KEY wk 6 lec 1 Flashcards
most common type of lung cancer
adenocarcinoma (non-small cell)
3 subtypes of non-small cell lung cancer
- adenocarcinoma
- squamous cell carcinoma
- large cell carcinoma
where are pan coast tumors located and in what type of cancer
apex of lung in squamous cell carcinoma (non-small cell)
which cancer is common in nonsmokers?
adenocarcinoma
location and tissue involvement in adenocarcinoma
peripheral and bronchial mucosal glands
location and histology of squamous cell carcinoma
central and keratin pearls
which lung cancer has hypercalcemia
squamous cell
large cell carcinoma
location
ddx of
histology
large peripheral masses
diagnosis of exclusion (see focal necrosis and keratin and gland formation so exclude squamous cell c. (keratin) and adenocarcinoma (gland)
small cell lung cancer
location
cells involved
centrally or hilum
neuroendocrine
spread of non-small cell vs small cell
small cell grow and spread more quickly
TNM acryonym for tumor stages in lung carcinoma
T: TUMOR size and spread locally?
N: spread to lymph NODES?
M: distant METASTASES or pleural fluid involvement?
4 stages of tumors/ cancer
stage 1: small tumor and no lymph involvement or metastases
stage 2 and 3: regional lymph involvement
stage 4: distant metastasis
lung cancer most of metastasizes to:
-region lymph nodes- hilar and mediastinal nodes
-brain
-bone
-liver
-adrenal glands
most common sx of lung cancer
cough
sx and signs in central vs peripheral tumors
central: cough, hemoptysis, dyspnea, wheezing, atelectasis, post obstructive pneumonia
peripheral: severe pain (from infiltration of parietal pleura and chest wall), pleural effusion, dyspnea, cough
common effects from pancoast tumor
shoulder and upper back pain bc effect ribs and spine
horners syndrome
which nerve involved and sx
tumor impinges sympathetic nerve plexus –> effects ipsilateral side
ptosis: upper eyelid droop
miosis: pupil constriction
anhidrosis: no sweating
pancoast syndrome
which nerve involved and sx
C8, T1, T2 nerves
severe arm and shoulder pain and paresthesia, radiate down arm in ulnar distribution
atrophy of hand muscles
Horner’s syndrome (ptosis, miosis, anhidrosis)
superior vena cava syndrome sx
Dyspnea, cough, edema of the face and/or upper extremity, venous distension, dysphagia, headache, all due to obstruction of the superior vena cava
sx of loco regional spread of lung cancer
-superior vena cava syndrome (dysnpena, cough, face edema, dysphagia, headache)
-hoarseness (paralyzed laryngeal nerve)
-hemidiapgram and dyspnea (phrenic nerve palsy)
-horner syndrome (brachial nerve root)
-dysphagia (esophageal compression)
-pericardial effusion
general symptoms of distant metastasis
weight loss, cachexia (muscle mass loss)
bone metastases sx
bone pain
spinal cord impingement (cramping muscles, constipation, erectile, paralysis)
brain metastases sx
headache
mental status
seizure
ataxia
N/V
liver metastases sx
hepatomegaly
anorexia
confusion
jaundice
nausea
paraneoplastic syndromes
nonmetastatic systemic effects
from substances made by cancer or cancer itself
impair organs i.e. endocrine, dermatologic, rheymatologic….
2 causes of paraneoplastic syndrome
from physiologically active substances made by cancer: hormones, hormone precursors, enzymes, cytokines
altered immune response (body makes antibodies which cross react with normal tissue)
small or non-small lung cancers have paraneoplastic syndromes more commonly?
small
examples of paraneoplastic syndromes
hypercalcemia (ectopic production of parathyroid hormone - squamous cell carcinoma)
syndrome of inappropriate antidiuretic hormone (small cell lung cancer)
digital clubbing and hypertrophic pulmonary osteoatropathy and trousseau syndrome of hyper coagulability (adenocarcinoma)
cushing syndrome (ectopic ACTH production - small cell)
endocrine symptoms from paraneoplastic syndromes and sx
hypercalcermia (hyperparathyroid –> thirst, muscle weakness, loss of appetite, confusion, ab pain, depression)
Syndrome of inappropriate antidiuretic hormone (SIADH) (hyponatremia –> thirst, muscle weakness, loss of appetite, confusion, abdominal pain, and depression)
cushing- high ACTH (hypokalemia –> increased serum and urine cortisol concentrations)
Cushing syndrome
Syndrome of inappropriate antidiuretic hormone (SIADH) secretion
Hypercalcemia
———- match with the answer——–
hyperparathyroid
hyponatremia
hypokalemia
Cushing- hypokalemia
SIADH - hyponatremia
hyperparathyroid - hypercalcemia
primary lung cancers are mainly (90%) from
tobacco smoke
carcinogens causing lung cancer
tobacco smoke
asbestos
radon
air pollution
what does tobacco do to cause lung cancer
- Polyaromatic hydrocarbons and nicotine-derived nitrosamine ketone are known to cause DNA damage by forming DNA adducts in animal models
- Benzo-A-pyrine induces molecular signaling and mutations in p53 and other tumor suppressor genes
main mutation in cancer
K-ras (oncogene)
esp in non-small cell lung cancers
also correlates with cigarette smoking
3 mutations in cancer
K-ras
EGFR
EML4-ALK translocation
Epidermal Growth Factor Receptor (EGFR) mutation in cancer
who most common in
mutation in tyrosine kinase domain
non smoker, women, east asian
EML4-ALK Translocations in cancer
most frequent in
metastases to
fusion of those 2 genes
non smokers
brain
carcinoids (rare) are in
2 subtypes
smoking or not?
growth?
do not cause
neuroendroceine cells of bronchial epitehlium
typical and atypical
not smoking
grow slower
DO NOT cause paraneoplastic syndromes
mesothelioma (rare) is in
caused by
sx
prognosis
pleural lining
asbestos
pleural effusion or a pleural mass, chest pain, and nonspecific symptoms, such as weight loss and malaise
poor- die in 18 months
metastasis via
most spread to which part of lung
lymphs or blood
edges and lower lobes
metastasize to lung from
- Bladder cancer
- Breast cancer
- Colorectal cancer
- Kidney cancer
- Melanoma
- Sarcomas
- Testicular
