Approach To Patients With Lung Cancer And Pleural Effusions Flashcards
Cigarette smoking carcinogen facts
90% of Lung cancers are in active smokers
60x greater chance of developing cancer with heavy smoking (2 packs a day for 20yrs)
Women are more susceptible to tobacco smoke carcinogens then men
Passive smoking increases risk of lung cancer and smoking pipes/cigars, just not as much as cigarettes
Linear correlation between frequency of cancer and pack-year cigarette smoking
P-450 genes and cancer
Having polymorphisms in the monoxygenase P-450 genes can increase the susceptibility to carcinogens found in cigarette smoke
Symptoms seen in carcinomas of the lung that provide an overall poor prognosis
Hoarseness
Chest pain
SUC syndrome
Pericardial/pleural effusion
Persistent segmental atelectasis
Pneumonitis
Also any metastatic spread symptoms (such as hepatomegaly, bone pain or neurologic change )
Tumor node metastasis
Used to stage cancer
1) look at the size of the tumor and how deep into the basement membrane it goes into (grade)
2) look to see how many lymph nodes it has reached (stage)
3) does distant metastasis exist?
Edema and effusions overview
Edema: accumulation of fluid in interstitial tissues
Effusions: accumulation of fluid in body cavities
Is caused due to an imbalance in the two opposing forces
- vascular hydrostatic pressure (if this goes up causes edema)
- protein colloid osmotic pressure (if this goes down causes edema)
note transudates is a type of edema and effusion that is protein poor and non-inflammatory
What diseases are common to see transudates in?
Heart failure
Renal disease
Liver failure
transudate is low protein and few cells, almost all water
Causes are:
- increased hydrostatic pressure
- decreased plasma osmotic pressure e
- increased sodium and water retention
- lymphatic obstruction is present (causes increased hydrostatic pressure indirectly)
What is the most common physiological disturbances associated with reduced plasma osmotic pressures?
Inadequate synthesis or loss of albumin levels
Most commonly seen in:
- liver diseases
- nephrotic syndromes
- protein malnutrition
Inflammation related effusions and edema
Caused almost always by vascular permeability increased due to inflammation mediators
Shows high protein content and water edema/effusions (compared to transudates)
Serious inflammation
Exudate that leads to effusions that are cell-poor, protien high and water high.
Fluid is not infected by destructive organisms and does not contain large number of leukocytes
Is a result of increased vasculature permeability
Fibrinous inflammation
Exudate that develops due to increased vascular permeability and/or a local procoagulant stimulus
The exudate contains heavy amounts of fibrin and fibrinogen as well as eosinophils which can cause extracellular fibrosis production
Exclusive to inflammation of the linings of body cavities (pericarditis, pleuritis, meningitis)
Purulent inflammation
Exudate that is pus
- contains neutrophils, necrotic cells and edema fluid
Most frequent cause is inflammation due to infections w/ bacteria that causes liquefactive tissue necrosis
Pleural euffsions
Usually defined as increased unneeded fluid of serous a cellular clear fluid within the pleural surface
Causes include:
- increased hydrostatic pressure (CHF)
- decreased osmotic pressure (Nephrotic syndrome)
- decreased lymph drainage (mediastinal carinomatosis)
- increased vascular permeability (pneumonia)
Hydrothorax
Subtype of pleural effusions that are non inflammatory collections of serous fluid within the pleural cavities
Fluid is clear and star colored (yellow)
Can be unilateral or bilateral
Most common cause is cardiac failure, but can also be seen in renal failure and liver cirrhosis
Hemothorax
Subtype of pleural effusions that are non inflammatory collections of blood
Almost always a fatal complication of ruptured aortic aneurysm or vascular trauma
Chylothorax
Subtype of pleural effusions that are non inflammatory collections of milky appearing fluid
Contains lymph and emulsified fats
Most common causes are thoracic duct trauma or obstruction
Can also be caused by malignancies