LUNG CANCER

PNEUMONIA

DEL CASTILLO, KRYZTAL ANNE

MARSAMOLO, KIMBERLEY M.

Report by: Ms. Glenda Gay I.

Del Castillo, Abapo
 CASE STUDY

A 20-year-old man with no history of tobacco use presented

with a several-months history of cough and lower back pain,
and an 11.3-kg weight loss. The patient was diagnosed with
pneumonia and was started on antibiotics, but he did not
improve.
LUNG CANCER IS A TYPE OF CANCER THAT BEGINS IN THE LUNGS.
YOUR LUNGS ARE TWO SPONGY ORGANS IN YOUR CHEST THAT TAKE IN
OXYGEN WHEN YOU INHALE AND RELEASE CARBON DIOXIDE WHEN YOU
EXHALE.

LUNG CANCER CLAIMS MORE LIVES EACH YEAR THAN DO COLON,

PROSTATE, OVARIAN AND BREAST CANCERS COMBINED (MAYOCLINIC
NEWS, 2016).

PEOPLE WHO SMOKE HAVE THE GREATEST RISK OF LUNG CANCER. THE
RISK OF LUNG CANCER INCREASES WITH THE LENGTH OF TIME AND
NUMBER OF CIGARETTES YOU'VE SMOKED.

LUNG CANCER TYPICALLY DOESN'T CAUSE SIGNS AND SYMPTOMS IN ITS

EARLIEST STAGES. SIGNS AND SYMPTOMS OF LUNG CANCER TYPICALLY
OCCUR ONLY WHEN THE DISEASE IS ADVANCED.
 RELATED TERMS:

BENIGN does not invade surrounding tissues

MALIGNANT it invades and metastasize to all parts of the body, fatal,
cancer
CYST an abnormal sac or closed cavity filled with liquid or semisolid
matter
TUMOR mass that is observed as a lump in the body
Can be: Benign tumor/Malignant tumor
 There are (3) three main types of lung cancer
Non-Small Cell Lung Cancer
This is the most common type of lung cancer. About 85% of lung cancers are
non-small cell lung cancers. Squamous cell carcinoma, adenocarcinoma, and
large cell carcinoma are all subtypes of non-small cell lung cancer. This is
usually the stage 1 cancer.
Small Cell Lung Cancer
Small cell lung cancer is also called oat cell cancer. About 10%-15% of lung
cancers are small cell lung cancers. This type of lung cancer tends to spread
quickly.
Lung Carcinoid Tumor
Fewer than 5% of lung cancers are lung carcinoid tumors. They are also
sometimes called lung neuroendocrine tumors. Most of these tumors grow
slowly and rarely spread.
 A number of factors may increase your risk of lung cancer. Some risk factors can be
controlled, for instance, by quitting smoking. And other factors can't be controlled, such
as your family history.
Risk factors for lung cancer include:
Smoking.Your risk of lung cancer increases with the number of cigarettes you smoke
each day and the number of years you have smoked. Quitting at any age can
significantly lower your risk of developing lung cancer.
Exposure to secondhand smoke.Even if you don't smoke, your risk of lung cancer
increases if you're exposed to secondhand smoke.
Exposure to radon gas.Radon is produced by the natural breakdown of uranium in
soil, rock and water that eventually becomes part of the air you breathe. Unsafe levels
of radon can accumulate in any building, including homes.
Radon testing kits, which can be purchased at home improvement stores, can determine
whether levels are safe. If unsafe levels are discovered, remedies are available.
Exposure to asbestos and other carcinogens.Workplace exposure to asbestos and
other substances known to cause cancer such as arsenic, chromium and nickel also
can increase your risk of developing lung cancer, especially if you're a smoker.
Family history of lung cancer.People with a parent, sibling or child with lung cancer
have an increased risk of the disease.
WHAT CAUSES CANCER?
Cancer is ultimately the result of cells that uncontrollably grow
and do not die. Normal cells in the body follow an orderly path of
growth, division, and death. Programmed cell death is called
apoptosis, and when this process breaks down, cancer begins to
form. Unlike regular cells, cancer cells do not experience
programmatic death and instead continue to grow and divide.
This leads to a mass of abnormal cells that grows out of control.

