Lung Cancer Chemotherapy Liming xiathe first affiliated hospital of Anhui College of Traditional Chinese Medicine Also called: Bronchogenic carcinoma Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the world. Cigarette smoking causes most lung cancers. Risk factors: cigarettes , high levels of pollution, radiation and asbestos exposure ,etc.Your lungs are two spongy organs in your chest that are divided into sections (lobes). Every time you inhale, air is carried through the windpipe to your lungs in two major airways (bronchi). Inside your lungs, the bronchi subdivide into a million smaller airways (bronchioles), which finally end in clusters of tiny air sacs (alveoli). Within the air sacs, oxygen is absorbed into your bloodstream and carbon dioxide is released. Types of lung cancer Small cell lung cancer. Small cell lung cancer, sometimes called oat cell carcinoma, occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer. Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types of lung cancers that behave in a similar way. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma. How Is Lung Cancer Diagnosed?1.Symptoms and syndromes Pulmonary symptoms Symptoms in other organs Symptoms linked to tumor metabolism Blood (hematologic) syndromes Vein and artery (vascular) syndromes Skin (cutaneous) syndromes Musculoskeletal syndromes Nervous system (neurologic) syndromes Hormonal (endocrine) syndromes Miscellaneous syndromes 2.Tests and diagnosis Screening Diagnosis Imaging tests Sputum cytology Tissue samples (biopsy) bronchoscopy mediastinoscopy needle biopsy (Left) Conventional CT scan without contrast showing possible tumor in the liver. (Right) Conventional CT scan of the same patient using contrast. Images courtesy of Dr. Peter Choyke, Department of Radiology, Clinical Center, National Institutes of Health. BronchoscopySmall Cell LungCarcinoma (above)accounts for about15 percent of alllung cancer cases.Normal lung cells(above).Stage I. Cancer at this stage has invaded the underlying lung tissue but hasnt spread to the lymph nodes. Stage II. This stage cancer has spread to neighboring lymph nodes or invaded the chest wall. Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes in the center of the chest. Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus all within the chest or to lymph nodes in the area of the collarbone or to the tissue that surrounds the lungs within the rib cage (pleura). Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain. Stages of non-small cell lung cancer 3.Staging Limited. Cancer is confined to one lung and to its neighboring lymph nodes. Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded both lungs, more remote lymph nodes or other organs. Stages of small cell lung cancer Surgery Chemotherapy Radiation therapyTargeted drug therapy Bevacizumab (Avastin) Erlotinib (Tarceva). Clinical trials Supportive (palliative) care Coping and support Learn all you can about lung cancer Take an active role in your treatment Build a strong support system Set reasonable goals Take time for yourself Stay active Alternative medicine AcupunctureHypnosis Massage Meditation Yoga TreatmentsLung cancer surgeryStage Common options Treatment options for non-small cell lung cancers I Surgery II Surgery, chemotherapy, radiation IIIA Combined chemotherapy and radiation, sometimes surgery based on results of treatment IIIB Chemotherapy, sometimes radiation IV Chemotherapy, targeted drug therapy, clinical trials, supportive care Stage Common options Treatment options for small cell lung cancers Limited Combined chemotherapy and radiation, sometimes surgery Extensive Chemotherapy, clinical trials, supportive care Chemotherapy Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be administered through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that your body can recover. Chemotherapy can be used as a first line treatment for lung cancer or as additional treatment after surgery. In some cases, chemotherapy can be used to lessen side effects of your cancer. Chemotherapy is usually the main treatment for SCLC Chemotherapy for SCLC generally uses a combination of 2 drugs. The drug combinations most often used for initial chemotherapy for SCLC are: cisplatin and etoposide carboplatin and etoposide cisplatin and irinotecan carboplatin and irinotecan cyclophosphamide, doxorubicin (Adriamycin), and vincristine If the cancer progresses during treatment or returns after treatment is finished, different chemotherapy drugs may be tried. The choice of drugs depends to some extent on how soon the cancer begins to grow again. (The longer it takes for the cancer to return, the more likely it is to respond to further treatment.) Chemotherapy for SCLC If the cancer progresses during treatment or relapses within 2 to 3 months of finishing treatment, drugs such as topotecan, ifosfamide, paclitaxel, docetaxel, irinotecan, or gemcitabine may be tried. If the relapse occurs from 2 to 3 months to 6 months after treatment, topotecan is often the drug of choice. Other drugs that may be tried include irinotecan, cyclophosphamide/doxorubicin/vincristine (known as the CAV regimen), gemcitabine, paclitaxel, docetaxel, oral etoposide, or vinorelbine. For relapses 6 or more months after treatment, the original chemotherapy regimen may still be effective and can often be tried again. Chemotherapy for SCLC Chemotherapy is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer that has spread (metastasized) to distant organs. Depending on the type and stage of lung cancer, chemotherapy may be given as the main (primary) treatment or as an addition (adjuvant) to surgery or radiation therapy. Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks, and initial treatment typically involves 4 to 6 cycles. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.NSCLC ChemotherapyMost often, initial treatment for advanced lung cancer uses a combination of 2 chemotherapy drugs. Studies have shown that adding a third chemotherapy drug doesnt add much benefit and is likely to cause more side effects. The drugs most frequently used for initial chemotherapy for NSCLC are: cisplatin carboplatin paclitaxel docetaxel gemcitabine vinorelbine irinotecan etoposide vinblastine pemetrexed NSCLC ChemotherapyThe most common combinations include either cisplatin or carboplatin plus one other drug, although some studies have found that using combinations with less severe side effects, such as gemcitabine with vinorelbine or paclitaxel, may be just as effective for many patients. For people whose cancers meet certain criteria, targeted therapy drugs such as bevacizumab (Avastin) or cetuximab (Erbitux) may be added to initial treatment as well (see Targeted therapies section). NSCLC ChemotherapySingle-drug chemotherapy is sometimes used for people who might not tolerate combination chemotherapy well, such as those in poor overall health. If the initial chemotherapy treatment is no longer working, second-line treatment usually consists of a single drug such as docetaxel or pemetrexed. Another option may be the targeted therapy erlotinib (Tarceva) Again, advanced age is no barrier to receiving these drugs as long as the person is in good general health. NSCLC ChemotherapyPossible side effects Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects. The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include: Possible causesside effectshair loss mouth sores loss of appetite nausea and vomiting increased chance of infections (due to low white blood cell counts) easy bruising or bleeding (due to low blood platelet counts) fatigue (due to low red blood cell counts) uThese side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. uSome drugs such as cisplatin, vinorelbine, docetaxel, or paclitaxel can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. (This is called peripheral neuropathy.) In most cases this goes away once treatment is stopped, but it may be long lasting in some people. Lasting time Thank YouThank You