Lung Cancer

(Lung cancer)

A lung cancer is the leading cause of cancer deaths worldwide. About 85% of all cases related to cigarette smoking related. Among the symptoms of coughing, tightness in the chest may or pain, weight loss and, less frequently, include hemoptysis. However, many patients present with metastatic disease without clinical symptoms before. The diagnosis is typically made based on chest X-ray or CT and secured with a biopsy. Depending on the stage of the disease, the treatment includes surgery, chemotherapy, radiotherapy or a combination. In recent decades, the prognosis for a patient with lung cancer was poor and only 15% of patients survived> 5 years from the time of diagnosis. In patients with stage IV (metastatic) disease, the 5-year survival rate was <1%. However, the outlook has improved since certain mutations, the treatment may be targeted, have been identified.

A lung cancer is the leading cause of cancer deaths worldwide. About 85% of all cases related to cigarette smoking related. Among the symptoms of coughing, tightness in the chest may or pain, weight loss and, less frequently, include hemoptysis. However, many patients present with metastatic disease without clinical symptoms before. The diagnosis is typically made based on chest X-ray or CT and secured with a biopsy. Depending on the stage of the disease, the treatment includes surgery, chemotherapy, radiotherapy or a combination. In recent decades, the prognosis for a patient with lung cancer was poor and only 15% of patients survived> 5 years from the time of diagnosis. In patients with stage IV (metastatic) disease, the 5-year survival rate was <1%. However, the outlook has improved since certain mutations, the treatment may be targeted, have been identified. Epidemiology In 2014, an estimated 224,210 were diagnosed new cases of lung cancer in the US, while 159,260 people died from the disease. The incidence of lung cancer in men has declined over the past two decades and in women it leveled off and got a slight decline. Etiology Cigarette smoking is the most important cause of lung cancer and is responsible for about 85% of cases. The risk of cancer is different depending on age, smoking intensity and duration of smoking. The risk of lung cancer increases with combined exposure to toxins and cigarette smoking. To the other public or potential risk factors of air pollution, exposure to cigar smoke and passive cigarette smoke and exposure to carcinogens (e.g., as asbestos, radiation, radon, arsenic, chromates, nickel, chloromethyl ethers, polycyclic aromatic hydrocarbons, mustard gas, coke include furnace emissions , primitive cooking, Heizhütten). The cancer risk drops after quitting smoking, but never returns to its initial value. About 15-20% of people who develop lung cancer have never smoked or minimally. Whether and how much exposure to household radon increases the risk of lung cancer is controversial. It is also thought that COPD, alpha-1-Antitryptsin deficiency and pulmonary fibrosis may increase lung cancer susceptibility. People whose lungs by other lung diseases (eg. As tuberculosis) have healed, may have an increased risk of lung cancer. In addition, active smokers who take beta-carotene supplements, have an increased risk of developing lung cancer. Clinical Calculator: estimate of lung cancer risk in smokers and former smokers (within 6 years) The epithelial cells of the respiratory tract requiring continued exposure to carcinogenic substances and accumulation of many genetic mutations before they are neoplastic (an effect which is called Feldkarzinogenese). In some patients with lung cancer secondary or additional mutations in genes that stimulate cell growth causing (K-ras, myc), abnormalities in growth factor receptor signals (EGFR, HER2 / neu), and inhibit apoptosis to contribute to the proliferation of abnormal cells , In addition, mutations may inhibit tumor suppressor genes (p53, APC), lead to cancer. The other mutations that may be responsible, including EML-4-ALK translocation and mutations in ROS-1, BRAF and PI3KCA. Genes such as these that are responsible for lung cancer in the first place, are called oncogenic driver mutations. Although oncogenic driver mutations can cause lung cancer in smokers or contribute to these mutations are particularly common a cause of lung cancer in non-smokers. In 2014er analysis, Lung Cancer mutation Consortium (LCMC) found driver mutations in 64% of 733 cases of lung cancer in smokers and non-smokers (25% K-ras mutations, 17% EGFR mutations, 8% EML-4-ALK and 2% BRAF mutations [1])). Advanced therapies aimed at onkogeneTreiber mutations are developed. In regard to etiology 1. Kris MG, Johnson BE, Berry LD, et al: Using multiplexed assays of oncogenic drivers in lung cancers to select targeted drugs. JAMA 311 (5): 1998-2006, 2014. Classification of lung cancer are divided into 2 main categories: small cell lung cancer (SCLC), about 15% of cases, non-small cell lung cancer (NSCLC), about 85% of SCLC is extremely aggressive and enters almost always in smokers. It grows very fast and about 80% of patients have metastases at diagnosis. The clinical behavior of NSCLC varies more and depends on the histologic type, but about 40% of patients have metastases at diagnosis outside the breast. Oncogenic driver mutations have been identified primarily in adenocarcinoma, although attempts are being made to identify similar mutations in squamous cell carcinoma. Other features of the two categories (. Eg location, risks, treatment, complications) also vary (see Table: Characteristics of lung cancer). Characteristics of lung cancer small cell non-small cell adenocarcinoma property Large Cell% of lung cancer cases 13-15% 35-40% 25-30% 10-15% location submucosa of the airways, perihilar mass Peripheral nodule or mass central, peripheral endobronchial nodule or mass risk factors Smoking Smoking (at 80-85% of patients; 15-20% never or only minimally smoked), smoking and especially Non smoking often have oncogenic driver mutations environmental and occupational exposures (mainly due to radon, asbestos, radiation, passive tobacco smoke, polycyclic