7/30/2019 Lung Cancer Intr n Class

1/36

LUNG CANCER

Sutjahjo Endardjo

Departemen Medik Patologi AnatomikFKUI/RS Cipto Mangunkusumo

7/30/2019 Lung Cancer Intr n Class

2/36

7/30/2019 Lung Cancer Intr n Class

3/36

Primary carcinoma of the lung Most common primary malignant tumor

in the world

Directly related to cigarette smoking(95% of patients related to smoking)

Associated with occupational exposure

to carcinogens Overall 5-year survival rate of 4-7%

7/30/2019 Lung Cancer Intr n Class

4/36

Estimated new cases and

deaths (US 2008) New cases: 215,020

Deaths: 161,840

7/30/2019 Lung Cancer Intr n Class

5/36

Pathological conditions which areassociated with development of

malignancy Malignant transformation of benign

tumors: adenoma -> colonic ca

Chronic inflammatory conditions:ulcerative colitis -> cancer,tuberculoma-> lung cancer

Intraepithelial neoplasia: metaplasia,dysplasia, carcinoma in situ

7/30/2019 Lung Cancer Intr n Class

6/36

CARCINOGENESIS Chemicals: industrial aniline dyes;

asbestos,

social habits- cigarette smoking,

diet aflatoxin.

Radiation

Viruses: HPV, Hepatitis B, EBV

7/30/2019 Lung Cancer Intr n Class

7/36

Pathogenesis SCC

7/30/2019 Lung Cancer Intr n Class

8/36

SYMPTOMS a cough that gets worse or does not go away

breathing trouble, such as shortness of

breath constant chest pain

coughing up blood

a hoarse voice frequent lung infections, such as pneumonia

feeling very tired all the time

weight loss with no known cause

http://www.cancer.gov/dictionary/db_alpha.aspx?expand=ihttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=phttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=phttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=i

7/30/2019 Lung Cancer Intr n Class

9/36

SYMPTOMS

7/30/2019 Lung Cancer Intr n Class

10/36

SYMPTOMS

7/30/2019 Lung Cancer Intr n Class

11/36

SYMPTOMS

7/30/2019 Lung Cancer Intr n Class

12/36

7/30/2019 Lung Cancer Intr n Class

13/36

7/30/2019 Lung Cancer Intr n Class

14/36

Epitheliallining of the

LUNG

7/30/2019 Lung Cancer Intr n Class

15/36

7/30/2019 Lung Cancer Intr n Class

16/36

HISTOLOGICAL Classification

(WHO, 1999) Squamous cell carcinoma(SCC)

Adenocarcinoma(Adeno)

Large cell carcinoma(LCC)

Small cell carcinoma(SCLC)

Neuroendocrine(carcinoid)

Other

7/30/2019 Lung Cancer Intr n Class

17/36

Squamous cell Ca (SCC) Histologi

Sitologi

7/30/2019 Lung Cancer Intr n Class

18/36

Adenocarcinoma(Adeno) Histologi

Sitologi

7/30/2019 Lung Cancer Intr n Class

19/36

Large cell Ca (LCC) Histologi

Sitologi

7/30/2019 Lung Cancer Intr n Class

20/36

Small cell lung Ca (SCLC) Histologi

Sitologi

7/30/2019 Lung Cancer Intr n Class

21/36

Carcinoid

typical atypic

7/30/2019 Lung Cancer Intr n Class

22/36

7/30/2019 Lung Cancer Intr n Class

23/36

7/30/2019 Lung Cancer Intr n Class

24/36

Perspectives in lung cancer1.Estimated 1.3 million new cases will be

diagnosed annually

2.Adenocarcinoma is the major histologicalsubtype

3.Increasing the incidence of typical & atypicalcarcinoid and large cell neuroendocrine

tumors4.Decreasing the incidence of small cell

carcinomaHansen: 2nd International Chicago Symposium on Malignacies of Chest and Head & Neck, October 2001

7/30/2019 Lung Cancer Intr n Class

25/36

SPECIMENS for DIAGNOSIS Histopathology

- surgical specimen

- biopsied specimen

Cytology

- sputum, bronchial washing / brushing- transthoracal needle aspiration(TTNA)

