LUNG CANCER 1 CHS 232 LECTURE 6 MRS

LUNG CANCER 1 CHS 232 LECTURE 6 MRS. LAMIS AL-SAYYARI

FIRST, HOW DO LUNGS WORK? Your lungs are part of the respiratory system, a group of organs and tissues that work together to help you breathe. The respiratory system's main job is to move fresh air into your body while removing waste gases. 2

WHAT ARE THE LUNGS? The lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). The trachea (windpipe) conducts inhaled air into the lungs through its tubular branches, called bronchi. The bronchi then divide into smaller and smaller branches (bronchioles), finally becoming microscopic. 3

WHAT ARE THE LUNGS? The bronchioles eventually end in clusters of microscopic air sacs called alveoli. In the alveoli, oxygen from the air is absorbed into the blood. Carbon dioxide, a waste product of metabolism, travels from the blood to the alveoli, where it can be exhaled. Between the alveoli is a thin layer of cells called the interstitium, which contains blood vessels and cells that help support the alveoli. 4

WHAT ARE THE LUNGS? The lungs are covered by a thin tissue layer called the pleura. The same kind of thin tissue lines the inside of the chest cavity -- also called pleura. A thin layer of fluid acts as a lubricant allowing the lungs to slip smoothly as they expand contract with each breath. 5

THE LUNGS From 0 to 1: 42 minute https: //www. youtube. com/watch? v=Urn_ztf 3 Tc. Q 6

WHAT IS LUNG CANCER? Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via the blood. 7

THE GENETIC BASIS OF LUNG CANCER All cells in the body contain the genetic material called deoxyribonucleic acid (DNA). Every time a mature cell divides into two new cells, its DNA is exactly duplicated. The cells are copies of the original cell, identical in every way. In this way our bodies continually replenish themselves. Old cells die off and the next generation replaces them. 8

THE GENETIC BASIS OF LUNG CANCER A cancer begins with an error, or mutation, in a cell’s DNA mutations can be caused by the normal aging process or through environmental factors, such as cigarette smoke, breathing in asbestos fibers, and to exposure to radon gas Researchers have found that it takes a series of mutations to create a lung cancer cell. Before becoming fully cancerous, cells can be precancerous, in that they have some mutations but still function normally as lung cells. 9

THE GENETIC BASIS OF LUNG CANCER When a cell with a genetic mutation divides, it passes along its abnormal genes to the two new cells, which then divide into four cells with errors in their DNA and so on. With each new mutation, the lung tissue cell becomes more mutated and may not be as effective in carrying out its function as a lung cell. At a later stage of disease, some cells may travel away from the original tumor and start growing in other parts of the body. This process is called ? ? 10

PRIMARY VERSUS SECONDARY LUNG CANCER Primary lung cancer starts in the lungs. The cancer cells are abnormal lung cells. Sometimes, people will have cancer travel from another part of their body or metastasize to their lungs. This is called secondary lung cancer because the lungs are a secondary site compared to the original primary location of the cancer. So, treatment prescribed will be where? 11

SYMPTOMS OF LUNG CANCER The signs and symptoms of lung cancer can take years to develop and they may not appear until the disease is advanced. Symptoms of lung cancer can happen in the chest or elsewhere in the body If the original lung cancer has spread, a person may feel symptoms in other places in the body. Common places for lung cancer to spread include other parts of the lungs, lymph nodes, bones, brain, liver, and adrenal glands. 12

SYMPTOMS OF LUNG CANCER THAT AREIN THE CHEST: Coughing, especially if it persists or becomes intense Pain in the chest, shoulder, or back unrelated to pain from coughing A change in color or volume of sputum Shortness of breath Changes in the voice or being hoarse Harsh sounds with each breath (stridor) Recurrent lung problems, such as bronchitis or pneumonia Coughing up phlegm or mucus, especially if it is tinged with blood Coughing up blood 13

SYMPTOMS OF LUNG CANCER THAT MAY OCCUR ELSEWHERE IN THE BODY: Loss of appetite or unexplained weight loss Muscle wasting (also known as cachexia) Fatigue Headaches, bone or joint pain Bone fractures not related to accidental injury Neurological symptoms, such as unsteady gait or memory loss Neck or facial swelling General weakness Bleeding Blood clots 14

SYMPTOMS OF LUNG CANCER From 1: 43 to 2: 22 https: //www. youtube. com/watch? v=Urn_ztf 3 Tc. Q 15

TYPES AND STAGING OF LUNG CANCER There are two main types of lung cancer. Small cell lung cancer (a type of cancer made up of small round cells in the lungs). (SCLC) Non-small cell lung cancer (cancer which grows in cells other than small cells inside the lungs). (NSCLC) Early-stage lung cancer (stages I and II) is difficult to detect, Why? 16

NON-SMALL CELL LUNG CANCER Non-small cell lung cancer accounts for about 85 percent of lung cancers and includes: Adenocarcinoma, the most common form of lung cancer in the United States among both men and women; Squamous cell carcinoma, which accounts for 25 percent of all lung cancers; Large cell carcinoma, which accounts for about 10 percent of NSCLC tumors. 17

