Necessary Rules about

Lung CancerMDs and Nurse Practitioners Needto Know

Marcos Nascimento, MDUCF Voluntary Professor

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General Concepts

AboutLung

Cancer

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General Concepts Lung Cancer

• Leading death cause from cancer• 90% Smoking related• ALL LC are associated w Smoking• Nonsmoker = Adenocarcinoma• Smokers = 10 times higher risk than

Nonsmokers• Smoking Cessation decreases the risk, but

NEVER to a Non Smoker!• No screening tests

N Engl J Med 2008, 359: 1367-1380

Bronchogenic

Lung Types

Cancer

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Bronchogenic LUNG CANCER TYPES

1. Small Cell ©• Para neoplastic Syndromes SIADH Cushing Syndromes Peripheral neuropathy/ Dementia Eaton - Lambert Syndrome2.Squamous © PTH Like Hormone

Mayo Clin Proc 2008; 83: 584- 594 / J of Clin Oncol 2007; 25: 561-570

Bronchogenic LUNG CANCER TYPES

3. Large Cell (P)

4. Adenocarcinoma (P)

- Bronchoalveolar Carcinoma

*** Pulmonary Solitary Nodule

Mayo Clin Proc 2008; 83: 584- 594 / J of Clin Oncol 2007; 25: 561-570

LEARN

LungPRESENTATIONS

Cancer

& Watch About

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Bronchoalveolar Carcinoma Presentation

1. Cough ( Most Common)2. Weight Loss/ Dyspnea3. Hemoptysis; 4. Hoarseness 5** Recurrent Pneumonia6. SVC Syndrome7. Pancoast Syndrome8. Horner Syndrome9. Effusion

Mayo Clin Proc 2008; 83: 584- 594

LungCancerHow Diagnosis ?

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Lung Cancer Diagnosis

• Sputum Cytology• Bronchoscopy for Central “S” Lesions• Needle Biopsy for peripheral Lesions• Mediastenoscopy • Cytology for Pleural Effusions

Necessary

Lung CancerMANAGEMENT AFTER DIAGNOSIS

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MANAGEMENT QUESTIONS AFTER LC DIAGNOSIS:

• Is the LC Ressectable?1. Thorax CT2. MRI3. PET Scan• If the LC is ressectable, is the patient a surgical

candidate?1. PFTs: FEV1> 50%?• Remember: Many LC are also COPD patients

Lung Cancer screening results: Easily Misunderstaood. Mayo Clin Proc 2007; 82: 14-15 / BTS Guidelines on the selection of patients with Lung Cancer for surgery. Thorax 2001; 56: 89-108

RULES5

In LUNG CANCER

FORCREATINGCHANGING

WORLD

RULES5

RU

LES

GENERAL CONCEPTS LUNG CANCER

LUNG CANCER HISTOLOGIC TYPES

LUNG CANCER PRESENTATIONS

LC DIAGNOSIS

LUNG CANCER MANAGEMENT

prioritize organize mobilize

Annotated Bibliography

Clinical Guidelines:• Alberts WM, American College of Chest Physicians.

Diagnosis and management of lung cancer. ACCP evidence- based guidelines. Chest 2007; 132: 1S- 422S

Screening • Survival of patients with stage I Lung Cancer detected of

CT screening. N Engl J Med 2006, 355: 1763-1771

Smoking• Wilson JF. In the Clinic. Smoking Cessation. Ann

Intern Med 2007; 146:ITC2-1 – ITC2-16

www.pulmaosa.com.br

THANK YOU

Dr. Marcos Nascimento, MdUCF Voluntary Professor