Carcinoma of the lung Flashcards
What is the histologic classification of lung cancer
Small cell lung cancer - 20% of all lung cancer
Non-small cell lung cancer- 80%
- squamous cell but decreasing
- adenocarinoma but increasing
- large cell carcinoma - 10%
- carcinoid tumors (rare)
- carnioma NOS/mixed subtypes
presentation/symptoms of lung cancer?
Most patients present with some kind of symptom attributable to their tracheobronchial tree
- Dyspnea
- hemoptysis
- cough
- chest pain
Clubbing/hypertrophic pulmonar osteoarthropathy
Eaton-Lambert
- strong association with SCLC
- antibody against voltage gated calcium channel
- proximal symmetric muscle weakness
Paraneoplastic syndromes
diagnosis of lung cancer
- Tissue diagnosis is critical for the accurate prognostic predication and treatment planning for lung cancer
- before starting any therapy, a biopsy and complete staging studies need to be performed
- inserting fiber optic bronchoscope to detect intrabronchial pathology
- limitation if lesion is peripheral or minimal endobronchial component
- limitation if upper lobe
bronchoscopy
- poking a needle from outside of the body into the lung
- probably need to see where you’re going to do that
- limitation if central lesion
Percutaneous image guided biopsy
-once the histologic diagnosis is secured, determining extent of spread further dictates treatment decisions
- favorite sites of metastatis for lung cancer
- other lung
- adrenal glands
- liver
- bones
- brain
Staging
- satellite photo
- really good at distinguishing anatomy
- can’t really tell cancer- not cancer
CT scan of the chest/abdomen/pelvis
- Inject radioactive glucose
- heat map
- crummy for anatomic differentiation
Position Emission Tomography
- CNS can act as a sanctuary site (chemo doesn’t get up there with blood brain barrier)
- need IV contrast
- MRI better for soft tissue eval
- can’t see up there with PET
Brain MRI with contrast
when staging- why do we get all that imaging?
- CT can’t see well in bone
- PET is active in bone
- lung cancer loves to go to bone
How do you know if the tumor can be cut out?
- if the patient can tolerate surgery and there is no mediastinal LN involvment or other distant disease
- if there is a mediasstinal node involvement, the answer may be no, or not yet
- if there is extensive involvement or distant disease, the answer is no
Treatment of non-small cell lung cancer
- For stage III disease, chemotherapy plus radiation is most commonly given
- the benefit of surgery in these patients is unclear
- most patients have distant relapse before local relapse
cytotoxic chemotherapies and side effects
- carboplatin
- pemetrexed
- paclitaxel
- docetaxel
Side effects
- Fatigue
- nausea
- low WBC
- neuropathy
treatment of small cell
Limited: confined to one hemithorax
- aggressive chemotherapy with radiotherapy
- in spite of the high response rate, the duration brief (4-6months)
- distant relapse common - brain, bones, liver
Extensive: everything else
- same chemotherapy regimen as limited stage with the addition of immunotherapy
- systemic relapse a certainty
- surgery has little to know role
- a little controversial- TNM is more descriptive in terms of disease burdern, but VALSG helps direct therapy
