Download - Large cell carcinoma
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Large cell carcinoma
•Accounts for 5-10% of all lung cancers .
•Strongly associated with cigarette smoking.
• The lesion occurs peripherally and grows
rapidly, with early metastases and a poor
outcome •They lack any diagnosic
features to suggest their diagnosis prior to biopsy .
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Pancoast tumors •Represent 1-3% of all lung cancers. •Typically involve the lower trunks of the
brachial plexus, intercostal nerves, stellate ganglion, adjacent ribs, and vertebrae.
• More than 95% are NSCC .•Horner's syndrome, mediastinal and
supraclavicular adenopathy and vertebral body invasion portends a poorer prognosis
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Pancoast Tumours Imaging
•MRI is more accurate in identification of the extent of tumor involvement; it is superior to CT scanning in
the detection of invasion of adjacent organs (eg, vertebral bodies, brachial plexus, subclavian vessels).
• CT or MRI of the brain is recommended in the initial evaluation, because distant metastases to the brain
are not infrequent •
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Differential Diagnosis of an opacity at the Superior Sulcus
•Mesothelioma.•Lymphoma.•Plasmacytoma.•Metastatic malignancies (thyroid, larynx).•Lymphomatoid granulomatosis.•Cervical rib syndrome.•Tuberculosis.•Fungal infections.
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Small Cell Lung Cancer•strong association with smoking
.•Rapid growth.•Early spread to distant sites.•Exquisite sensitivity to chemo
and radiotherapy.•Frequent association with
distinct paraneoplastic syndromes .
•Surgery usually plays no role in its management, except in rare
situations (<5% of patients) in which it presents at a very early
stage as a solitary pulmonary nodule
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Small cell lung cancer•18% of all lung cancers.•Often present with bulky
hila and mediastinal lymph node masses .
•TNM system does not provide important
prognostic information; only useful in <5%.
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Staging of Small Cell Carcinoma Stage Description
Limited stage Disease confined to one hemithorax; includes involvement of mediastinal, contralateral hilar, and/or supraclavicular and scalene lymph nodes.
Extensive stage
Disease has spread beyond the definition of limited stage, or malignant pleural effusion is present
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•With central tumors, distinguishing primary tumor from lymph node
metastasis may be impossible
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International Staging System for Lung Cancer
•This is the common evaluation framework,because, patient treatment
options and prognosis are directly related to their tumor stage at presentation.
•Derived from a TNM classification scheme with four separate stage groups from I to IV.
Stage I reflects the best prognosis, stage IV the worst .
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Tumor (T)
–TX - Positive malignant cytology, no lesion seen –T1 - Diameter smaller than or equal to 3 cm –T2 - Diameter larger than 3 cm –T3 - Extension to pleura, chest wall, diaphragm,
pericardium, within 2 cm of carina, or total atelectasis –T4 - Invasion of mediastinal organs (eg, esophagus,
trachea, great vessels, heart), malignant pleural effusion, or satellite nodules within the primary lobe
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T1 Tumor
•Diameter of 3 cm or smaller ,
surrounded by lung or visceral
pleura.
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T2: A tumor with any of the following features:
•Larger than 3 cm.•Associated with
atelectasis or post-obstructive
pneumonitis that does not involve the entire
lung. •Invades the visceral
pleura.
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T3: A tumor of any size that directly invades any of the following:
•The chest wall (including superior
sulcus tumors), diaphragm,
mediastinal pleura, parietal pericardium.
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T3: A tumor of any size that directly invades any of the following
•Tumor in the main bronchus less than 2 cm distal to the carina (but without involvement of
the carina).•Tumor associated with
atelectasis or obstructive pneumonitis
of the entire lung .
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