Lung cancer non-small cell

* Tobacco: high risk beyond 20 PA; Carcinogenic: benzopyrene and polycyclic hydrocarbons; nitrosamines;phenols; arsenic.

* Other FDR: asbestos (amphibole overcoats, for little or no chrysotile); arsenic; nickel; chromium; iron oxide;hydrocarbons; beryllium; ionizing radiation.

* Genetic factors: HLA B12 group.

* Late effects of tuberculosis -> adenocarcinoma

A- Pathology:

1- squamous carcinomas:

– 40-50% of lung cancers

– Bronchial lobar or segmental> bronchi

– Bud with obstructive infiltration of the bronchial wall; frequent central necrosis

– Differentiation squamous +/- marked (intercellular bridges and / or keratinization)

– Cytokeratin (CSC); ACE negative or weakly positive

2- Adenocarcinoma:

– 20% of lung cancer

– Subpleural peripheral tumors with destruction of structures

– The bronchoalveolar form is little or no destructive with alveolar dissemination (cough with copious expectoration).

– Immunohistochemistry: ACE, surfactant (Clara cell differentiation); SAP; keratin.

B- Clinical Syndromes:

1- Pancoast tumor:

– Tumors of the apex with

– Neuralgia C8-D1

– Horner’s syndrome ipsilateral

– Lyse rib of the posterior arch of the first 2 ribs.

– Atrophy of the muscles of the hypothenar

– Risk of vertebral and spinal extension

2- paraneoplastic syndromes:

– Clubbing

– Hypercalcemia, repeated phlebitis; SIADH

– Hypertrophic pulmonary arthropathy Osteopathy Pierre-Marie with:

* Clubbing

* Arthropathy and soft tissue thickening +/- joint pain

* Periostosis radiological sheathing

* Especially the fact Kc squamous

3- Other events:

– Superior vena cava syndrome (less common than for small cell Kc) with:

* Edema in cape of the face, neck and MS

* Venous circulation collateral

* Risk of cerebral edema ++

– Phrenic paralysis -> hiccups …

– Mediastinal syndrome: left recurrent laryngeal paralysis (bitonal voice); Dysphagia

– Recurrent pneumonitis; hemoptysis …

Diagnostic features

– Chest X-ray and CT scan: tumor opacity Central reached (perihilar) or peripheral +/- excavated and irregular boundaries

– Fibroscopy with bronchial bronchial aspiration and biopsies of the lesions (sprouting aspect, infiltrating …).

– If endoscopy can confirm the diagnosis before an abnormal chest image (atelectasis, excavated opacity round image parenchymal) => thoracotomy is indicated in doubt.

Treatment C:

Surgery is the treatment of choice; hypercapnia is a cons-indication to any act of excision

a- TNM:

1- T (primary tumor):

– Tx: presence of tumor cells in sputum without further radiological signs or bronchoscopic

– T1: ≤ 3cm; no more proximal lobar bronchus attained only

– T2:> 3cm; more than 2 cm from the hull; atelectasis of not reaching all the lung; achieving the visceral pleura.

– T3: achieving the chest wall; the diaphragm; the mediastinal pleura; pericardium within 2 cm of the hull without reaching it.

– T4: achievement of the trachea or carina; mediastinum; the heart and great vx; esophagus; secondary tumor nodule in the same lobe as the original; reached the vertebral body; neoplastic pleurisy histologically proven

2- N (regional lymph nodes) and M (distant metastasis):

– N1: ipsilateral hilar reached

– N2: ipsilateral mediastinal involvement and / or under carinaire

– N3: contralateral disease (hilar and / or mediastinal); scalene or supraclavicular lymph node

– M1: included tumor nodule in another lobe that primitive (metastasis)

b- occult carcinoma: TXN0M0

Stage 0: TisN0M0 (in situ tumor) -> Treatment: Photodynamic; cryotherapy or endobronchial brachytherapy

Stage IA: T1N0 -> Survival to 5 years:> 70% -> Treatment: Surgical treatment / No radiation so complete surgical … / chemotherapy if inoperable (+/- radiotherapy)

Stage IB: T2N0 -> Survival to 5 years: 60% -> Treatment: Surgical treatment / No radiation so complete surgical … / chemotherapy if inoperable (+/- radiotherapy)

Stage IIA: T1N1 -> Survival to 5 years: 50% -> Treatment: Surgical treatment / No radiation so complete surgical … / chemotherapy if inoperable (+/- radiotherapy)

Stage IIB: T2N1; T3N1 -> Survival to 5 years: 30-40% -> Treatment: Surgical treatment / No radiation so complete … surgery / chemotherapy if inoperable (+/- radiotherapy)

Stage IIIA: T1N2; T2N2; T3N2 -> Survival to 5 years: 10-30% -> Treatment: Surgical treatment routine postoperative radiotherapy +.

Stage IIIB: T1N3; T2N3; T3N3; T4 -> Survival to 5 years <5% -> Treatment: Radiotherapy Thoracic

Stage IV: M1 -> Survival to 5 years: <1% -> Treatment: Radiotherapy analgesic; exclusive chemotherapy

– Secondary lung tumors: single or multiple nodules predominantly in the lower lobes; although limited;carcinomatous lymphangitis; excavated tumor …