Complications of Bronchogenic carcinoma, Prevention and risk factors of lung cancer

Bronchogenic carcinoma is a type of lung cancer that originates in the epithelial cells of the bronchial tree. It is one of the most common and deadliest forms of cancer worldwide, often associated with smoking but also linked to environmental and genetic factors.

Complications of Bronchogenic Carcinoma

  • Destructive spread to other organs, including the brain, liver, bones
  • Pleural effusion.
  • Pneumonia.
  • Lung collapse
  • Pathological fractures in case of spread to bones.

Staging

A. Staging of NSCLC:

  • Stage I, II, IIIA → Operable.
  • Stage 111B, IV Inoperable.

B. Staging of SCLC:

  • Limited stage: Disease confined to a single radiation portal or localized to one hemithorax.
  • Extensive stage: Any disease outside of the hemithorax.
Bronchogenic Carcinoma

Bronchogenic Carcinoma

Prevention

Prevention is the most cost-effective means of mitigating lung cancer development, While in most countries industrial and domestic carcinogens have been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of lung cancer, and smoking cessation is an important preventive tool in this process.

Policy interventions to decrease passive smoking in public areas such as restaurants and workplaces have become more common in many Western countries.

The long-term use of supplemental vitamin A, vitamin C, vitamin D or vitamin E, does not reduce the risk of lung cancer, Some studies suggest that people who eat diets with a higher proportion of vegetables and fruit tend to have a lower risk.

Screening

Screening refers to the use of medical tests to detect disease in asymptomatic people, Possible screening tests for lung cancer include sputum cytology, chest radiograph, and computed tomography (CT). Screening programs using CXR or cytology have not demonstrated any benefit. Screening those at high risk (i.e. age 55 to 79 who have smoked more than 30 pack years or those who have had previous lung cancer) annually with low-dose CT scans may be of much benefit.

Treatment

A. Surgery

  • In most cases of early-stage non-small cell lung cancer, removal of a lobe of the lung (lobectomy) is the surgical treatment of choice.
  • In patients who are unfit for a full lobectomy, a smaller sub-lobar excision (wedge resection) may be performed. However, wedge resection has a higher risk of recurrent disease than lobectomy.
  • Rarely, the removal of a whole lung (pneumonectomy) is performed.

B. Radiotherapy:

Radiotherapy is often given together with chemotherapy and may be used with curative intent in patients with non-small cell lung carcinoma who are not eligible. for surgery. This form of high-intensity radiotherapy is called radical radiotherapy.

A refinement of this technique is continuous hyperifactionated accelerated radiotherapy (CHART), in which a high dose of radiotherapy is given in a short time period. Post-operative thoracic radiotherapy generally should not be used after curative intent surgery for non-small cell lung carcinoma. Some patients with mediastinal N2 lymph node involvement might benefit from post-operative radiotherapy.

For small-cell lung carcinoma cases that are potentially curable, chest radiotherapy is often recommended in addition to chemotherapy. If cancer growth blocks a short section of the bronchus, brachytherapy (localized radiotherapy) may be given directly inside the airway to open the passage.

Compared to external beam radiotherapy, brachytherapy allows a reduction in treatment time and reduced radiation exposure to healthcare staff. Prophylactic cranial irradiation (PCI) is a type of radiotherapy for the brain used to reduce the risk of metastasis. For both non-small cell lung carcinoma and small cell lung carcinoma patients, smaller doses of radiation to the chest may be used for symptom control (palliative radiotherapy).

C. Chemotherapy

In SCLC: Even if relatively early stage, small cell lung carcinoma is treated primarily with chemotherapy and radiation. In small-cell lung carcinoma, cisplatin and etoposide are most commonly used. Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, topotecan, and irinotecan are also used

In NSCLC: In advanced non-small cell lung carcinoma, chemotherapy improves survival and is used as first-line treatment, provided the patient is well enough for the treatment. Typically, two drugs are used, of which one is often platinum-based (either cisplatin or carboplatin). Other commonly used drugs are gemcitabine, paclitaxel, and docetaxel.

Advanced non-small cell lung carcinoma is often treated with cisplatin or carboplatin, in combination with gemcitabine, paclitaxel, docetaxel, etoposide, or vinorelbine. Recently, pemetrexed has become available.

Adjuvant Chemotherapy: refers to the use of chemotherapy after apparently curative surgery to improve the outcome. In non-small cell lung carcinoma, samples are taken of nearby lymph nodes during surgery to assist staging. If stage II or III disease is confirmed, adjuvant chemotherapy improves survival by 5% at 5 years. The combination of vinorelbine and cisplatin is more effective than older regimens.

D. Palliative care:

In patients with terminal disease, palliative care or hospice management may be appropriate. These approaches allow additional discussion of treatment options and provide opportunities to arrive at well-considered decisions and may avoid unhelpful but expensive care at the end of life.

Chemotherapy may be combined with palliative care in the treatment of non-small cell lung carcinoma. In advanced NSCLC, appropriate chemotherapy improves average survival over supportive care alone, as well as improving quality of life. With adequate physical fitness, maintaining chemotherapy during lung cancer palliation offers a 1.5 to 3 months prolongation of survival, symptomatic relief, and an improvement in quality of life, with better results seen with modern agents.

Prognosis

Prognostic factors in non-small cell lung carcinoma include the presence or absence of pulmonary symptoms, tumor size, cell type (histology), degree of spread (stage) and metastases to multiple lymph nodes, and vascular invasion. For patients with inoperable disease, the prognosis is adversely affected by poor performance status and weight loss of more than 10%. Prognostic factors in small cell lung cancer include performance status, gender, stage of disease, and involvement of the central nervous system or liver at the time of diagnosis.

The prognosis is generally poor. Of all patients with lung cancer, 15% survive for five years after diagnosis. The stage is often advanced at the time of diagnosis. At presentation, 30^4-0% of cases of non-small cell lung carcinoma (NSCLC) are stage IV, and 60% of small cell lung carcinoma (SCLC) are stage IV.

For NSCLC, the best prognosis is achieved with complete surgical resection of stage IA disease, with up to 70% five-year survival. For SCLC, the overall five-year survival for patients is about 5%. Patients with extensive-stage SCLC have an average five-year survival rate of less than 1%. The median survival time for limited-stage disease is 20 months, with a five-year survival rate of 20%.

Lung cancer arises from the bronchial tree or lung parenchyma. Centrally located lung tumours (near hilum) should be differentiated from mediastinal lesions.

Mediastinal lesions are lesions found inside the mediastinum. The mediastinum is the area that separates the right lung from the left lung. An imaginary line in the lateral film of chest X-ray extending horizontally from the manubro-stemal joints separates the superior mediastinum (above this line) from the other compartments of the mediastinum. The region of cardiac shadow in the lateral film represents the site of the middle mediastinum and separates the anterior mediastinum (anterior to it) from the posterior mediastinum (posterior to it).

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