1. The BIG Kahuna among Tumors
Lung Cancer
The BIG Kahuna among Tumors

2. Why is Lung Cancer the BIG Kahuna?
Number 1 cause of cancer deaths in both men and women now
Only major cancer that continues to show an increase in rates of new cases
Has an overall 5-year survival rate of less than 50% (approximately 44%)
One of the most preventable but least treatable of cancers

3. Major Types of Lung Tumors
99% of all lung cancers arise from the epithelial cells of lung tissue and are therefore Bronchogenic Carcinomas
Approximately 1% arise from lymphoid tissue or other supporting structures within the lung; these are mostly Mesotheliomas

4. Bronchogenic Carcinomas
Two Types
Small Cell (SCLC)
Non-small Cell (NSCLC)
Important to differentiate
Small Cell are more aggressive and respond better to chemotherapy and radiation
Non-small Cell are best treated with surgery (unless advanced); chemotherapy not as useful

5. Non-small cell lung cancer 3 types
Squamous Cell (also called epidermoid) – cancer of the cells that line the bronchi or small and large airways – the most common
Adenocarcinoma - cancer of the mucus producing or gland cells within the lung
Giant Cell - cancer of the cells that make up the walls of the air sacks

6. Small Cell Lung Cancer Also called Oat Cell
Cancer involving the small cells that resemble lymphocytes and line the walls of the bronchi and alveoli (air sacks) as infection fighters

7. Risk Factors SMOKING!!!!! Secondary smoke Environmental
Occupational exposure to radiation or inhaled carcinogens
Air pollution
Immuno-suppressed states
Diet

8. Smoking Smoking markedly increases risk for ALL forms of lung cancer
The risk appears to be non-linear; the more a person has smoked, and the longer they have smoked combines to accelerate risk as they get older
Even after smoking cessation of years, former smokers still have a greater risk than people who have never smoked

9. Secondary Smoke
The Environmental Protection Agency has declared secondary smoke a major carcinogen
The risk to persons from secondary smoke may in fact be higher for the same amount of exposure as for the smoker, because secondary smoke is NOT filtered through the cigarette

10. Environmental Exposures
Environmental Radiation, especially radon
Occupational radiation exposure as seen in uranium, coal, and iron miners
Medical radiation, especially adjuvant radiation for breast cancer treatment, Hodgekins Disease or lymphomas
Asbestos – the primary risk for mesotheliomas and sarcomas of the lung

11. Immuno-suppressed States
HIV/AIDS patients
Transplant patients on anti-rejection drugs
Persons with certain auto-immune diseases such as Rheumatoid Arthritis or Ankylosing Spondylitis
Persons with other forms of cancer

12. Diet
Dietary deficiencies in Vitamin E and Beta Carotene are associated with increased incidence of lung cancer among already high risk smokers
Vitamin A in significant doses has been shown to reduce the incidence of lung cancer and retard its progression

13. ALL of the other risk factors in lung cancer are adversely affected by SMOKING!!!

14. It is important to note that lung cancer does NOT have a large hereditary factor, so you can’t blame this cancer on not choosing your parents well!

15. Prevention NEVER start smoking Smokers need to QUIT
Should note that marijuana is even more toxic to the lungs that tobacco with a higher risk
Smokers need to QUIT
Avoid second-hand smoke, especially children and young people because effects are cumulative

16. Prevention (continued)
Pay attention to air quality indices and warnings
Avoid exposures to other airborne carcinogens whenever possible
Wear approved and properly fitted respirators in hazardous occupations like coal mining and fire fighting
Avoid exposure to radiation when possible

17. Hazardous Radiation
Most common airborne radiation exposure is radon which is found naturally around concrete
If you have a concrete basement, have it checked for radon levels; if high, insulate it and/or ventilate it
Don’t ask for or insist on x-rays that you might not need; avoid excessive CT scans

18. Detection
Single most common symptom of lung cancer is a persistent cough without the presence of infection, especially a cough that changes or becomes bloody
Definitive study is usually a chest x-ray; questionable cases may need a CT scan of the chest or an MRI
Absolute diagnosis needs a tissue sample from a biopsy or bronchoscopy

19. More on Detection
Hoarseness without presence of infection or another obvious cause is another disturbing symptom, usually caused by tumor invading or wrapping itself around the nerve to the vocal cords, or direct invasion of the cords

20. Staging Lung cancer is staged by looking at three things
The size and location of the tumor
The presence of lymph nodes with tumor in them
The presence or absence of metastases
The higher the number in each of these categories: T, N, M, the worse the disease

21. Treatment - NSCLC
Non-small cell tumors with no metastases and few or no positive lymph nodes are best treated with complete surgical excision of the segment or lobe of the lung involved
If lymph nodes are positive or if there has been local spread, radiation and chemotherapy may be added
If metastases are present, chemotherapy is usually essential

22. Treatment - SCLC
The hallmark of small cell lung cancer treatment is chemotherapy as many of these cancers are exquisitely sensitive to the newer chemotherapy regimens
Radiation can be used as an adjunct or in some cases as the primary therapy

23. Prognosis
The overall prognosis in lung cancer is not good – that’s why prevention is SO IMPORTANT – STOP SMOKING!!!
In early NSCLC disease 5 year cure rates may be as high as 85%
Stage 4 disease with metastases is dismal, less than 1% with survival of less than 6 months being the rule

24. Prognosis (continued)
Intermediate disease is becoming more amenable to treatment as newer regimens of chemotherapy are being discovered and surgical techniques are improving
Even in non-operable terminal disease, palliative radiation and chemotherapy can improve quality of life frequently

25. Recurrent Disease
The incidence of a new primary tumor, frequently in the other lung, is very common in post-lung cancer patients, so frequent surveillance and follow up is essential
IF YOU DON’T SMOKE, DON’T START, IF YOU DO, QUIT NOW!

26. THE GREAT AMERICAN SMOKEOUT
The Great American Smokeout is this month
Contact your local chapter of the American Cancer Society for more information or call
Or go to

27. Questions?