Lung cancer occurs when a lung cell's gene mutation

makes the cell unable to correct DNA damage and unable
to commit suicide. Mutations can occur for a variety of
reasons. Most lung cancers are the result of inhaling
carcinogenic substances.
CARCINOGENS
Carcinogens are a class of substances that are directly responsible for damaging
DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic, radiation such as
gamma and x-rays, the sun, and compounds in car exhaust fumes are all
examples of carcinogens. When our bodies are exposed to carcinogens, free
radicals are formed that try to steal electrons from other molecules in the body.
These free radicals damage cells and affect their ability to function and divide
normally.
About 87% of lung cancers are related to smoking and inhaling the carcinogens in
tobacco smoke. Even exposure to second-hand smoke can damage cells so that
cancer forms.
GENES
Cancer can be the result of a genetic predisposition that is inherited from family
members. It is possible to be born with certain genetic mutations or a fault in a
gene that makes one statistically more likely to develop cancer later in life.
Genetic predispositions are thought to either directly cause lung cancer or greatly
increase one's chances of developing lung cancer from exposure to certain
environmental factors.
SIGNS AND SYMPTOMS OF LUNG CANCER MAY INCLUDE:

A NEW COUGH THAT DOESN'T GO AWAY

CHANGES IN A CHRONIC COUGH OR "SMOKER'S COUGH
COUGHING UP BLOOD, EVEN A SMALL AMOUNT
SHORTNESS OF BREATH
CHEST PAIN
WHEEZING
HOARSENESS
LOSING WEIGHT WITHOUT TRYING
BONE PAIN
HEADACHE
Lung cancer can cause COMPLICATIONS, such as:

Shortness of breath.People with lung cancer can experience

shortness of breath if cancer grows to block the major airways. Lung
cancer can also cause fluid to accumulate around the lungs, making it
harder for the affected lung to expand fully when you inhale.

Coughing up blood.Lung cancer can cause bleeding in the airway,

which can cause you to cough up blood (hemoptysis). Sometimes
bleeding can become severe. Treatments are available to control
bleeding.

Pain.Advanced lung cancer that spreads to the lining of a lung or to

another area of the body, such as a bone, can cause pain.
 Fluid in the chest (pleural effusion).Lung cancer can cause fluid to
accumulate in the space that surrounds the affected lung in the chest
cavity (pleural space).

Cancer that spreads to other parts of the body

(metastasis).Lung cancer often spreads (metastasizes) to other parts
of the body, such as the brain and the bones.

Cancer that spreads can cause pain, nausea, headaches, or other signs
and symptoms depending on what organ is affected. Once lung cancer
has spread to other organs, it's generally not curable. Treatments are
available to decrease signs and symptoms and to help you live longer.
 DIAGNOSTIC TESTS:
Imaging tests.
an x-ray image of your lungs may reveal an abnormal mass or nodule.
A CT scan can reveal small lesions in your lungs that might not be
detected on an x-ray.

Sputum cytology.
if you have a cough and are producing sputum, looking at the sputum
under the microscope can sometimes reveal the presence of lung
cancer cells.

Tissue sample (biopsy).

a sample of abnormal cells may be removed in a procedure called a
biopsy.
 STAGES OF LUNG CANCER
Stage I.
Cancer is limited only in the lung and hasn't spread to the
lymph nodes. The tumor is generally smaller than 2 inches (5
centimeters) across.

Stage II.
The tumor at this stage may have grown larger than 2 inches,
or it may be a smaller tumor that involves nearby structures,
such as the chest wall, the diaphragm or the lining around the
lungs (pleura). Cancer may also have spread in the lung and to
the nearby lymph nodes.
Stage III.
The tumor at this stage may have grown very large and invaded other
organs near the lungs and this stage may indicate a smaller tumor
accompanied by cancer cells in lymph nodes farther away from the
lungs. Cancer is found in the lung and in the lymph nodes in the middle
of the chest, also described as locally advanced disease. Stage III has
two subtypes:
If
the cancer has spread only to lymph nodes on the same side of the
chest where the cancer started, it is called stage IIIA.
If the cancer has spread to the lymph nodes on the opposite side of the
chest, or above the collar bone, it is called stage IIIB.

