Chapter 24- Neoplastic Disorders Flashcards
What are the paraneoplastic syndromes associated with bronchogenic carcinoma?
Hypertrophic pulmonary osteoarthroscopy and clubbing Hyponatremia Hyerpcalcemia Cushing Syndrome Eaton-Lambert myasthenic syndrome Other neuromyopathic disorders Thrombophlebitis
What is the cell type of Hypertrophic pulmonary osteoarthroscopy and clubbing?
All except small cells
What is the mechanism of Hypertrophic pulmonary osteoarthroscopy and clubbing?
Unknown
What is the cell type of hyponatremia?
Small cell most common; can be any type
What is the mechanism of hyponatremia?
SIADH, ectopic antidiuretic hormone production by tumor
What is the cell type of Hypercalcemia?
Usually squamous cell
What is the mechanism of hypercalcemia?
Bone metastases, osteoclast-activating factor, parathyroid hormone-like hormone, prostaglandins
What is the cell type of cushings syndrome?
Usually small cell
What is the mechanism of cushings syndrome?
Ectopic ATCH production
What is the cell type of Eaton-Lambert myasthenic syndrome?
Usually small cell
What is the mechanism of Eaton-Lambert myasthenic syndrome?
Voltage-sensitive calcium channel antibodies in >75%; affects presynaptic neuronal calcium channel activity
What is the cell type of other neuromyopathic disorders?
Small cell most common; may be any type
What is the mechanism of other neuromyopathic disorders?
Antineuroinal nuclear antibodies, also known as anti-hu; others uknown
What is the cell type of thrombophlebitis?
All types
What is the mechanism of thrombophlebitis?
Unkown
What does TNM stand for in the staging system for lung cancer?
Primary tumor (T) Nodal involvement (N) Metastasis (M)
What is T1 in the TNM staging system for lung cancer?
Tumor < or equal to 3cm diameter without invasion more proximal than lobar bronchus
What is T2 in the TNM staging system for lung cancer?
Tumor >3cm diameter or tumor of any size with any of the following characteristics:
Invasion of the visceral pleura
Atelectasis of less than entire lung
Proximal extent at least 2cm from carina
What is T3 in the TNM staging system for lung cancer?
Tumor of any size with any of the following characteristics:
Invasion of chest wall
Involvement of diaphragm, mediastinal pleura, or pericardium
Atelectasis involving the entire lung
Proximal extent within 2cm of carina
What is T4 in the TNM staging system for lung cancer?
Tumor of any size with any of the following:
Invasion of the mediastinum
Invasion of the heart of great vessels
Invasion of trachea or esophagus
Invasion of vertebral body or carina
Presence of malignant pleural or pericardial effusion
Satellite tumor nodule(s) within same lobe as the primary tumor
What is N0 in the TNM staging system for lung cancer?
No regional node involvement
What is N1 in the TNM staging system for lung cancer?
Metastasis to ipsilateral hilar and/or ipsilateral peribronchial nodes
What is N2 in the TNM staging system for lung cancer?
Metastasis to ipsilateral mediastinal and/or subcarinal nodes
What is N3 in the TNM staging system for lung cancer?
Metastasis to contralateral mediastinal or hilar nodes or ipsilateral or contralateral scalene or supraclavicular nodes
What is M0 in the TNM staging system for lung cancer?
Distant metastasis absent
What is M1 in the TNM staging system for lung cancer?
Distant metastasis present (included metastatic tumor nodules in a different lobe from the primary tumor)
What is stage IA in the stage groupings of TNM subsets for staging lung cancer?
T1 N0 M0
What is stage IB in the stage groupings of TNM subsets for staging lung cancer?
T2 N0 M0
What is stage IIA in the stage groupings of TNM subsets for staging lung cancer?
T1 N1 M0
What is stage IIB in the stage groupings of TNM subsets for staging lung cancer?
T2 N1 M0
T3 N0 M0
What is stage IIIA in the stage groupings of TNM subsets for staging lung cancer?
T3 N1 M0
T1-3 N2 M0
What is stage IIIB in the stage groupings of TNM subsets for staging lung cancer?
ANY T N3 M0
T4 ANY N M0
What is stage IV in the stage groupings of TNM subsets for staging lung cancer?
ANY T ANY N M1
What is the leading cause of cancer death in men and women in the US?
lung cancer
What are the 2 types of lung cancer?
Small cell carinoma
Non-small cell carcinoma (most common)
What 3 things make up non-small cell carcinoma?
squamous cell carcinoma
adenocarcinoma
large cell carcinoma
What are the S/S of lung cancer?
mild cough, dyspnea, increased sputum production, hemoptysis, CP, weight loss
What are the PE of lung cancer?
May be normal or reveal changes (i.e. crackles, inspiratory wheeze, dullness to percussion)
Lymph node enlargement in neck or axilla = metastatic disease
What are lung cancers in the apex of the chest and invade apical chest wall structures? Cause pain radiating down the arm or Horner syndrome (ptosis, miosis, anydrosis)
Superior sulcus or Pancoast tumors
Localized carcinoma forms and later extends beyond bronchial mucosa. Usually found in central airways and may lead to obstruction. Lowest rate of metastasis
Squamous cell lung cancer
Develop as peripheral lesion and may be assoc. with pneumonitis and hilar adenopathy
Two subtypes: giant cell and clear cell
Large cell carcinoma
Most common type of lung cancer and most common type in nonsmokers. Usually found in periphery of the lung. Assoc. with PE and distant metastasis. Can cause mucus production. Poor prognosis
Adenocarcinoma
Strongly assoc. with smoking. Perihilar location. Assoc. lymphadenopathy. Metastasize fast and outcome is very poor.
Small Cell Lung Carcinoma
How is lung cancer diagnosed?
tissue biopsy
Sampling of PE to assess for malignant cells
Treatment for lung cancer?
chemo, radiation
Surgery is the only curative therapy
Single, rounded lesion in lung <3cm in diameter
solitary pulmonary nodule
If a nodule has discrete borders, diffuse/central/popcorn/laminated calcifications, no change in size in 2 years. Is it benign or malignant?
Benign most likely
If you suspect a lesion is malignant what should you do?
remove it
Neurologic syndomes that are elicited by patient’s immune response to tumors in the lung, ovaries, breast, lymphatic system
Paraneoplastic syndromes
S/S of paraneoplastic syndromes
develop over weeks
Difficulty walking or swallowing, loss of muscle tone, loss of fine motor coordination, slurrred speech, memory loss, vision problems, dementia, sleep disturbances, seizures and vertigo
Stiff person syndrome, encephalomyelitis, cerebellar degeneration, neuromyotonia, sensory neuorpathy are examples of what?
paraneoplastic syndromes
What is the presurgical evaluation of lung cancer?
PFT, FEV1, cardiopulmonary exercise testing (CPET)
