Lungenkrebs. Lungenkrebs Häufigkeit

Transcription

1 Lungenkrebs Prof. Dr. E.W. Russi Pneumologie Lungenkrebs Häufigkeit The Principles and Practice of Medicine William Osler New York D. Appleton and Company 1892 Section IV DISEASE OF THE RESPIRATORY SYSTEM Disease of the Lung 9. New Growth of the Lung While primary growths of the lung are rare, secondary growths are not uncommon The disease is most common in the middle period of life The primary form affects the sexes equally Theconditions which predispose to it are quite unknown (Minen)

2 Cancer Statistics 2003 Estimated new cases American Cancer Society Estimated deaths A.Jemal et al. CA Cancer J Clin 2003; 53: Lung Cancer Mortality compared to the next four most prevalent causes of cancer death x Annual Mortality Rate 80 Lung Cancer Colon Breast Prostatic Gland Pancreas Landis SH. et al. Cancer Statistics 1999; CA Cancer J Clin 1999; 49: 8

3 Timeline of lung cancer progression by number of tumor doublings and volume doubling rate Bach, P. B. et al. Chest 2007;132:69S-77S Growth Rate of Malignant Tumors Growth rate of malignant tumors generally between 30 and 500 days (median 100 days) Doublings Cells Diameter um microscopic 20 1 x mm microscopic 30 1 x cm detectable CXR 35 1 x cm Diagnosis 40 1 x cm Death

4 5 Jahre Überlebensraten Lungenkrebs 15% 8% ~ 1960 Kolonkarzinom 61% Brustkrebs 86% Prostatakarzinom 96% Lungenkrebs Inzidenz Swiss Association of Cancer Registries Statistics of Cancer Incidence Latin Switzerland Alemanic Switzerland European Standardized Rates by Period

5 Doll, R., Hill B. Smoking and Carcinoma of the Lung: a Preliminary Report British Medical Journal 1950; 2: cigarette smoking is a factor, and an important factor, in the production of carcinoma of the lung Age-Specific Lung Cancer Mortality Rates Among Men and Women of Comparable Smoking Levels Smoked 20 Smoked 40 Cigarettes / Day Cigarettes / Day Age Group Neveryr Smokers 30 Years 40 Years 30 Years 40 Years Men Women Thun et al.; US Government Printing Office 1997;

6 Beziehung zwischen Lungenfunktion und Inzidenz von Lungenkrebs Masse > T1 Rundherd Coin Lesion Pulmonary Nodule T1

7 Masse > T1 Husten Hämoptoe Dyspnoe Heiserkeit Rundherd Coin Lesion Pulmonary Nodule T1 keine Symptome Metastasen-Symptome Bronchuskarzinom Symptome Primärtumor Metastasen paraneopl. Husten Thoraxschmerz Haemoptoe Dysphagie Dyspnoe... Heiserkeit Knochenschmerzen Lymphknotenschwellung neurologische Symptome... Gewichtsverlust Cushing Inappetenz Lambert-Eaton Clubbing... Dermatomyositis

8 Bronchuskarzinom Befunde Primärtumor Dämpfung Atemgeräusch lokalisiertes Pfeifen Metastasen Klopfdolenz Lymphknoten neurologische Befunde Einflussstauung paraneopl. Gewicht Clubbing Dermatomyositis Cushing

9 squamous ~ 30 % small cell ~ 20 % adeno ~ 30 %

10 Small Cell Lung Cancer TNM, I-IV limited/extensive limited: no detectable disease outside the hemithorax with or without ipsilateral, mediastinal, hilar or supraclavicular lymph nodes extensive: anything else Lung Cancer Staging Methods loco regional CT (MRI) Bronchoscopy PET Mediastinoscopy VAT extrathoracic PET CT (brain) MRI Sonography Bone Scan

11 < 3 cm Stage IA Stage IB

12 Stage IIA Stage IIB

13 Stage IIIA Stage IIIB TNM - Tumorstadium M N3 N2 N1 N0 IV III B III A II A II B I A II B II B T1 T2 T3 T4

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15 Management of Patients with Lung Cancer The 3 Determining Entities Diagnosis NSCLC SCLC resectable Stage I-IV TNM limited/ extensive Function FEV 1 DLCO VO 2 max

16 Lethality Rate of Lunge Cancer in den US over Time 20 5-Year Survival (%) Cancer Statistics 1995, 1999 CA Cancer J Clin 1995; 45: 8 CA Cancer J Clin 1999; 49: Thoraxchirurgie Resektionen Segmentresektion Lobektomie Pneumonektomie Bilobektomie

17 Mortality Rate for Surgical Resection in Lung Cancer Intervention % n Mediastinoscopy Wedge resection Lobectomy Pneumonectomy Kiser A.C., Detterbeck F.C. Diagnosis and Treatment of Lung Cancer Saunders 2001 Lung Cancer Survival Based on Hospital Volume Bach PB, N Engl J Med 2001

18 Bronchuskarzinom nicht-kleinzelliges Therapeutische Optionen Chirurgie: Resektion Bestrahlung: palliativ Chemotherapie: neoadjuvant adjuvant palliativ Multimodale Therapiekonzepte interdisziplinär! Screening for Lung Cancer Low-dose CT LDCT scanning is a promising technology due to its sensitivity and ability to assess growth of nodules... However, due to the absence of evidence regarding mortality and concerns about overdiagnosis, we recommend against screening for individuals without symptoms or a history of cancer Several ongoing high quality clinical studies Chest 2003; 123; (Suppl.) 83S

19 Screening for Lung Cancer CXR Sputum Cytology The results of five RCTs suggest that neither CXR nor sputum cytology satisfy the primary criterion of a beneficial screening test! London BMJ 1969, Thorax 1968 Mayo ARRD 1984 Czechoslovakia Cancer 1986, 2000 MSKCC Cancer 2000 Johns Hopkins ARRD 1984 Lung Cancer Screening Recommendations from Health Organizations 2007 American Cancer Society (2001) American College of Chest Physicians (2003) US Preventive Task Force (2005) against routine screening of asymptomatic persons only in the context of well-designed clinical trials evidence is insufficient to recommend for or against screening