bronchogenic carcinoma Flashcards
what are the risk factors for lung cancer?
smoking atmosphere pollution individual variation effect of gender occupational exposure previous lung disease nutritional factors
what is the clinical presentation of bronchogenic carcinoma?
may be
asymptomatic
extra thoracic
intra thoracic
what are the presentations with extra thoracic presentation ?
metastatic- liver, brain, bone and adrenal gland
non metastatic - para neoplastic
non-metastatic - paraneoplastic syndrome
what are the presentation of intra thoracic presentation
broncho-pulmonary manifestation
pleural manifestations
thoracic inlet syndrome
mediastinal syndrome
what are the broncho-pulmonary manifestations ?
bronchial irritation ( cough and expectoration )
bronchial erosion/ulceration ( haemoptysis and dull aching chest pain )
bronchial obstruction
what are the types of bronchial obstructions ?
-partial block : localized wheeze localized emphysema -complete block : atelectasis and distal infection leading to unresolved pneumonia and lung abscess
what is a pancoast tumor ?
malignant tumor of the superior pulmonary sulcus, involves the brachial plexus
and cervical sympathetic nerves
what are the symptoms of rib erosion in pancoast tumor ?
Rib erosion ( 1st and 2nd ribs )
* Dull aching chest pain & severe shoulder pain radiating toward the axilla and scapula
* Dullness in kronig’s isthmus, clavicle & infraclavicular region * Apical mass in CXR
what are the symptoms associated with infiltration of the subclavian artery ?
unequal pulse volume
unequal blood pressure
unilateral clubbing
what are the symptoms associated with subclavian vein infiltration ?
edema of upper limbs and dilated veins
what are the symptoms associated with brachial neuralgia ?
wasting of the small muscles of the hand especially ulnar distribution
what are the symptoms associated with the affection of the cervical sympathetic chain ?
horner's syndrome ptosis anhidrosis myosis enopthalmos unilateral nasal obstruction loss of spino-ciliary reflex
what structures are affected in the mediastinal syndrome?
affection of hollow organs : trachea oesophagus bronchi vagus phrenic nerve left recurrent laryngeal nerve
what does affection of the vagus result in ?
first bradycardia then tachycardia and dyspnea
what does affection of the phrenic nerve result in ?
irritation leading to shoulder pain
later on diaphragm paralysis leading to dyspnea
later paralysis leading to dyspnea
what is d’espine’s sign?
d’Espine sign is a bronchial breathing heard over the vertebral spines below the level of tracheal bifurcation
associated with mediastinal syndrome
which paraneoplastic endocrinal abnormalities are seen with small cell lung carcinoma SCLC ?
ectopic ACTH syndrome
somatostatinoma
SIADH
somatostatinoma
which paraneoplastic endocrinal abnormalities are seen with large cell carcinoma and adenocarcinoma ?
gynectomasia
which paraneoplastic endocrinal abnormalities are seen with squamous cell carcinoma ?
1- hypercalcaemia
osteolytic metastatic disease
2- hypoglycaemia
hypoglycaemia
what are the vascular and heamatogoneous manifestations that may occur with paraneoplastic syndromes?
migrating thrombosis
fibrinogen deficiency
anemia
eosinophilia
what are the metastatic workup ?
Abd US
CT brain
Bone scan
if we have central affection what type of investigation would we perform ?
bronchoscopy
if we have mediastinal affection what type of investigation would we perform ?
lymph node biopsy
in cases of pleural effusion what type of investigation would we perform ?
thoracoscopy
what are the types of non-small cell carcinoma ?
squamous cell carcinoma
adenocarcinoma
large cell carcinoma
what type of staging do we use for non small cell carcinoma ?
TNM staging
tumor
nodes
metastasis
what is the staging used for small cell lung carcinoma ?
limited vs extensive
what is the median survival of limited SCLC ?
1-2 years
what is the median survival of extensive SCLC ?
6-12 months
what is the treatment for NSCLC ?
surgery if there is a resectable mass and no metastasis
radiotherapy
chemotherapy
what is the treatment of SCLC ?
metastasis is usually present at the time of presentation
chemotherapy
surgery is contra-indicated in most cases
how is pack year calculated ?
packs/day x years of smoking
what are the different paraneoplastic syndromes ?
Cushing syndrome – suggests small cell
syndrome of inappropriate ADH production (SIADH) – suggests small cell
Lambert–Eaton syndrome – suggests small cell
hyperparathyroidism – suggests squamous cell
what are the two types of pleural manifestations ?
pleural effusion and pleuritic chest pain
what are the different entities under pleural effusion ?
transudate - compressing SVC
exudate - infection distal to obstruction or malignant cells in pleural fluid
haemorrhagic - pleural invasion by tumor
chylothorax - mass compressing the thoracic duct
pyothorax - pyogenic infection on top
