L62 Flashcards
What enzyme system with genetic polymorphism is an inherited predisposition to lung cancer?
P450
Which 2 lung cancers are more commonly associated with smoking?
Small cell
Squamous cell carcinoma
Which 2 oncogenes are closely tied to lung cancer?
EGFR
ALK
These both have targeted therapies against them
Describe the lesion on CT for small cell carcinoma
Central mass - endobronchial growth
Might see LN involvement
Where in the lung do squamous cell carcinoma occur? What is the classic histo pattern?
Central
Infiltrating nest of tumor cells w/ central necrosis -> cavitation
Keratin
What are 2 important variants of squamous cell carcinoma?
Papillary pattern
Basaloid variant
What is the difference between adenocarcinoma in situ and minimally invasive adenocarcinoma?
Pre-invasive lesions:
- AAH
- Adenocarcinoma in situ (lesions 3 cm lesion and more than 5mm invasion
Adenocarcinoma characteristics on histo
Gland like structures
Might see type 2 pneumocytes
Adeno on CT scan
Ground glass opacities on periphery
If see solid components = invasive
What is pancoast syndrome?
Lung cancer that is destructive into thoracic inlet - brachial plexus or cervical sympa nerve involvement
- Severe shoulder pain
- Atrophy of hand/arm muscles
- Horner’s!!!
Do lung cancer pts usually present with clinical symptoms?
If they do - means late stage By time you have symptoms you're stage 3/4 Cough Weight loss Dyspnea Chest pain Hemoptysis
If you have this clinical symptom, how/where has your lung cancer met to Dysphagia Hoarseness Horner's Pancoast Pleural effusion SVC syndrome Effusion or tamponade
Dysphagia - tumor compression esophagus
Hoarseness - laryngeal nerve paralysis
Horner’s - symptomatic nerve paralysis
Pancoast - cervical/thoracic nerve invasion
Pleural effusion - lymphatic obstruction
SVC syndrome - vascular obstruction (see co-laterals draining, worried about cerebral edema)
Effusion or tamponade - pericardial/cardiac extension
What does a beaded interstitial pattern on CT mean?
Look for lines in the periphery = septal lines
Means lymphatic spread of cancer
What are the paraneoplastic syndromes that might occur due to a lung tumor?
- Hypertrophic pulmonary osteoarthropathy
- SI-ADH (seem hyponatremic but really hypervolemic)
- Hypercalcemia due to increased PTH like compound
- Cushing syndrome - increased ACTH
- Lambert Easton Syndrome - opposite of MG, strength improves w/ activity
- Clubbing
What is hypertrophic pulmonary osteoarthropathy
Tumor causes angiogensis and osteogenesis
New periosteal thickening of long bones
Association with clubbing
What is the most likely site of mets for lung cancer?
Adrenals
Why don’t you do PET scan on a CT that shows ground glass opacities?
Ground glass - probably carcinoid or adenocarcinoma
These won’t pick up glucose well - not good for PET
What are the 3 ways you can biopsy the lung?
- Transbronch/endobronch biopsy (bronchoscopy)
- Endobronch US guided biopsy
- CT transthoracic biopsy
How stage small cell lung cancer?
Limited = confined to hemi-thorax Extensive = anything outside that area
Treat small cell lung cancer: Chemo Radiation Surg Combos
Chemo + radiation
How stage non-small cell lung cancer?
T0-4 = tumor size 0/1 more peripheral 4 = hugging more important things N0-3 = LN invovlement N2: mediastinal LN N3: crosses to other lung LN M0-1 = yes or no distant mets
What system do you use to evaluate pts lifestyle before starting their cancer treatment?
ECOG
What is the treatment for non-SC lung cancer stage: 1 = lung only 2 = local LN 3 = mediastinal LN 4 = distant mets
1 = surg *Catch early b/c surg is often curative - If not a surg candidate, might try radiation 2 = surg + local chemo 3 = regional chemo + radiation 4 = disseminated chemo
What are the 3 types of chemo you might use for lung cancer?
- Platinum based - cisplatin, carboplatin
- Non-platinum
- Targeted:
EGFR inhibitors - cetuximab
ALK inhibitors