Stage IV.
Cancer has spread beyond the affected lung to the other lung or to
distant areas of the body and to other parts such as the liver or other
organs.
 Treatment for lung cancer primarily involves surgical removal
of the cancer, chemotherapy, or radiation therapy, as well as
combinations of these treatments. Targeted therapies and
immunotherapy are becoming more common, as well. The
decision about which treatments will be appropriate for a given
individual must take into account the location and extent of the
tumor, as well as the overall health status of the patient.
As with other cancers, therapy may be prescribed that is
intended to be curative (removal or eradication of a cancer) or
palliative (measures that are unable to cure a cancer but can
reduce pain and suffering). More than one type of therapy may
be prescribed. In such cases, the therapy that is added to
enhance the effects of the primarytherapy is referred to as
adjuvant therapy. An example of adjuvant therapy is
chemotherapy or radiotherapy administered after surgical
removal of a tumor in an attempt to kill any tumor cells that
remain following surgery.
ESTABLISHED CANCER TREATMENTS:

SURGERY

RADIATION THERAPY

CHEMOTHERAPY

BIOLOGICAL THERAPY
 SURGERY
Surgery is mostly used to treatnon small cell lung cancer (Stage 1
cancer). But it may be better for you to have other cancer treatment such
asradiotherapy,chemotherapyor possibly both if your cancer is very
near any of the following structures: heart, windpipe, food pipe
(oesophagus), and major blood vessels.
Surgery is not normally used to treatsmall cell lung cancer, except if it is
at a very early stage. This is because small cell lung cancer has usually
spread beyond the lung when it is diagnosed and so it is not then
possible to remove it all with surgery. Chemotherapy and radiotherapy
are more often used than surgery for small cell lung cancer.
The type of surgery you have will depend on the size of the cancer and
its position within the lung.
Lobectomy is the removal of one lobe of the lung.
Bilobectomy is the removal of two lobes of the lung.
 There are fiveprimary procedures that may be done to treat lung cancer:

1. Pneumonectomy:refers to the removal of a whole lung.

2. Lobectomy:one of the lobes of a lung is removed (the right lung has
three lobes, and the left lung has two lobes.)
3. Wedge Resection:the tumor is removed along with a wedge-shaped
area of lung tissue surrounding the tumor.
4. Sleeve Resection:a lobe of the lung, along with part of the bronchus
(the airways leading to the lung,) is removed.
5. Segmentectomy:a segment of a lobe is removed. The amount of tissue
removed by this procedure is more than a wedge resection, but less than a
lobectomy.

Common side effects of surgery include infections, bleeding, and

shortness of breath, depending on lung function prior to surgery and the
amount of lung tissue removed.
 RADIATION THERAPY
Radiotherapy uses high energy rays to kill cancer cells. Cancer
specialists use radiotherapy to treat all types of lung cancer. For early
stage lung cancer, the radiotherapy may aim to get rid of the cancer
completely.
Fornon small cell lung cancer you may have radiotherapy on its own or
you may have it with another treatment, such as chemotherapy or
surgery.
Forsmall cell lung cancer, radiotherapy is sometimes used with or after
chemotherapy. Chemotherapy makes the tumour in the lung shrink.
Giving radiotherapy as well improves the results. You may also have
radiotherapy to your brain, which aims to kill off any cancer cells that
may have spread to the brain. It is called prophylactic cranial irradiation
(PCI).
For more advanced lung cancer, the treatment aims to shrink the cancer
and control it for some time. It also reduces symptoms such as coughing
General Side Effects of Radiotherapy includes:

