Carcinogenesis, Smoking, Pathology, Presentation

Update Series on Respiratory Nursing

Carcinoma of Lung

Ca Lung

Overview

Carcinogenesis

Smoking

Pathology

Presentation

Management

Diagnosis

TMN Definitions

Treatment

Assessment

Operation

Surgery

Pre-operative care

Intra-operative care

Post-operative care

Specific care

　

Carcinogenesis

Multiple steps

-	Initiation
-	Promoter
-	Metastases

Definite order or steps for carcinogensis

Accumulation of genetic alterations rather than a specific order that is critical

Reverse only one or two abnormalities to have profound effect on tumour cell growth and tumorgenicity

Smoking

		Carcinogen: polycyclic aromatic hydrocarbons, nitrosamines
		Genetic: only 15% of cigarette smokers develop lung cancer
		Risk of lung cancer is dependent on the age at which smoking starts, the intensity of smoking, and the duration of the habit

Pathology

~ 95% of all lung tumours are malignant

Squamous cell carcinoma usually centrally located and may grow to a relatively large size before metastases

Adenocarcinoma usually mixed pattern of acinor,
papillary or even bronchioloalveolar

Increasing trend

Bronchioloalveolar grows along alveolar septi,
frequently multifocal, variable appearance, e.g.
solitary nodule, multiple infiltrate, or pneumonia with
air bronchogram radiologically

Large cell undifferentiated ca

-	No consensus on their histogenesis
-	More aggressive clinical behaviour
-	Giant cell variant may mimic metastatic giant cell carcinoma of thyroid or pancreas

Presentation

Factors affecting the presentation

1.	Asymptomatic, e.g. incidental finding during body check-up
2.	Secondary to the primary tumour (cough, dyspnea, wheezing haemoptysis, pneumonia. lung abscess, paraneoplastic)
3.	Metastatic spread
4.	Systemic, malaise, anorexia, weight loss