Lung cancer is the second most common cancer diagnosed in the UK after breast cancer.

2. Lung cancer is the second most common cancer diagnosed • in the UK after breast cancer. • Lung cancer is the second most common cancer in men after • prostate cancer, • Lung cancer is the third most common cancer in women • after breast and bowel cancer. • Around 41,000 people were diagnosed with lung cancer in the UK • in 2008, that’s 112 people every day • Overall, less than 10% of lung cancer patients survive the disease • for at least five years after diagnosis.

4. Cases by Age

6. Lung cancer (C33-34), European Age-standardised Incidence Rates, UK, 1993-2008

10. Age-specific mortality rates of lung cancer, males, England and Wales, 1950-2008

11. Age-specific mortality rates of lung cancer, females, England and Wales, 1950-2008

12. LUNG CANCER - CAUSES • TOBACCO SMOKE

13. LUNG CANCER - CAUSES • TOBACCO SMOKE • ionising radiation • asbestos • fibrosing alveolitis • other industrial chemicals arsenic chloromethyl ethers chromium nickel polyaromatic hydrocarbons vinyl chloride

14. LUNG CANCER - CAUSES • Smoking causes almost 90% of lung cancer deaths. • In Britain, 1 in 5 adults smoke cigarettes - 9.5 million people. • Less than 1% of 11 and 12 year olds in England are smokers, • This rises to 15% by age 15 • Stopping smoking before middle age avoids most of the • risk of smoking-related lung cancer. • Living with someone who smokes, increases risk of lung cancer • in non-smokers by about a quarter. • exposure to passive smoke in the home causes around • 11,000 deaths every year in the UK from lung cancer, • stroke and ischaemic heart disease.

15. LUNG CANCER - TYPES LUNG primary secondary (breast, kidney, bladder, testis) PLEURA primary (mesothelioma) secondary (OTHER CELL TYPES)

16. PRIMARY LUNG CANCERS Small cell 24% Non Small cell 76%

17. PRIMARY LUNG CANCERS Large cell 10% Adenocarcinoma 13% Small cell 24% Non Small cell 76% Other 5% Squamous 48%

19. Small Cell Squamous Cell

20. LUNG CANCER CLINICAL PRESENTATION • Symptoms + Chest radiograph • Metastases • Non-metastatic manifestations • (post mortem)

21. LUNG CANCER CLINICAL PRESENTATION cough haemoptysis chest pain breathlessness stridor hoarse voice weight loss facial swelling weeks or months

22. LUNG CANCER CLINICAL EXAMINATION weight loss finger clubbing lymphadenopathy chest assymmetry focal chest signs consolidation fluid hepatomegaly neuropathy

25. LUNG CANCER SPECIFIC PRESENTATIONS PANCOAST SYNDROME

27. LUNG CANCER SPECIFIC PRESENTATIONS Superior Vena Caval Obstruction

31. NON-METASTATIC MANIFESTATIONS Finger clubbing Hypertrophic Pulmonary Osteoarthropathy (HPOA) Hormone syndromes Hypercalcaemia Inappropriate ADH Ectopic ACTH Neuromyopathies Eaton-Lambert Syndrome Peripheral neuropathy Dementia Cerebellar syndrome

32. LUNG CANCER - INVESTIGATION • Confirm diagnosis • Determine cell type • Small cell chemotherapy • Non-small cell is it operable?

33. MAKING AND CONFIRMING THE DIAGNOSIS History Examination Chest radiograph /

34. MAKING AND CONFIRMING THE DIAGNOSIS History Examination Chest radiograph / CT Scan Bloods (FBC, LFTs, Calcium) Fibreoptic bronchoscopy ~ 60% Percutaneous needle biopsy Node biopsy Mediastinoscopy / mediastinotomy Thoracotomy

35. RIGHT MAIN BRONCHUS TUMOUR

38. NON-SMALL CELL - IS IT OPERABLE ? Is the patient fit enough? Is the tumour resectable?

39. NON-SMALL CELL - IS IT OPERABLE ? Is the patient fit enough? General issues Respiratory fitness Cardiovascular fitness

40. NON-SMALL CELL - IS IT OPERABLE ? Is the patient fit enough? Is the tumour resectable? local spread distant spread Staging CT scan FDG-PET scan

41. Tis Carcinoma in situ T1 tumour < 3cm T2 tumour > 3cm T3 <2cm from carina / lung collapse / chest wall, pleura, pericardial invasion T4 mediastinal, heart, great vessel, trachea, oesophagus, vertebral invasion Nx nodes not assessed N0 no lymph node metastasis N1 metastasis to ipsilateral hilar nodes N2 metastasis to ipsilateral mediastinal/subcarinal nodes N3 metastasis to supraclavicular, contralateral hilar/scalene or mediastinal nodes Mx cannot be assessed M0 no distant metastasis M1 distant metastasis

42. STAGE GROUPINGS - NSCLC IA T1 N0 M0 IB T2 N0 M0 IIA T1 N0 M0 IIB T2 N1 M0 T3 N0 M0 IIIA T1-2 N2 M0 IIIB T1-3 N3 M0 T4 N0-3 M0 IV any T, any N, M1 STAGE GROUPINGS - SmallCLC Local Extensive

43. NON-SMALL CELL - IS IT OPERABLE ? Inoperable if: Distant metastasis Mediastinal spread Recurrent laryngeal nerve palsy Phrenic nerve palsy Poor pulmonary function Frequent angina / heart failure Psychological failure

44. THE MULTI-DISCIPLINARY TEAM • Respiratory Physician • Lung cancer nurse specialist • Thoracic surgeon • Histopathologist / Cytopathologist • Radiologist • Oncologist • (Palliative Care • Nuclear Medicine specialist)

45. THE MULTI- DISCIPLINARY TEAM MEETING !

46. LUNG CANCER TREATMENT NON-SMALL CELL Surgery Radical Radiotherapy Palliation symptomatic radiotherapy chemotherapy SMALL CELL Chemotherapy Palliation

47. 130 lung cancers 30 small cell 100 non-small cell 75 inoperable 25 operable 29 die within 1 year 20 operation 5 inoperable 15 recurrent disease 5 cured < 1 cured