Tiredness and feeling run down

A sore throat and difficulty swallowing
Cough
Hair Loss
Chest pain
Increase in temperature, shivering, feeling sick
Sore skin in the treated area
 CHEMOTHERAPY
Chemotherapy means using anti cancer (cytotoxic) drugs to destroy
cancer cells. These work by disrupting the growth of cancer cells.
Chemotherapy may be given alone, as an adjuvant to surgical therapy,
or in combination with radiotherapy. While a number of
chemotherapeutic drugs have been developed, the class of drugs
known as the platinum-based drugs have been the most effective in
treatment of lung cancers.
Chemotherapy is the treatment of choice for most small cell lung
cancer, since these tumors are generally widespread in the body when
they are diagnosed.
 Chemotherapy may be given as pills, as an intravenous infusion, or as
a combination of the two. Chemotherapy treatments usually are given
in an outpatient setting. A combination of drugs is given in a series of
treatments, called cycles, over a period of weeks to months, with
breaks in between cycles. Unfortunately, the drugs used in
chemotherapy also kill normally dividing cells in the body, resulting in
unpleasant side effects. Damage to blood cells can result in increased
susceptibility to infections and difficulties with blood clotting (bleeding
orbruisingeasily). Other side effects include fatigue, anemia,
neutropenia, depression, weight loss or loss of appetite,hair loss,
nausea,vomiting,diarrhea, andmouth sores. The side effects of
chemotherapy vary according to the dosage and combination of drugs
used and may also vary from individual to individual. Medications
have been developed that can treat or prevent many of the side
effects of chemotherapy. The side effects generally disappear during
the recovery phase of the treatment or after its completion.
GOAL OF CHEMOTHERAPY
1. Palliation: alleviation off symptoms; prolong life
2. Cure: eradication
3. Adjuvant: surgery &/or radiotherapy then chemotherapy;
done after initial tx
4. Neoadjuvant: chemotherapy then surgery &/or radiotherapy

. Drug Combination: efficacy, toxicity

 CHEMOTHERAPEUTIC AGENTS
CELL-CYCLE SPECIFIC AGENTS
Phase-specific effective while cells are in the active cycle
but do not require that the cell be in a particular phase.
Alkylating agents
Antitumor antibiotics
Cisplatin

Phase non-specific most active against cells that are in a

specific phase of the cell cycle.
Vinca alkaloids
Antimetabolites
 CELL-CYCLE NON-SPECIFIC AGENTS
they are effective in all phases, including G0 (outside the
cell).
- Nitrosoureas
- Radiation
 Combinations of chemotherapy tend to work better than
single drugs. Usually doctors
combineCisplatinorCarboplatin (Paraplatin)with at least
one other drug such as:
Vinorelbine
Gemcitabine
Paclitaxel (Taxol)
Doxorubicin
Etoposide
 CISPLATIN (PLATINOL), CARBOPLATIN
(PARAPLATIN)
A miscellaneous anticancer drug (chemotherapy drug), usually an
alkylating agent, that is used to treat different types of cancer,
including:
Testicular cancer
Germ cell cancer
Head and neck cancer
Bladder cancer
Cervical cancer
Non small cell lung cancer
 It is also sometimes used for other types of cancer. At the
centre of this drug is an atom of the metal platinum.

MOA: Cisplatin interferes with DNA replication, which kills the

fastest proliferating cells, which in theory are
carcinogenic.Carboplatinundergoes activation inside cells and
forms reactive platinum complexes that cause the intra- and
inter-strand cross-linkage of DNA molecules within the cell. This
modifies the DNA structure and inhibits DNA synthesis.

S/E: nephrotoxicity, nausea and vomiting, bone marrow

depression
 VINORELBINE (NAVELBINE)
Vinorelbine is a chemotherapy drug that has the brand name Navelbine.
It is a treatment for:
Advanced breast cancer
Non small cell lung cancer
Mesothelioma (cancer of the outer covering of the lung)

Vinorelbine belongs to the group of drugs called Vinca alkaloids. These

are often called plant alkaloids because the first of these drugs was
developed from the periwinkle plant (Vinca). They are a type of drug
called microtubule inhibitors. This describes the way they work in
damaging cancer cells. Vinorelbine stops the cancer cells from
separating into two new cells. So it blocks the growth of the cancer.
 MOA: The antitumoractivity of vinorelbineis thought to be due
primarily to inhibition of mitosis at metaphase through its
interaction with tubulin.

