mo
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Beyond IHC
• Molecular analysis of certain mutations has become increasingly important for determining therapy
• EGFR mutations are a target for TKI's• KRAS mutations indicate a resistance to
TKI's• ALK mutations provide a target for ALK
inhibitors (crizotinib)
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Further Work Up
PET scan, MRI of the brainBronchoscopyMediastinoscopy/USPFT's Lab tests: CBC, electrolytes