otto visser june 2019 9 visser_lung... · 0 100 200 300 400 500 600 700 800
TRANSCRIPT
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Lung cancer
Otto VisserJune 2019
Coding issues
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Introduction
• Epidemiological information
• Incidence & mortality trend in Europe, survival
• Distribution according to age and sex
• Risk factors
• (Diagnostics & staging procedures)
• Topography & morphology
• Stage
• Treatment
• Quality issues
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Incidence of lung cancer in Europe in 2018
males females
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0
100
200
300
400
500
600
700
800
<35 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95+
males 1989
males 2018
females 1989
females 2018
Netherlands
Age specific incidence of lung cancer by sex
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0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Bul
garia
Wal
es
Lith
uani
a
Mal
ta
Eng
land
N Ir
elan
d
Sco
tland
Irel
and
Latv
ia
Est
onia
Cze
chia
Den
mar
k
Cro
atia
Slo
vaki
a
Slo
veni
a
Por
tuga
l
Nor
way
Spa
in
Pol
and
EU
RO
PE
Fin
land
Net
herla
nds
Icel
and
Sw
eden
Italy
Ger
man
y
Aus
tria
Fra
nce
Sw
itzer
land
Bel
gium
one year
five year
Relative survival of lung cancer (2000-2007)
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Risk factors & Symptoms
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Risk factors
• Smoking
• Radiation
• Radon
• Small dust particals
• Asbestos
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Symptoms
• Often no or only aspecific symptoms such as weight loss, fever, loss of appetite or fatigue
• Cough, hemoptoë
• Short of breath, stridor
• Pain on the chest
• Atelectasis (collapse of the lung)
• Hoarseness
Absence of symptoms is the main reason for the high stage at diagnosis
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Topography
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Trachea C33.9
Main bronchus C34.0
Middle lobe C34.2
Lower lobe C34.3
Upper lobe C34.1
Overlapping C34.8NOS C34.9
5 lobes (2 left and 3 right) which are composed of a total of 20 segments
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Morphology
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New morphology codes/terms in ICD-O-3
Code Term
8250/2 Adenocarcinoma in situ, non-mucinous
8253/2 Adenocarcinoma in situ, mucinous
8250/3 Bronchiolo-alveolar adenocarcinoma � Lepidic adenocarcinoma
8256/3 Minimally invasive adenocarcinoma, non-mucinous (C34._)
8257/3 Minimally invasive adenocarcinoma, mucinous (C34._)
Bronchiolo-alveolar adenocarcinoma = Adenocarcinoma of the lung
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Overview
Term ICD-O-3 2nd revision
Adenocarcinoma in situ, non-mucinous 8250/2
Adenocarcinoma in situ, mucinous 8253/2
Lepidic adenocarcinoma (Bronchiolo-alveolar carcinoma, NOS) 8250/3
Bronchiolo-alveolar carcinoma, non-mucinous 8252/3
Bronchiolo-alveolar carcinoma, mucinous 8253/3
Bronchiolo-alveolar carcinoma, mixed mucinous and non-mucinous 8254/3
Minimally invasive adenocarcinoma, non-mucinous 8256/3
Minimally invasive adenocarcinoma, mucinous 8257/3
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Morphology: clinical
• Small cell carcinoma
• Non-small cell carcinoma
• Squamous cell carcinoma
• Adenocarcinoma
• Large cell carcinoma
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Morphology: pathological
• Neuro-endocrine tumours/carcinomas
• Carcinoid/NET gr 1
• Atypical carcinoid/NET gr 2
• Large cell neuro-endocrine carcinoma
• Small cell carcinoma
• Non-epithelial cancers
• Sarcoma
• Non-small cell carcinoma
• Squamous cell carcinoma
• Adenocarcinoma
• Large cell carcinoma
• Rare carcinoma subtypes
• Unspecified cancers
(no pathology)
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Morphology and topography
• Squamous cell carcinoma and small cell carcinoma are mostly located in the central parts of the lung (main bronchus and its branches)
• Adenocarcinoma is mostly located in more peripheral parts of the lung (the alveoli of the lung)
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Large cell carcinoma & carcinoma, NOS
• Large cell carcinoma (8012) is not really a subtype, but only descriptive (‘large cells’)
• Adenocarcinoma and squamous cell carcinoma have also large cells
• If next to large cell carcinoma another diagnosis is available, the more specific one has preference
• Try also to avoid the use of ‘carcinoma, NOS’ (8010) and ‘non-small cell lung cancer’ (8046)
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Morphology: distribution by sex (EU 2012)
[CATEGORI
ENAAM][PERCENTA
GE]
SCC
14%
NET/NEC
16%
large cell
carcinoma17%
other
1% unspecified
16%
males females
[CATEGORI
ENAAM][PERCENTA
GE]
SCC
27%
NET/NEC
13%
large cell
carcinoma15%
other
1% unspecified
18%
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
15 6 12 5 23 9 2 19 20 27 1 16 21 14 8 11 EU 25 29 7 13 26 10 18 17 4 22 28 24 3
adeno
squamous cell
NET/NEC
large cell
other
unspecified
Morphology by country: males
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
23 12 15 19 2 5 6 9 11 20 21 27 16 1 8
EU 26 14 18 25 7 13 10 4 29 17 24 28 3 22
adeno
squamous cell
NET/NEC
large cell
other
unspecified
Morphology by country: females
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Morphology: subtypes of adenocarcinoma
• Adenocarcinoma
• Acinar (8550)
• Bonchiolo-alveolar/lepidic (8250); mucinous (8253); non-mucinous (8252); mixed (8254)
• Mucinous (8480/8481)
• Papillary (8260)
• Solid (8230)
• Rare types
• Salivary gland tumours
• Muco-epidermoid (8430)
• Adenoid cystic (8200)
• Epithelial-myoepithelial (8562)
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Treatment
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• Stage I & II: surgery / radiotherapy
• Stage III: chemoradiotherapy
• Stage IV: systemic treatment (chemotherapy or targeted therapy), palliative radiotherapy
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Surgery
Sleeve lobectomy
Carina resection
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Targeted therapy
• A number of drugs have been developed or are being developed that target several processes in the cancers cells
• Depending on the type of aberration in the cancer cell the drug will be effective (or not)
• Resistance to the drug often develops after some time as the cancer cells may change at cell division
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EXERCISES
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www.encr.eu