S/E: Chemotherapy-induced peripheral neuropathy(a progressive,

enduring and often irreversible tingling numbness, intense pain,
and hypersensitivity to cold, beginning in the hands and feet and
sometimes involving the arms and legs), lowered resistance to
infection, bruising or bleeding,anaemia,constipation,
vomiting,diarrhea,nausea, tiredness and a general feeling of
weakness (asthenia), inflammation of the vein into which it was
injected (phlebitis). Seldom severehyponatremiais seen. Less
common effects are hair loss and allergic reaction.
 GEMCITABINE (GEMZAR)
Gemcitabine is one of a group of chemotherapy drugs called anti
metabolites. Anti- metabolites are similar to normal body molecules but
they are slightly different in structure. These differences mean that anti
metabolites stop cells working properly.
It is a treatment for:
Cancer of the pancreas
Non small cell lung cancer
Breast cancer that has spread (in combination with paclitaxel)
Bladder cancer that has spread (in combination with cisplatin)
Ovarian cancer (in combination with carboplatin)
Gemcitabine is also sometimes used for other types of cancer as part
of clinical trials.
 MOA: Chemically gemcitabine is anucleoside analogin which
thehydrogenatomson the 2' carbon ofdeoxycytidineare replaced
byfluorineatoms. As withfluorouraciland other analogues of pyrimidines,
the triphosphate analogue of gemcitabine replaces one of the building
blocks of nucleic acids, in this casecytidine, duringDNA replication. The
process arrests tumor growth, as only one additional nucleoside can be
attached to the "faulty" nucleoside, resulting inapoptosis. Another target of
gemcitabine is the enzymeribonucleotide reductase(RNR). The diphosphate
analogue binds to RNR active site and inactivates the enzyme irreversibly.
Once RNR is inhibited, the cell cannot produce the deoxyribonucleotides
required for DNA replication and repair, and cell apoptosis is induced.

S/E: Flu-like symptoms such as muscle pain, headache, chills, fever (within
612 hours of first dose), fatigue, nausea (mild), vomiting, poor appetite,
skin rash, allergic reaction, diarrhea, weakness, hair loss, mouth sores,
difficulty sleeping, and SOB.
 PACLITAXEL (TAXOL)
Paclitaxel is achemotherapy drug. It also known by its original brand
name, Taxol. The drug is made from the needles of a particular type of
yew tree. It works by stoppingcancer cellsseparating into two new
cells, so it blocks the growth of the cancer. It is a treatment for various
types of cancer, including:
Ovarian cancer
Breast cancer
Non small cell lung cancer.
AIDS related Kaposi's sarcoma
MOA: Promote microtubule assembly and stabilization, thus
prohibiting cell division.
S/E: Fatigue, nausea (mild), vomiting, poor appetite, skin rash,
allergic reaction, diarrhea, weakness, hair loss
DOXORUBICIN (ADRIAMYCIN/RUBEX)

Doxorubicin is a type of chemotherapy drug called an

anthracycline.
MOA: Doxorubicin slows or stops the growth of cancer cells.
One way that doxorubicin works is by blocking anenzymecalled
topoisomerase 2 that cancer cells need to divide and grow.
S/E: Feeling sick, fatigue, hair loss, sensitivity to sunlight,
watery eyes, loss of fertility.
 ETOPOSIDE (TOPOSAR)
Etoposide is a chemotherapy drug mainly used to treat lung cancer
andtesticular cancer. It is also used to treat other types of cancer
including stomach cancer and non-Hodgkins lymphoma.Etoposide is
made from the mandrake plant.
MOA: Etoposide works by blocking an enzyme (called topoisomerase
2) which is necessary for cancer cells to divide and so grow into 2 new
cells. If this enzyme is blocked, the cell's DNA gets tangled up and the
cell can't divide. DNA is the genetic code that is in the nucleus of all
animal and plant cells. It controls everything the cell does.
S/E: Feeling sick, fatigue, hair loss, metallic taste, sore mouth and lost
of appetite.
 BIOLOGICAL THERAPY
These are treatments that control or stop the growth of cancer
cells. Some types of biological therapy can treat advanced non small
lung cancer. Other types are being tested in research or clinical
trials. Research is also looking at using some biological therapies to
treat earlier stages of lung cancer.

