Lung cancer

Otto VisserJune 2019

Coding issues

Introduction

• Epidemiological information• Incidence & mortality trend in Europe, survival• Distribution according to age and sex

• Risk factors• (Diagnostics & staging procedures)• Topography & morphology• Stage • Treatment• Quality issues

Incidence of lung cancer in Europe in 2018males females

0

100

200

300

400

500

600

700

800

<35 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95+

males 1989

males 2018

females 1989

females 2018

Netherlands

Age specific incidence of lung cancer by sex

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Bulg

aria

Wal

es

Lith

uani

a

Mal

ta

Engl

and

N Ir

elan

d

Scot

land

Irela

nd

Latv

ia

Esto

nia

Cze

chia

Den

mar

k

Cro

atia

Slov

akia

Slov

enia

Portu

gal

Nor

way

Spai

n

Pola

nd

EUR

OPE

Finl

and

Net

herla

nds

Icel

and

Swed

en

Italy

Ger

man

y

Aust

ria

Fran

ce

Switz

erla

nd

Belg

ium

one year

five year

Relative survival of lung cancer (2000-2007)

Risk factors & Symptoms

Risk factors

• Smoking• Radiation• Radon• Small dust particals• Asbestos

Symptoms

• Often no or only aspecific symptoms such as weight loss, fever, loss of appetite or fatigue

• Cough, hemoptoë• Short of breath, stridor• Pain on the chest• Atelectasis (collapse of the lung)• HoarsenessAbsence of symptoms is the main reason for the high stage at diagnosis

Topography

Trachea C33.9

Main bronchus C34.0

Middle lobe C34.2

Lower lobe C34.3

Upper lobe C34.1

Overlapping C34.8NOS C34.9

5 lobes (2 left and 3 right) which are composed of a total of 20 segments

Morphology

New morphology codes/terms in ICD-O-3

Code Term8250/2 Adenocarcinoma in situ, non-mucinous8253/2 Adenocarcinoma in situ, mucinous8250/3 Bronchiolo-alveolar adenocarcinoma Lepidic adenocarcinoma8256/3 Minimally invasive adenocarcinoma, non-mucinous (C34._)8257/3 Minimally invasive adenocarcinoma, mucinous (C34._)

Bronchiolo-alveolar adenocarcinoma = Adenocarcinoma of the lung

Overview

Term ICD-O-3 2nd revisionAdenocarcinoma in situ, non-mucinous 8250/2Adenocarcinoma in situ, mucinous 8253/2Lepidic adenocarcinoma (Bronchiolo-alveolar carcinoma, NOS) 8250/3Bronchiolo-alveolar carcinoma, non-mucinous 8252/3Bronchiolo-alveolar carcinoma, mucinous 8253/3Bronchiolo-alveolar carcinoma, mixed mucinous and non-mucinous 8254/3Minimally invasive adenocarcinoma, non-mucinous 8256/3Minimally invasive adenocarcinoma, mucinous 8257/3

Morphology: clinical

• Small cell carcinoma• Non-small cell carcinoma

• Squamous cell carcinoma• Adenocarcinoma• Large cell carcinoma

Morphology: pathological

• Neuro-endocrine tumours/carcinomas• Carcinoid/NET gr 1• Atypical carcinoid/NET gr 2• Large cell neuro-endocrine

carcinoma• Small cell carcinoma

• Non-epithelial cancers• Sarcoma

• Non-small cell carcinoma• Squamous cell carcinoma• Adenocarcinoma• Large cell carcinoma• Rare carcinoma subtypes

• Unspecified cancers(no pathology)

Morphology and topography

• Squamous cell carcinoma and small cell carcinoma are mostly located in the central parts of the lung (main bronchus and its branches)

• Adenocarcinoma is mostly located in more peripheral parts of the lung (the alveoli of the lung)

Large cell carcinoma & carcinoma, NOS

• Large cell carcinoma (8012) is not really a subtype, but only descriptive (‘large cells’)

• Adenocarcinoma and squamous cell carcinoma have also large cells• If next to large cell carcinoma another diagnosis is available, the more

specific one has preference

• Try also to avoid the use of ‘carcinoma, NOS’ (8010) and ‘non-small cell lung cancer’ (8046)

Morphology: distribution by sex (EU 2012)

adenocarcinoma36%

SCC14%

NET/NEC16%

large cell carcinoma

17%

other1% unspecified

16%

males females

adenocarcinoma26%

SCC27%

NET/NEC13%

large cell carcinoma

15%

other1% unspecified

18%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

15 6 12 5 23 9 2 19 20 27 1 16 21 14 8 11 EU 25 29 7 13 26 10 18 17 4 22 28 24 3

adenosquamous cellNET/NEClarge cellotherunspecified

Morphology by country: males

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

23 12 15 19 2 5 6 9 11 20 21 27 16 1 8

EU 26 14 18 25 7 13 10 4 29 17 24 28 3 22

adenosquamous cellNET/NEClarge cellotherunspecified

Morphology by country: females

Morphology: subtypes of adenocarcinoma

• Adenocarcinoma• Acinar (8550)• Bonchiolo-alveolar/lepidic (8250);

mucinous (8253); non-mucinous (8252); mixed (8254)

• Mucinous (8480/8481)• Papillary (8260)• Solid (8230)• Rare types

• Salivary gland tumours• Muco-epidermoid (8430)• Adenoid cystic (8200)• Epithelial-myoepithelial (8562)

Treatment

• Stage I & II: surgery / radiotherapy• Stage III: chemoradiotherapy• Stage IV: systemic treatment (chemotherapy or targeted therapy),

palliative radiotherapy

Surgery

Sleeve lobectomy

Carina resection

Targeted therapy

• A number of drugs have been developed or are being developed that target several processes in the cancers cells

• Depending on the type of aberration in the cancer cell the drug will be effective (or not)

• Resistance to the drug often develops after some time as the cancer cells may change at cell disivison

EXERCISES

www.encr.eu