aromatic hydrocarbons, arsenic, chromate or nickel) Treatment etoposide plus cisplatin or carboplatin Sometimes irinotecan or topotecan instead of etoposide in disease extensivem stage Concurrent radiotherapy for the disease to a limited Stadium No role for surgical stage I and II: surgery with or without adjuvant therapy stage IIIA: surgery with or without adjuvant therapy or concurrent chemotherapy or radiotherapy, chemotherapy plus radiotherapy and chiru rgischer intervention, chemotherapy with surgery or chemotherapy plus radiotherapy stage IIIB: radiotherapy with or without chemotherapy Stage IV: Systemic targeted therapy or chemotherapy with or without palliative radiotherapy complications SVC syndrome paraneoplastic syndrome hemoptysis, airway obstruction, pneumonia, pleuritic involvement with pain , pleural effusion, SVC syndrome, Pancoast tumor (caused shoulder or arm pain), hoarseness due to laryngeal nerve involvement, neurological symptoms due to brain metastases, pathological fractures by bone metastases, jaundice due to liver metastases five years survival in treatment Limited: 20% Comprehensive: <1% Stage I: 60-70% Stage II: 39-55% Stage III: 5-25% Stage IV: <1% = SVC superior vena cava. Symptoms and complaints About 25% of lung cancer cases are asymptomatic and are discovered by chance in X-ray chest images. The symptoms and complaints may result from local tumor growth, regional spread and distal metastasis. Paraneoplastic syndromes and general symptoms can occur at any stage of the disease. Although the symptoms for classification or histology of the tumor are not specific, certain complications in certain types are more likely (see Table: Characteristics of lung cancer). Local tumor The local tumor causes coughing and dyspnea rare by airway obstruction, atelectasis and postobstruktive parenchymal degradation due to lymphatic spread. Fever can occur in postobstruktiver pneumonia. Up to half of patients experience dull or localized chest pain. Hemoptysis are rare and the blood loss is minimal, except in the rare case in which the tumor eroded a large artery, leading to massive hemoptysis and often death by asphyxiation and exsanguination führt.Regionales growth Regional tumor growth can pleuritic chest pain or dyspnea by the emergence cause of pleural effusion, hoarseness by infiltration of the recurrent laryngeal nerve, as well as dyspnea and hypoxia by diaphragmatic paralysis due to involvement of the phrenic nerve. Vena cava superior (SVC) syndrome results from compression or invasion of the SVC and may cause headache or a feeling of head fullness, swelling of the face or upper extremities, shortness of breath in supine position, dilated veins in the neck, face and upper body, and cause facial and body-Flushing (plethora). A Pancoast syndrome occurs when apical tumors usually NSCLC (Pancoast tumor), the brachial plexus, pleura or ribs infiltrate and cause pain in the shoulder and upper limbs and weakness or atrophy of the ipsilateral hand. For Pancoast syndrome and Horner's syndrome can include. Horner's syndrome (ptosis, miosis, anhidrosis) results in stellate involvement of paravertebral Sympatikusstrangs or cervical ganglion. A tumor growth into the pericardium may be asymptomatic or lead to constrictive pericarditis or pericardial tamponade. In rare cases, a compression of the esophagus by the tumor metastases caused Schluckbeschwerden.Metastasen lead over time to symptoms that vary depending on the location. Metastases can spread to the liver, cause pain, nausea, supersaturation and eventually liver failure. Brain, cause behavioral changes, confusion, aphasia, -, paresis or Plegien, nausea and vomiting, and finally coma and death. Bone pain and pathological fractures cause adrenal glands, rarely cause adrenal insufficiency paraneoplastic syndromes as paraneoplastic syndromes are referred to symptoms that occur in places that are from the tumor or its metastases removed. Common paraneoplastic syndromes in patients with lung cancer are hypercalcemia (in patients with squamous cell carcinoma, which arises because the tumor produces a parathyroid hormone-related protein) syndrome of inappropriate antidiuretic hormone secretion (SIADH) Finger hitting with or without hypertrophic pulmonary osteoarthropathy hypercoagulable with migratiorischer superficial thrombophlebitis (Trousseau's syndrome) myasthenia-like symptoms (Lambert-Eaton syndrome) Cushing's syndrome Several other neurological syndromes other neurological syndromes include neuropathies, encephalopathies, encephalitis, myelopathy and disorders of the cerebellum. Pathological mechanisms of neuromuscular syndromes tumor expression of autoantigens include the production of autoantibodies, but the cause of most other syndromes is unknown. Diagnostic chest X-ray CT or combined PET-CT cytopathology exam of pleural fluid or sputum usually bronchoscopy-guided biopsy and core biopsy Sometimes biopsy of open lung imaging techniques, the first imaging is often a chest x-ray absorption. It can be seen clearly defined pathological findings: z. As solitary or multifocal tumors or a solitary pulmonary nodule, an enlarged hilus, a widened mediastinum, tracheobronchial stenoses, atelectasis, persistent parenchymal infiltrates, caverns or unexplained pleural thickening or -ergüsse. These findings are suggestive, but not diagnostic of lung cancer and require further CT scans or combined PET-CT and a cytopathic diagnosis. Primary lung cancer Image courtesy of Anne S. Tsao, M.D. var model = {thumbnailUrl: '/-/media/manual/professional/images/primary_lung_cancer_orig_high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/primary_lung_cancer_orig_high_de.jpg?la = en & thn = 0 ', title:' Primary lung cancer ', description:' u003Ca id = "v38395519 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eDer chest x-ray shows in the left upper lobe of a non-small lung cancer with mediastinal and hilar lymphadenopathy left. The primary tumor is cavitated and an air-fluid level is present u003c / p u003e u003c / div u003e. 'Credits' Image courtesy of Anne S. Tsao

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