Possible S/E: tiredness (fatigue), weakness, diarrhea, skin rashes or

discoloration, sore mouth, feeling sick, loss of appetite, low blood
counts, swelling of parts of the body due to build-up of fluid.
 CASE STUDY

A 20-year-old man with no history of tobacco use presented

with a several-months history of cough and lower back pain,
and an 11.3-kg weight loss. The patient was diagnosed with
pneumonia and was started on antibiotics, but he did not
improve.
Posteroanterior view of the chest demonstrates complete opacification of
the right hemithorax.
 CASE STUDY ANSWER
Because of the persistent cough and development of hemoptysis, further
imaging studies were obtained. A chest radiograph revealed total opacification
of the right lung.
Infectiousserologies were negative. Further imaging revealed retroperitoneal
lymphadenopathy, renal and pancreatic masses, skeletal metastases in the
pelvis and vertebral bodies, and intraparenchymal brain metastases.
Interestingly, both adrenal glands were spared.
Biopsyof the mediastinal mass shows a poorly differentiated carcinoma, non-
small-cell type. (Courtesy Kevin Leslie,MD, of the Department of Pathology,
Mayo Clinic Arizona; with permission)
The patient was urgently treated with cisplatin and etoposide. Radiotherapy
was also initiated to lung, spine, and pelvis. He improved clinically, but
required several hospitalizations throughout chemotherapy. Ultimately, his
disease progressed, and he died within 9 months of the initial diagnosis.
 QUIZ
1. This is ultimately the result of cells that uncontrollably grow and do not die.
Normal cells in the body follow an orderly path of growth, division, and death.
Unlike regular cells, the cells do not experience programmatic death and
instead continue to grow and divide. This leads to a mass of abnormal cells
that grows out of control.
2. Programmed cell death is called ________.
3. This doesn't typically cause signs and symptoms in its earliest stages (signs
and symptoms occur only when the disease is advanced). This occurs when a
lung cell's gene mutation makes the cell unable to correct DNA damage and
unable to commit suicide.
4. This is known to be a mass that is observed as a lump in the body.
5. A procedure that allows your doctor to look at your airway through a thin
viewing instrument called abronchoscope.
6-9. Give some lung cancer treatments?
10. This stage of cancer is limited only in the lung and hasn't spread to the
lymph nodes. The tumor is generally smaller than 2 inches (5 centimeters)
across.
11. This stage of cancer has spread beyond the affected lung to the other
lung or to distant areas of the body and to other parts such as the liver or
other organs.
12-13. Give at least 2 primary procedures in treating lung cancer through
surgery.
14. T/F Tiredness, feeling run down, sore throat, difficulty swallowing,
cough, hair loss, chest pain, increase in temperature, shivering, feeling
sick, sore skin in the treated area are some side effects of radiotherapy.
15. _____ means using anti cancer (cytotoxic) drugs to destroy cancer
cells. These work by disrupting the growth of cancer cells.
Bonus:
Give some chemotherapeutic drug combinations for lung cancer treatment
and 1 side effect for each.
 ANSWERS
1.Cancer
2.Apoptosis
3.Lung Cancer
4.Tumor
5.Bronchoscopy
6.Surgery
7.Radiation Therapy
8.Chemotherapy
9.Biological Therapy
10.
Stage 1
11.Stage IV
12-13. Pneumonectomy
Lobectomy
Wedge Resection
Sleeve Resection
Segmentectomy
14. True
15. Chemotherapy
Bonus:
.Cisplatin or Carboplatin with:
.Vinorelbine
.Gemcitabine
.Paclitaxel (Taxol)
.Doxorubicin
.Etoposide
S/E: nephrotoxicity, nausea and vomiting, bone marrow depression, Flu-like symptoms such as muscle pain, headache, chills, fever (within 612 hours of first dose), fatigue, nausea
(mild), vomiting, poor appetite, skin rash, allergic reaction, diarrhea, weakness, hair loss, mouth sores, difficulty sleeping, and SOB.
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