Screening and early detection of lung cancer
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1. Screening for lung cancer through low-dose helical CT is more sensitive than chest X-rays and can detect early-stage lung cancers when treatment may work better. 2. Early detection of lung cancer through screening improves survival rates as prognosis is better if the disease is detected before it has spread beyond early stages. 3. Biomarkers from sputum, blood, and other non-invasive sample types show promise as screening tools but require further validation before use in widespread screening.
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Screening and early detection of lung cancer
- 1. Screening And Early Detection Of Lung Cancer By Mahmoud .E Abou Elmagd Assistant Lecturer of pulmonary and critical care medicine Mansoura university
- 2. INTRODUCTION
- 3. Screening • Screening means testing for a disease when there are no symptoms or history of that disease give a screening test to find disease early on, when treatment may work better. • Screening is tool for early detection. • Methods of early detection should have the highest yields among those at greatest risk for lung cancer.
- 4. Importance of screening and early detection • Have major importance in survival of patients with lung cancer. • The stage at diagnosis is the primary determinant of prognosis. • Prognosis is better and treatment more successful if disease is detected while still localized.
- 5. Chest X-ray PA and lateral view The sensitivity is dependent on: The size and location of the lesion The quality factors related to image Skill of the interpreting physician Obscured lesion by the mediastinum, heart or diaphragm
- 6. Low-Dose Helical CT • Allows entire chest to be surveyed in a single breathhold – Time: approximately 7 - 15 seconds – Reduces motion artifact – Eliminates respiratory misregistration • Narrower slice thickness • Hourly throughput - 4 patients per hour • Radiation dose one tenth of diagnostic CT
- 7. Low-Dose Helical CT • Chest CT is more sensitive than chest radiography for the detection of early lung cancers presenting as small, non-calcified, solitary pulmonary nodules (SPNs). • most of these lesions were detected in an early and thus resectable stage (stages IA to IB) .
- 8. What do we see on CT? Definition of terms • GGO (non-solid): Nodule with hazy increased lung attenuation which does not obscure underlying bronchovascular markings. • Mixed (part-solid): Nodules containing both ground glass and solid components • Solid (soft tissue): Nodules with attenuation obscuring the bronchovascular structures
- 9. Downstream Effects of CT Screening • Radiation carcinogenesis – screening & consequent diagnostic tests: CT, PET • Additional minimally invasive procedures – Percutaneous Lung FNA – Bronchoscopy – VATS • Thoracotomy for benign disease – Is there an acceptable percentage? – Potential post-operative morbidity & mortality – Treatment for disease without biopsy? • Evaluation for other observations: cardiac, renal, liver, adrenal disease
- 10. Sputum cytometry • The diagnostic yield of sputum cytology is known to vary in relation to tumour location. • It has greatest use in the identification of central tumours and is of little or no value in the identification of peripheral cancers. • there is now evidence to suggest that its sensitivity can be much improved through the use of molecular genetic and immunocytochemical markers of malignancy.
- 11. Autofluorescence bronchoscopy • This technique exploits the differences in the fluorescence properties of bronchial mucosa compared to mucosa of pre-invasive and invasive disease. • The LIFE (Lung Imaging Fluorescence Endoscopy)system,is the best known instrument. • This uses a blue helium cadmium laser to illuminate the bronchial mucosa, and the resulting fluorescence is then digitised into a real-time video image. • Other devices, such as the D-light auto-fluorescence system.
- 12. biomarkers • A large number of biomarkers have been studied for the early detection of lung cancer, including DNA, promoter hypermethylation, microsatellite instability, loss of heterozygosity, chromosomal aneusomy, tumour-associated antibodies, tumour- associated antigens, proteomic profiles, messenger RNA (mRNA), micro-RNA (miRNA) and volatile organic compounds (VOCs).
- 13. biomarkers • These biomarkers have in turn been investigated in different specimens obtained by more or less invasive procedures: bronchial biopsies or bronchioloalveolar lavagefluid, induced sputum, buccal/nasal swabs, blood ( plasma, serum, circulating tumour cells and peripheral blood mononuclear cells) and exhaled breath . • An ideal early detection biomarker for large-scale screening should be applicable on easily accessible specimens through non-invasive procedures, have an easy and reproducible quantification, a high sensitivity and specificity and a low cost.
- 14. Molecular markers • Changes in genes, gene products and chromosomal abnormalities can be used as biomarkers of premalignant conditions. • Genes of ras family • Genes of Her-2/neu is over expressed in non- small cell lung cancer. • P53 and rb are good candidate genes for detection by antisera or PCR • Chromosomal abnormalities have been reported in chromosome numbers 3,11,13,17.
- 15. Endobronchial ultrasonography It allows a view beyond the airway wall so adding endobronchial ultrasonography to whit light or florescent bronchoscope can significantly help in : Staging of lung cancer Early detection of mucosal changes and early invasion to submucosa.
- 16. Summery • A chest X-ray should be ordered when lung cancer is a possibility, particularly when patients present with the following important “early” symptoms: • Haemoptysis • Unexplained or persistent (>3 weeks): - cough - chest / shoulder pain - dyspnoea