1. Early diagnosis of Lung Cancer
Dr. Aparna Sreevatsa Consultant Medical Oncologist Sahyadri Narayana Multispeciality Hospital, Shimoga

2. Overview Pathogenesis Epidemiology of Lung Cancer in India
Differentiate TB from Lung Cancer
Recent advances in the management of Lung Cancer

3. Pathogenesis Genetic disease
Imbalance between oncogenes and tumor suppressor genes
Deficient DNA repair mechanism
Multistep carcinogenesis

4. Molecular Biology of Lung Ca

5. Case Scenario 1 A, 60 yr, male Chronic Smoker Cough 15 days
Hemoptysis 3 days
CXR Right upper zone patch with hilar lymph node

6. Case Scenario 2 B, 40 yr, female Non Smoker Cough 15 days
Hemoptysis 3 days
CXR Right upper zone patch with hilar lymph node

7. Case Scenario 3 50 y, smoker Cough Breathlessness
CT Chest- Ca lung with pleural effusion & adrenal mets.
?? Palliative Care
??Cancer directed therapy

8. Epidemiology of Lung Cancer in India
GLOBOCAN 2012
Lung ca the most common cancer in men in India.
Changes in the incidence among smokers and non smokers.

9. Changing Epidemiology of Lung Ca in India

10. Lung Ca in Non Smokers
Incidence increasing in females & never smokers.
Adeno carcinoma
Younger age
Advanced disease
EGFR mutation positive.

11. Histopathological Types

12. Tuberculosis- A diagnostic chameleon

13. Difference between pulmonary TB & Lung Cancer

14. History & Examn. TB Lung Ca Age Smoking fever Weight loss
Usually young
Middle age/elderly
Smoking
+/-
fever +
Weight loss
breathlessness
Chest pain
Clubbing
Cervical lymph nodes
Hoarseness
rare

15. Radiology TB Lung Cancer Predilection for upper zone
CXR features
Predilection for upper zone + -
Parenchymal infiltrates
+/-
Lymphadenopathy
Cavity
Pleural effusion
Miliary mottling
Rib erosion
Mass lesion

16. CT Chest Pulmonary TB Lung Cancer
Centrilobular densities in and around the small airways
Tree in bud appearance
Mass lesion, spiculated margins
Tumor size, site, invasion to adjoining structures
Hilar and mediastinal lymph nodes

17. Histopathology/Cytology
FNAC
Trucut Biopsy
USG/CT guided/Bronchoscopic/BAL
AFB staining

18. Treatment Plan Stage I & Stage II- Surgery/RT Stage III-RT/NACT->RT
Stage IV- CT

19. Management of Metastatic Lung Cancer

20. Goals of therapy... Palliation of symptoms Improvement in QOL
Prolongation of Survival

21. Therapeutic Options... Chemotherapy Monoclonal Antibodies
Tyrosine Kinase Inhibitors
Immunotherapy

22. ROLE OF CHEMOTHERAPY

23. Agents used over years... First generation 1970s 2nd generation 1980s
3rd generation
1990s
Cyclophophamide
Doxorubicin
Methotrexate
Procarbazine
Lomustine
5-FU
Carmustine
Cisplatin
Etoposide
Vindesine
Vinblastine
Mitomycin-C
Ifosfamide
Vinorelbine
Gemcitabine
Paclitaxel
Docetaxel
Irinotecan
Topotecan

24. Cis-based regimens 6–8 months
Improved OS...
Significant Milestones in 1st-Line Therapy
Median survival (months)
P-based doublets
3rd gen.
8–10 months
Cis-based regimens 6–8 months
BSC
2–4 months
1970s
1980s
1990s

25. Chemotherapy

26. Paul Ehrlich German physician Father of Chemotherapy
Majic Bullet theory

27. Targeted Therapy

28. EGFR mutation Positive
Erlotinib
Gefitinib
Axitinib

29. ALK positive
Crizotinib
Ceretinib
Alectinib

30. Monclonal Antibodies
Bevacizumab

31. Immunotherapy
Nivolumab
Pembrolizumab

32. Take Home Message Lung Cancer is increasing in females & non-smokers.
Cough >3 wks with hemoptysis +/- chest pain requires CXR evaluation.
If pt is not improving on ATT, prompt CT Chest to rule out lung cancer.
Targeted therapy improves survival to many months to years.

33. Thank You