While the vast majority of lung cancer cases are linked to tobacco, more and more non-smokers are diagnosed with this deadly disease.

“There seems to be kind of an increase over the last twenty years in lung cancers in non-smokers. We see now more women, more younger people, and more non-smokers,” says Dr. Lowell Hart, who is an oncologist on medical staff of Lee Memorial Health System.

Non-smokers are more likely to get a slower growing form of lung cancer, one with a driver mutation, compared to people who smoked.

“Cigarette smoke, tobacco smoke, has a lot of carcinogens in the smoke. So these can cause lots and lots of mutation in the lung tissue that leads to cancer. For the patients that haven’t been smokers, they more often will have a driver mutation. One gene goes bad in the lung tissue and drives the cancer,” says Dr. Hart.

As doctors get a better look at non-smoking lung cancer, they’ve identified better treatment options - therapy that identifies the precise driver and directly attacks it.

“For some of these mutations we now have good treatments that we can give without necessarily having to use chemotherapy on. We now have ways of shutting down some of those gene pathways and there’s more things coming out all the time,” says Dr. Hart.

The closer researchers look, the more variations they are finding.

“When I show a pie chart and talk about lung cancer there used to be just small cell type and non-small cell type. Nowadays they’re cutting this pie into smaller and smaller pieces so that we have more targeted treatment,” says Dr. Hart.

The end goal is to reveal solutions to make lung cancer livable.

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Lee Memorial Health System in Fort Myers, FL is the largest network of medical care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For nearly a century, we’ve been providing our community with everything from primary care treatment to highly specialized care services and robotic assisted surgeries.

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Lung cancer survivor Terri has had a long journey to her diagnosis. A "tiny" spot on her lung was initially dismissed and eventually led to her diagnosis a decade later with stage IIIA non-small lung cancer. Learning her tumor was KRAS-positive allowed her to make the most informed treatment decisions for her lung cancer. Watch as she shares her journey and advice for taking control of your health and getting the best care.

Terri’s advice, “Hope shared is hope multiplied. Take control of your journey and get connected. These actions are key to staying on your path to empowerment.”

Lung cancers consists of Small Cell Carcinoma, Sqamous Cell Carcinoma, Adenocarcinoma and Large Cell Carcinoma. We will be reviewing Epidemiology, Pathology Pathophysiology, Clinical Signs and Symptoms, Investigations and Treatment/Management of Lung Cancer.

EPIDEMIOLOGY OF LUNG CANCER
Adenocarcinoma is the most common right now and is the most common. It is the third most common cancer and is the most common cause of cancer death.

RISK FACTORS OF LUNG CANCER
Smoking, Asbestos, Radiation, Arsenic Chromium, Nickel.
Genetics, Scar Formation (Wegeners, Fibrosis, Scleroderma)
Air pollution, HIV.

CLINICAL SIGNS AND SYMPTOMS OF LUNG CANCER
Pulmonary Symptoms, most common is cough, Hemoptysis (which ca lead to asphyxia) Chest Pain (dull achy), Dyspnea (secondary to pneumonia, atelectasis, lymphatic tumor spread, pleural effusion and pneumothorax), hoarsenes (when laryngeal nerve involved), pleural effusion (serous, serosangiounous, bloody) which may be caused by metastasis into pleural fluid. Super Vena Cava Syndrome occurs when central tumor invades SVC which causes red, edematous face, prominent veins throughout the body and this is more common in small cell lung cancer. Pancoast tumor is a lung cancer located in the apex of the lungs. Pancoast tumor may lead to thoracic outlet syndrome (pain weakness in arm and hand). Horner Syndrome causes miosis, anhydrosis and ptosis (MAP) and this is more common in Non Small Cell Lung Cancer.

Paraneoplastic syndromes are due to hypercalcemia (PTHrP) bone mets, calcitriol release, cytokine. SIADH causes increase water absorption leading to dilution hyponatremia, cerebral edema, anorexia, nausea vomiting. Resolves with chemo and treatment. Lambert Eaton Myasthenic Syndrome (LEMS) is a condition with auto-antibodies of the calcium channels in the Neuromuscular Junction. Proximal Muscle weakness and rising and standing. Hematologic derangements such as anemia, leukocytosis, thrombocytosis and hypercoagulability. Hypertrophic osteoarthropathy may lead to digital clubbing, periositis, Arthralgia, Cushings due to release of Ectopic ACTH.

Metastasis symptoms occur when metastasis of lung cancer to liver, adrenal gland, Lung, Spine, Brain. Screen with PET-CT.

INVESTIGATIONS FOR LUNG CANCER
X-Ray may show a coin lesion. First step in management is to look at a previous x-ray and look for a sign of lung cancer on the old x-ray.

Cytology of the sputum, bronchoscopy, and percutaneous.

CT Scan and PET CT

Small Cell Lung Cancer
Oat cells look like small cells with little cytoplasm. All are of neuroendocrine origin (feyrter cells) on bronchus. Small Cell Lung Cancer is found central and has limited stage (Lung and 1 lymph node) Extended stage is spread beyond the lungs. Usually has early metastasis. May release ACTH, SIAD, Lambert eaton myasthenic syndrome.

Adenocarcinoma
Mucin and TTF-1 Positive type of Lung Cancer. Graded from low grade to high grade. Bronchoalverolar carcionma is in situ carcinoma and has better prognosis. Most common in Non-Smokers (BAC)

Squamous Cell Lung Cancer
Irritation of bronchus causing metaplasia, then dysplasia, then carcinoma in situ and finally lung cancer. Also associated with Keratin pearls and cavitation from central necrosis. Goes into hilar nodes and gets late metastasis. Asymptomatic and can be deteetd with sputum cytology.


Large Cell Lung Cancer
Lots of cytoplasm, unknown origin and is a waste basket column. Peripheral and has late metastasis and can use cancer.

TREATMENT OF LUNG CANCER
Small Cell Lung Cancer metastasizes early on and therefore surgery is not an option. Cisplatin, Carboplatin and vincristin is also used. Responds very well to chemotherapy. Prophylactic cranial irradiation (PCI) to prevent brain metastasis. Surgery is possible if the tumor is very small and no metastsis

Non Small Cell Lung Cancer is not responsive to chemotherapy or radiotherapy so surgery is the only option.