Malignant transformation of benign tumors: adenoma -> colonic ca. ▫ Chronic
inflammatory conditions: ulcerative colitis -> cancer, tuberculoma-> lung cancer.
LUNG CANCER Sutjahjo Endardjo Departemen Medik Patologi Anatomik FKUI/RS Cipto Mangunkusumo
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%
Estimated new cases and deaths (US 2008)
New cases: 215,020 Deaths: 161,840
Pathological conditions which are associated 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
CARCINOGENESIS
Chemicals: industrial – aniline dyes; asbestos, social habits - cigarette smoking, diet – aflatoxin. Radiation Viruses: HPV, Hepatitis B, EBV
Pathogenesis SCC
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
SYMPTOMS
SYMPTOMS
SYMPTOMS
Epithelial lining of the LUNG
HISTOLOGICAL Classification (WHO, 1999)
Squamous cell carcinoma(SCC) Adenocarcinoma(Adeno) Large cell carcinoma(LCC) Small cell carcinoma(SCLC) Neuroendocrine(carcinoid) Other
Squamous cell Ca (SCC)
Histologi
Sitologi
Adenocarcinoma(Adeno)
Histologi
Sitologi
Large cell Ca (LCC)
Histologi
Sitologi
Small cell lung Ca (SCLC)
Histologi
Sitologi
Carcinoid typical
atypic
Perspectives in lung cancer
1.Estimated 1.3 million new cases will be diagnosed annually 2.Adenocarcinoma is the major histological subtype 3.Increasing the incidence of typical & atypical carcinoid and large cell neuroendocrine tumors 4.Decreasing the incidence of small cell carcinoma Hansen: 2nd International Chicago Symposium on Malignacies of Chest and Head & Neck, October 2001
SPECIMENS for DIAGNOSIS
Histopathology - surgical specimen - biopsied specimen Cytology - sputum, bronchial washing / brushing - transthoracal needle aspiration(TTNA) - transbronchial needle aspiration - pleural fluid
Processing specimen
Histopathology Frozen section - hematoxilin eosin - histokimia - immunohistology Fixation - 10% formaline - fresh
Cytology - papanicolaou - giemsa - diff-quick - sitokimia - immunocytology Fixation - 95% alcohol - dry
CYTOLOGY of LUNG Cancer in RSUP Persahabatan 2000-2001 Type
N
%
Adeno
172
76
SCC
52
23
LCC
3
1
SCLC
-
-
Carcinoid
-
-
Positivity of specimens
RSUP Persahabatan 2000-2001 Specimen Surgical
Total 138
Malignant 36
% 26
TTB
459
135
29
Wash/Brus
834
91
11
S.Endardjo, 2001
Positivity of sputum cytology Cara periksa
Endardjo 1990 Astowo 1995 Titin M S 2002
Direct %
Inhalation Saccomano % %
5.2 16
26 4.3
18.3
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 into alcohol 95% or put into saccomano solution
Para-neoplastic symptoms
Para-neoplastic symptoms
Para-neoplastic symptoms
Stages of Small Cell Lung Cancer using two stages: Limited stage: Cancer is found only in one lung and its nearby tissues. Extensive stage: Cancer is found in tissues of the chest outside of the lung in which it began. Or cancer is found in distant organs.
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 lining. A Stage 0 tumor is also called carcinoma 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 more than 3 centimeters across (less than 1 ¼ 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 the lungs 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 may have 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 parts of the body, such as the brain, adrenal gland, liver, or bone.
Important points (lung ca)
5-year survival rate is very low Incidence increasing Screening is expensive Related to cigarettes smoking and other carcinogens Adenocarcinoma type increasing Need a certain diagnostic ability/approach
