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• Cells are oval or vaguely spindleshaped ,have scant cytoplasm
Squamous cell carcinoma
• the most frequent form of the tumor(30-50 percent of all cases • bronchial epithelium and growth in situ
adenocarcinoma
• areas of scarring is associated with the occurrence of adenocarcinoma. • Peripheral adenocarcinomas are usually wellcircumscribed, grey-white masses that rarely cavitate. • It arises from the submucosal glands,located in peripheral airways and alveoli • Female
Regionnal spread to hilar and mediastinal nodes may cause dysphagia due to esophageal compression horseness due to recurrent laryngeal nerve compression horner’s syndrome due to sympathetic nerve involvement elevation of the hemidiaphragm from phrenic nerve compression.
How is Lung Cancer Evaluated?
• Because almost all patients will have a tumor in the lung, a chest x-ray or CT scan of the chest is performed • The diagnosis must be confirmed with a biopsy • The location(s) of all sites of cancer is determined by additional CT scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging) • It is important to find out if cancer started in the lung or somewhere else in the body. Cancer arising in other parts of the body can spread to the lung as well
• It is related to cigarette smoking
• Cavitation can occure in the distal to the obstructing mass • Central location
• Intercellular bridges and cellular pleomorphism
Physical examinations
• Endobronchial obstruction may result in a localized wheeze • Lobar collapse may result in an area of decreased breath sounds and dullness to percussion.
• Superior sulcus, or pancoast’s tumor may involve the brachial plexus, resulting in a c7-t2 neuropathy with pain, numbness, and weakness of the arm. • Cardiac involvement is seen in About 20-25 percent of patients
incidence of lung cancer
Classifications
• According to anatomy: (1)Central lung (2) peripheral lung cancer
• According to histologic classification: Small cell lung cancer(SCLC) and Non-small cell lung cancer(NSCLC). NSCLC includes Squamous cell carcinoma, large cell carcinoma, adenocarcinoma, adenosquamous carcinoma.
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• Extrapulmonary manifestations. Including metastasis to other organs, such as brain, central nervous system, skeleton system, liver,adrenal glands and lymph nodes ects.
• Paraneoplastic syndromes are remote effects of tumor. They lead to metabolic and neuromuscular disturbances unrelated to the primary tumor, metastases, or treatment. They may be the first sign of the tumor.They do not indicate that a tumor has spread.
• squamous cell carcinoma usually occurs near the bronchi, the tumor can cause cough (sometimes a cough that is tinged with blood), shortness of breath, wheezing, and pneumonia in the area between the tumor and the edge of the lung • it causes symptoms early in the disease
lung cancer
What is Lung Cancer?
• Begins when cells in the lung grow out of control and form a tumor
Etiology and pathogenesis
• • •
Cigarette smoking Other factors include air pollutions Nowadays It is reported that tuberculosis is associated with the
Small cell lung cancer(SCLC)
Oat-cell carcinoma
• SCLC grows very rapidly and is very aggressive. • Soon after the original cell becomes cancerous, it quickly multiplies to form a tumor. • These cells swiftly spread to distant sites in the body • SCLC belongs in a group of tumors derived from neuroendocrine cells that are responsible for the production and secretion of specific peptide product.they may related to paraneoplastic syndrome.
Chest X-ray
It is the most important method to find lung cancer The most frequent finding is a mass in the lung field
On chest X-ray, secondary manifestations include lobar collapse, pleural effusion, pneumonitis, elevation of the hemidiaphragm, hilar and mediastinal adenopathy, and erosion of ribs or vertebrae due to metastases.
Physical examinations
• Usually in early stage, most of the patients with lung cancer have no positive physical findings. • General findings include abnormal percussion, breath sounds changes, moist rales (when pneumonia happens) • Digital clubbing, superior vena cava syndrome, horner’s syndrome(unilaterally constricted pupil, enophthalmos,narrowed palpebral fissure and loss of sweating on the same side of the face.
• Due to primary lesions: cough, dyspnea, hemoptysis, sputum, wheezing, weight loss, fever, pneumonia • Due to local extension: chest pain,hoarseness,superior vena cava syndrome, horner’s syndrome, dysphagia, pericardial effusion,pleural effusion, diaphragm paralysis • Only 5-15 percent of patients are asymptomatic when discovered to have bronchogenic carcinoma.
large cell carcinoma
• large nuclei,prominent nucleoli,abundant cytoplsma
• usually located peripherally • can be quite large and not infrequently cavitate
the Symptoms of Lung Cancer
• • • • • • • • Fatigue (tiredness) Cough Shortness of breath Chest pain Loss of appetite Coughing up phlegm Hemoptysis (coughing up blood) If cancer has spread, symptoms include bone pain, difficulty breathing, abdominal pain, headache, weakness, and confusion