- transbronchial needle aspiration

- pleural fluid

7/30/2019 Lung Cancer Intr n Class

26/36

Processing specimen Histopathology

Frozen section

- hematoxilin eosin

- histokimia

- immunohistology

Fixation- 10% formaline

- fresh

Cytology

- papanicolaou

- giemsa- diff-quick

- sitokimia

- immunocytology Fixation

- 95% alcohol

- dry

7/30/2019 Lung Cancer Intr n Class

27/36

CYTOLOGY of LUNG Cancer in

RSUP Persahabatan 2000-2001Type N %

Adeno 172 76

SCC 52 23

LCC 3 1

SCLC - -

Carcinoid - -

7/30/2019 Lung Cancer Intr n Class

28/36

Positivity of specimens

RSUP Persahabatan 2000-2001Specimen Total Malignant %

Surgical 138 36 26

TTB 459 135 29

Wash/Brus 834 91 11S.Endardjo, 2001

7/30/2019 Lung Cancer Intr n Class

29/36

Positivity of sputum cytologyCara

periksaDirect

%

Inhalation

%

Saccomano

%

Endardjo1990

5.2

Astowo

1995

16 26

Titin M S

2002

4.3 18.3

7/30/2019 Lung Cancer Intr n Class

30/36

Collecting sputum Sputum early morning

No dental-brushing

Deep cough, can be induced

Collect in a clean tray

Send to PathLab as soon as possible/smear on glass object and fix intoalcohol 95% or put into saccomanosolution

7/30/2019 Lung Cancer Intr n Class

31/36

Para-neoplastic symptoms

7/30/2019 Lung Cancer Intr n Class

32/36

Para-neoplastic symptoms

7/30/2019 Lung Cancer Intr n Class

33/36

Para-neoplastic symptoms

7/30/2019 Lung Cancer Intr n Class

34/36

Stages of Small Cell Lung Cancer

using two stages:Limited stage: Cancer is found only in onelung and its nearby tissues.

Extensive stage: Cancer is found in tissues ofthe chest outside of the lung in which it began.Or cancer is found in distant organs.

7/30/2019 Lung Cancer Intr n Class

35/36

Stages of Non-Small Cell Lung Cancer.

Stage 0:Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through this l ining. A Stage 0 tumor is also calledcarcinoma in situ. The tumor is not an invasive cancer.

Stage IA: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no morethan 3 centimeters across (less than 1 inches).

Stage IB: The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes. .

Stage IIA:The lung tumor is no more than 3 centimeters across. Cancer cells are found in nearby lymph nodes.

Stage IIB: The tumor is one of the following:Cancer cells are not found in nearby lymph nodes, but the tumor has invaded the chest wall, diaphragm, pleura, main bronchus, or tissue

that surrounds the heart (see the picture of the diaphragm).

Stage IIIA: The tumor may be any size. Cancer cells are found in the lymph nodes near the lungs and bronchi, and in the lymph nodes between thelungs but on the same side of the chest as the lung tumor.

Stage IIIB: The tumor may be any size. Cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumor mayhave invaded nearby organs, such as the heart, esophagus, or trachea. More than one malignant growth may be found within the same lobe of the lung.

The doctor may find cancer cells in the pleural fluid.

Stage IV:Malignant growths may be found in more than one lobe of the same lung or in the other lung. Or cancer cells may be found in other partsof the body, such as the brain, adrenal gland, liver, or bone.

http://www.cancer.gov/dictionary/db_alpha.aspx?expand=chttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=ihttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=ihttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=dhttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=dhttp://www.cancer.gov/cancertopics/wyntk/lung/page2http://www.cancer.gov/dictionary/db_alpha.aspx?expand=ehttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=ehttp://www.cancer.gov/cancertopics/wyntk/lung/page2http://www.cancer.gov/dictionary/db_alpha.aspx?expand=dhttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=ihttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=c

7/30/2019 Lung Cancer Intr n Class

36/36

Important points (lung ca) 5-year survival rate is very low

Incidence increasing

Screening is expensive

Related to cigarettes smoking and othercarcinogens

Adenocarcinoma type increasing

Need a certain diagnosticability/approach