246b lung cancer

Question 1

lung cancer - overview (first aid)

Answer 1

Lung cancer is the leading cause of cancer death.

Presentation: cough, hemoptysis, bronchial obstruction, wheezing, pneumonic “coin” lesion on x-ray film or noncalcified nodule on CT.

In the lung, metastases (usually multiple lesions) are more common than 1° neoplasms. Most often from breast, colon, prostate, and bladder cancer.

Sites of metastases from lung cancer—adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly).

Question 2

Lung cancer complications (first aid)

Answer 2

SPHERE of complications:
Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)

All lung cancer types except bronchial carcinoid
are associated with smoking.

Squamous and Small cell carcinomas = Sentral (central)

Question 3

adenocarcinoma - location, characteristics, histology (First aid)

Answer 3

peripheral

most common overall and nonsmokers

mutations: k-ras, EGFR, ALK

causes osteoarthropathy (clubbing)

bronchioloalveolar subtype - CXR shows hazy infiltrate similar to pneumonia b/c grows along alveolar walls –> thick walls

Question 4

squamous cell carcinoma - location, characteristics, histology (fist aid)

Answer 4

think C’s

Central

hilar mass from bronchus: Cavitation, Cigarettes, hyperCalcemia (produces PTHrP)

keratin pearls and intercellular bridges

Question 5

small cell carcinoma - location, characteristics, histo (first aid)

Answer 5

think A’s

central

undifferentiated –> aggressive

ACTH, ADH, Antibodies against Ca channels (LEMs), Amplification of myc oncogene

inop - treat with chemo

neoplasm of neuroendocrine Kulchitsky cells –> small dark blue cells

Question 6

Large Cell carcinoma - location, characteristics, histo (first aid)

Answer 6

peripheral

highly anaplasic undifferentiated tumor –> poor prognosis

no chemo, remove with surgery

pleomorphic giant cells

Question 7

bronchial carcinoid tumor - characteristics, histo (first aid)

Answer 7

excellent prognosis - rarely spreads

symptoms due to mass effect
can get carcinoid syndrome (5-HT secretion –> flushing, diarrhea, wheezing)

nests of neuroendocrine cells (chromogranin A +

Question 8

important physiologic considerations when deciding lung surgery? what values are good?

Answer 8

1 FEV1

both should be >40% postoperative (predicted)

cardiac function - RV increased afterload b/c smaller vascular bed