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SMALL CELL LUNG CANCER Small cell lung cancer accounts for the remaining 15 percent of lung cancers in the United States. They tend to grow more quickly than NSCLC tumors. Usually, SCLC is more responsive to chemotherapy than NSCLC 20

STAGES OF SMALL CELL LUNG CANCER Limited stage: In this stage, cancer is found on one side of the chest, involving just one part of the lung and nearby lymph nodes. Extensive stage: In this stage, cancer has spread to other regions of the chest or other parts of the body 21

STAGES OF LUNG CANCER From 2: 23 to 5: 26 https: //www. youtube. com/watch? v=Urn_ztf 3 Tc. Q 22

TREATMENT OF LUNG CANCER Treatment will depend on the type of lung cancer TREATMENT CARING TEAM doctors; nurses; pharmacists; physiotherapists; radiographers; occupational therapists; and dietitians. 23

NON-SMALL CELL LUNG CANCER TREATMENT Surgery Most stage I and stage II non-small cell lung cancers are treated with surgery to remove the tumor Chemotherapy and Radiation For people with stage III lung cancer that cannot be removed surgically, doctors typically recommend chemotherapy in combination with definitive (highdose) radiation treatments. In stage IV lung cancer, chemotherapy is typically the main treatment. In stage IV patients, radiation is used only for palliation of symptoms. 24

NON-SMALL CELL LUNG CANCER TREATMENT Targeted Treatments One of the most exciting developments in lung cancer medicine is the introduction of targeted treatments. Unlike chemotherapy drugs, which cannot tell the difference between normal cells and cancer cells, targeted therapies are designed specifically to attack cancer cells by attaching to or blocking targets that appear on the surfaces of those cells. People who have advanced lung cancer with certain molecular biomarkers may receive treatment with a targeted drug alone or in combination with chemotherapy 25

NON-SMALL CELL LUNG CANCER TREATMENT Immunotherapy has recently emerged as a new treatment option for certain lung cancers. While any cancer treatment can cause side effects, immunotherapy is generally well-tolerated; this is in part due to its mechanism of action. Our immune system is constantly working to keep us healthy. It recognizes and fights against danger, such as infections, viruses, and growing cancer cells. In general terms, immunotherapy uses our own immune system as a treatment against cancer. 26

SMALL CELL LUNG CANCER TREATMENT Chemotherapy and Radiation Therapy For people with small cell lung cancer, regardless of stage, chemotherapy is an essential part of treatment. Radiation treatment may be used as well depending on the stage of cancer. For people with limited-stage small cell lung cancer, combination chemotherapy plus radiation therapy given at the same time is the recommended treatment Surgery A very small percentage of people who have limitedstage small cell lung cancer and no lymph node tumors may benefit from surgery, after which adjuvant chemotherapy is given. 27

MANAGING TREATMENT SIDE EFFECTS Blood clots Bone issues Cancer that starts in or spreads to the bones can lead to bone pain and an increase in risk for complications, including weakening of the bone, fractures, and high calcium levels in the blood. Chemobrain Problems with memory and concentration, along with a general feeling of not functioning as well mentally as usual, are informally referred to by patients as chemobrain. 28

MANAGING TREATMENT SIDE EFFECTS Dental issues Side effects from cancer treatment may include tooth decay and other mouth issues, including dry mouth and mouth sores. Diarrhea Defined as two or more loose bowel movements per day, diarrhea may be caused by some types of chemotherapy and radiation to certain areas of the body. 29

MANAGING TREATMENT SIDE EFFECTS Fatigue is the most commonly reported side effect of cancer and its treatment. Hair loss from chemotherapy treatment occurs because hair follicles are weakened by chemotherapy, which causes the hair to fall out much more quickly than it would normally. 30

MANAGING TREATMENT SIDE EFFECTS Lymphedema People with cancer who have undergone lymph node removal and/or radiation as part of their treatment are at risk for developing lymphedema, a painful swelling that happens when the body’s lymphatic fluid is unable to circulate properly and builds up in the soft tissues instead. Mouth sores “Oral mucositis” refers to mouth sores caused by irritation of the mucosa—the soft tissues that cover the tongue and inside of the mouth, and can be a serious side effect of chemotherapy treatment 31

MANAGING TREATMENT SIDE EFFECTS Nausea and vomiting While many people who are treated for cancer experience nausea and vomiting, medicines exist that can help control these side effects. Neuropathy Some people who receive chemotherapy experience numbness or tingling in their hands and feet, what doctors call peripheral neuropathy. 32

MANAGING TREATMENT SIDE EFFECTS Pain Rash A type of targeted treatment that blocks epidermal growth factor receptors (EGFRs) often causes rashes and other bothersome skin conditions. Weight loss or gain Cancer treatments can usually lead to weight loss, but people with cancer can also experience weight gain from chemotherapy treatment, steroid medications, and hormone therapy. 33

TREATMENT OF LUNG CANCER From 5: 27 to 7: 47 https: //www. youtube. com/watch? v=Urn_ztf 3 Tc. Q 34

LUNG CANCER RISKS Because our lungs draw in and utilize the air from outside of our body, anything that we breathe in can affect their health. 35

