1. Occupational cancer Fariba Rezaeetalab Assistant professor

2. Cancer Registry by Industry Excess Nasopharyngeal: carpenters Colorectal: machinery manufacturing, printing Liver: general construction and rubber and plastics Gallbladder: electrical equipment Lung: primary metals, shipbuilding, construction, and stone, clay, and glass Mesothelioma: shipbuilding and asbestos manufacturing

3. Breast: (Black females) chemical and pharmaceutical Bladder: (white males) apparel and textile industries. Non-Hodgkin's lymphoma: – (white females) printing – (white male) bakers and motor vehicle manufacturing Lymphocytic leukemia: chemical and construction

4. What Is Lung Cancer ? Lung cancer is the leading cause of cancer death for men and women. It is also the most preventable form of cancer. Tobacco use accounts for 87% of lung cancers. There are two major types of lung cancer: 1. Non-small cell lung cancer (87%) 2. Small cell lung cancer (13%) Each grows and spreads in different ways and is treated differently.

5. The American Cancer Society’s Estimates In the United States during 2008: – 215,020 new cases of lung cancer will be diagnosed. – 161,840 deaths will occur as the result of this disease.

6. Who Is At Risk? Cigarette smoking is by far the greatest risk factor for lung cancer. – The longer a person uses tobacco and the more they use, the greater their risk. – If a person quits before cancer develops, the damaged lung tissue gradually improves. Others at risk include: – Nonsmokers who breathe in secondhand smoke. – Occupational or environmental exposure to radon, asbestos, certain metals, radiation or air pollution. If people are exposed to the above carcinogens & also smoke, their risk is greatly increased.

7. Lung Cancer Risk Factors 1- Arsenic : Byproduct of copper, lead, zinc,tin, smelting – in organic trivalent arsenic – containing pesticides 2- Asbestos : In several industries : miners, shipyard, cement 3- Bis-chloromethyl ether : Industries producing ion exchange resins, polymers, plastics

8. Lung Cancer Risk Factor Chromium : used in metal alloys, electroplating, lithography,paint pigments, cement, rubber Nickel : used in electroplating, manufacturing of steel and other alloys, ceramics, storage batteries, electric circutis Radon : Undeground miners Vinylchloride : used in production of plastics

9. Clinical presentations 1. Constitutional symptoms 2. Primary Tumor 3. Intrathoracic spread 4. Asymptomatic 5. Extrathoracic spread 6. Paraneoplastic symptoms

10. Asymptomatic (10%)

11. Primary Tumor (30%) Cough (75%) SOB (60%) Chest discomfort (50%) Hemoptysis (35%)

12. Cough - endobronchial mass or post- obstructive pneumonia – esp concerned if new onset/changed character SOB – tumor occluding the airway Chest discomfort – intermittent/aching Hemoptysis -acute bronchitis is the common cause of hemoptysis, lung CA should always be suspected in pts >40

13. Intrathoracic Spread (40%) Recurrent laryngeal nerve paralysis Phrenic nerve paralysis Pancoast ’ s tumor Horner Syndrome Chest wall invasion Pleural effusion Esophageal compression Superior vena cava obstruction

14. Extrathoracic Spread (30%) Bone mets – bone pain, fracture Brain mets – HA, N/V, focal neurol deficits, seizures, confusion, personality change Liver mets Adrenal gland mets Spinal cord mets

15. Comments Quitting tobacco use, or not starting at all Take protective measures against cancer- causing chemicals at work