Download - Lung Cancer Intr n Class
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LUNG CANCER
Sutjahjo Endardjo
Departemen Medik Patologi AnatomikFKUI/RS Cipto Mangunkusumo
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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%
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Estimated new cases and
deaths (US 2008) New cases: 215,020
Deaths: 161,840
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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
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CARCINOGENESIS Chemicals: industrial aniline dyes;
asbestos,
social habits- cigarette smoking,
diet aflatoxin.
Radiation
Viruses: HPV, Hepatitis B, EBV
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Pathogenesis SCC
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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 -
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SYMPTOMS
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SYMPTOMS
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SYMPTOMS
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Epitheliallining of the
LUNG
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HISTOLOGICAL Classification
(WHO, 1999) Squamous cell carcinoma(SCC)
Adenocarcinoma(Adeno)
Large cell carcinoma(LCC)
Small cell carcinoma(SCLC)
Neuroendocrine(carcinoid)
Other
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Squamous cell Ca (SCC) Histologi
Sitologi
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Adenocarcinoma(Adeno) Histologi
Sitologi
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Large cell Ca (LCC) Histologi
Sitologi
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Small cell lung Ca (SCLC) Histologi
Sitologi
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Carcinoid
typical atypic
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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
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SPECIMENS for DIAGNOSIS Histopathology
- surgical specimen
- biopsied specimen
Cytology
- sputum, bronchial washing / brushing- transthoracal needle aspiration(TTNA)
- transbronchial needle aspiration
- pleural fluid
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Processing specimen Histopathology
Frozen section
- hematoxilin eosin
- histokimia
- immunohistology
Fixation- 10% formaline
- fresh
Cytology
- papanicolaou
- giemsa- diff-quick
- sitokimia
- immunocytology Fixation
- 95% alcohol
- dry
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CYTOLOGY of LUNG Cancer in
RSUP Persahabatan 2000-2001Type N %
Adeno 172 76
SCC 52 23
LCC 3 1
SCLC - -
Carcinoid - -
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Positivity of specimens
RSUP Persahabatan 2000-2001Specimen Total Malignant %
Surgical 138 36 26
TTB 459 135 29
Wash/Brus 834 91 11S.Endardjo, 2001
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Positivity of sputum cytologyCara
periksaDirect
%
Inhalation
%
Saccomano
%
Endardjo1990
5.2
Astowo
1995
16 26
Titin M S
2002
4.3 18.3
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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
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Para-neoplastic symptoms
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Para-neoplastic symptoms
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Para-neoplastic symptoms
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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.
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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.
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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