LUNG CANCER RISKS The most important risk factor for lung cancer is smoking tobacco. Nearly 87% of all lung cancers in the United States are smoking-related. Quitting smoking helps to reduce that risk Exposure to secondhand smoke also increases the risk of lung cancer. According to the Surgeon General’s Report on the effects of secondhand smoke, nonsmokers exposed to secondhand smoke at home or at work increase their risk of developing lung cancer by 20 percent to 30 percent. Secondhand smoke also increases the risk of heart disease and other ailments. 36

THE HISTORY OF THE DISCOVERY OF THE CIGARETTE–LUNG CANCER LINK What is the surgeon general’s report? What was the first report about? Homework 37

THE TREND OF SMOKING IN USA 38

THE HISTORY OF THE DISCOVERY OF THE CIGARETTE–LUNG CANCER LINK Rarity of lung cancer In 1878, malignant lung tumors represented only 1% of all cancers seen at autopsy in the Institute of Pathology of the University of Dresden in Germany. By 1918, the percentage had risen to almost 10% and by 1927 to more than 14%. In the 1930 edition of the authoritative Springer Handbook of Special Pathology it was duly noted that malignant lung tumors had begun to increase at the turn of the century and perhaps even more so after World War I and that, possibly, they still were on the increase 39

THE HISTORY OF THE DISCOVERY OF THE CIGARETTE–LUNG CANCER LINK Mass marketing towards the end of the 19 th century popularized the cigarette habit, however, causing a global lung cancer epidemic. Cigarettes were recognized as the cause of the epidemic in the 1940 s and 1950 s, with the confluence of studies from epidemiology, animal experiments, cellular pathology and chemical analytics. Cigarette manufacturers disputed this evidence, as part of an orchestrated conspiracy to salvage cigarette sales. 40

THE HISTORY OF THE DISCOVERY OF THE CIGARETTE–LUNG CANCER LINK Propagandizing the public proved successful, judging from secret tobacco industry measurements of the impact of denialist propaganda. As late as 1960 only one-third of all US doctors believed that the case against cigarettes had been established. The cigarette is the deadliest artifact in the history of human civilization! 41

LUNG CANCER ENVIRONMENTAL SUBSTANCES OR EXPOSURES RISKS Asbestos are tiny, hair-like fibers found in some types of rock. Asbestos is a natural mineral that is fireproof and insulating and was used in building construction materials and in some manufacturing processes. 42

LUNG CANCER ENVIRONMENTAL SUBSTANCES OR EXPOSURES RISKS When asbestos is inhaled, the fibers can irritate the lung and may eventually cause lung disease. People who smoke and are exposed to asbestos have a higher risk of developing lung cancer. Fortunately, professional protective breathing equipment can reduce the risk of breathing in asbestos fibers for those who work with or around asbestos. 43

LUNG CANCER ENVIRONMENTAL SUBSTANCES OR EXPOSURES RISKS Radon is an odorless gas released by some soil and rocks that contain uranium. Some homes may have high levels of radon, especially on the lower levels, because they are built on soil that naturally contains radon. Environmental Protection Agency-approved kits in hardware stores can be used to measure the amount of radon in homes. 44

RADON IN KSA 45 http: //www. alriyadh. com/825293

LUNG CANCER ENVIRONMENTAL SUBSTANCES EXPOSURES RISKS Industrial substances can include arsenic, uranium, beryllium, vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, gasoline, and diesel exhaust. Radiation exposure such as X-rays to the chest area can increase the risk of lung cancer, especially in people who smoke. Air pollution can contain trace amounts of diesel exhaust, coal products, and other industrial substances. 46

LUNG CANCER ENVIRONMENTAL SUBSTANCES EXPOSURES RISKS Tuberculosis can cause scarring of lung tissue, which can be a risk factor for developing lung cancer. Genetics Military service, why? 47

SCREENING FOR LUNG CANCER Unlike mammography for breast cancer or colonoscopy for colon cancer, a widely accepted screening tool for early-stage lung cancer has not been available until recently. Regular chest X-rays are not reliable enough to find lung tumors in their earliest stages, when many doctors believe the tumors are at their smallest and most curable state. 48

SCREENING FOR LUNG CANCER Recent guidelines from the American Society of Clinical Oncologists suggests annual screening with low-dose computed tomography (LDCT) for smokers and former smokers at high risk for developing lung cancer. ? 49

WHO IS AT HIGH RISK FOR DEVELOPING LUNG CANCER. ? High risk factors include being between the age of 55 to 74, having smoked for 30 years or more, and either continuing to smoke or having quit within the past 15 years. 50

PREVENTION OF LUNG CANCER Managing risk factors examples? From 7: 47 onwards https: //www. youtube. com/watch? v=Urn_ztf 3 Tc. Q 51

QUIT SMOKING ! https: //www. youtube. com/watch? v=f. Lb. Qf. Mmr. ISE 52

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REFERENCES http: //www. lungcancer. org/find_information/publicati ons/163 -lung_cancer_101/265 http: //tobaccocontrol. bmj. com/content/21/2/87. full http: //www. surgeongeneral. gov/library/reports/ 61