LA pulm-cancers/nodules Flashcards
5 year survival rate for bronchogenic cancer
15%
SCLC
occurance rate, location, mets, tx
- Oat cell 25-35% cases
- AGGRESSIVE, prone to early mets, spreads early
- originate in CENTRAL bronchi and mets to regional lymphnodes
- chemo. rarely amenable to sx.
- Kulchitsky cells(dk blue cells)
**can secrete ADH and ACTH
- Kulchitsky cells(dk blue cells)
5 year survival rate for NSCLC
35-40%, grows slowly and amenable to surgery
squamous cell
occurance rate, location, dx
25-35% of cases.
bronchial in origin, it is a centrally located mass
hemoptysis so do a sputum cytology.
**hypercalcemia; keratin pearls
** Kulchitsky cells(dk blue cells)
SCLC
**hypercalcemia; keratin pearls
squamous cell
adenocarcinoma
occurance rate, location, dx
overall most common. 40%
arise from mucous glands, usually appears on PERIPHERAL
cannot do a sputum cytology
**NON SMOKERS, clubbing
bronchoalveolar subtype
from adenocarcinoma. low grade.
CXR has hazy infiltrates. Good prognosis.
large cell carcinoma
characteristics, location, dx
10%
rapid doubling time; mets early; poor prognosis
central or peripheral mass
do cytology
do surgery. less responsive to chemo
**polymorphic giant cells, secrete b HCG(gynocomastia)
**polymorphic giant cells, secrete b HCG(gynocomastia)
large cell carcinoma
which cancers are central
squamous and small cell
lung cancer mets locations
LABB: liver, adrenal, brain, bone
bronchial carcinoid tumor
prognosis, mets, sx
good prognosis and mets rare.
carcinoid syndrome
** nests of neuroendocrine cells
** nests of neuroendocrine cells
bronchial carcinoid tumor
carcinoid syndrome
flushing, diarrhea, tachycardia, bronchoconstriction, hypoTN
think bronchia carcinoid tumor
S/S of lung cancer
symptoms: new or changing cough, hemoptysis, pain, anorexia, wt loss, athenia, night sweats, resistant pneumonia
signs: lymphadenopathy, hepatomegaly, clubbing
* paraneoplastic syndromes 10-20%
tests to order for lung cancer dx
CXR, CT, cytologic exam of sputum,
bronchoscopy and central biopsy, exam of pleural fluid
*FNA if peripheral
horner’s syndrome
apical pancoast tumor compresses sympathetic trunk, ptosis, miosis, facial anhidrosis
lung ca FEV1 and ratio
both low
solitary nodule in non smoker screening
CT every 6 months for 2 years
low dose CT scan annual screening for who
ages 55-74, 30 pack/yr, quit smoking in the last 15 years
stages TMN
tumor size, mets, node
stage 1 tx
only lung: resection and radiation (75% survival)
stage 2 tx
lung and hilar nodes: resection and chemoradiation (50% survival)
stage 3 tx
lung and mediastinal nodes: chemoradiation
stage 4 tx
lung and distant mets: chemotherapy only
what causes an increased risk of malignancy in a solitary pulm nodule
spiculated nodule, upper lobe, over 40 y/o
what is the most common mediastinal tumor
thymoma
etio most common with a solitary pulm nodule
infectiour granulomas
imaging of choice for solitary pulm nodule
CT chest, get CXR first
bronchoscopy shows pink to purple well vascularized centrall located tumor
bronchial carcinoid tumor
what tumor is resistant to radiation and chemotherapy
bronchial carcinoid tumor
1st and 2nd most common locations for carcinoid tumor
- GI tract
- lung
may secrete serotonin, ADH, ACTH, melanocyte stimulating hormone
bronchial carcinoid tumor
octreotide
reduces symptoms in bronchial carcinoid tumor. decreases secretion of active hormones.
second most common cancer dx in US (after prostate and breast)
lung
what is synergistic with smoking and lung cancer
asbestosis
lung ca screening with low dose CT in what ages
55-80 who have no symptoms plus a 30 PPY current smoking hx or quit within15 years
most common primary lung cancer in smokers and non smokers; what is second
- adenocarcinoma
- squamous cell lung carcinoma
lung cancer for pts with exposure to silica, asbestos, radon, heavy metals
adenocarcinoma
peripheral on CXR; lepidic (non invasive growth along intact alveolar septae)-voluminous sputum and interstitial lung pattern
adenocarcinoma
histology: gland formation and mucin production
adenocarcinoma
bronchial in origin. arises from proximal portions of tracheobronchial epithelium.
squamous cell lung carcinoma
bx: keratinization and/or intracellular desmosomes (bridges)
squamous cell lung carcinoma
CCCP characteristics of squamous cell lung carcinoma
centrally located, cavitary lesions, hypercalcemia, Pancoast syndrome
s/s of hypercalcemia
confusion, lethargy, nausea, abd pain, tachycardic, short QT interval
think squamous cell lung carcinoma
confusion, lethargy, nausea, abd pain, tachycardic, short QT interval
hypercalcemia
squamous cell lung carcinoma
what comprises 15% of all lung cancers, aggressive and associated with early mets
small cell(oat cell)
paraneoplastic syndromes in which lung cancer
small cell(oat cell)
SVC syndrome, SIADH(hyponatremia), cushing syndrome, lambert eaton syndrome
paraneoplastic syndromes
small cell(oat cell)
histology: sheets of small dark blue cells with rosette formation
small cell(oat cell)
small cell(oat cell) located where and tx
central.
chemotherapy with or w/out radiation
what is lambert eaton syndrome
antibodies against presynaptic voltage gated calcium channels prevent acethycholine release, leading to muscle weakness
antibodies against presynaptic voltage gated calcium channels prevent acethycholine release, leading to muscle weakness
lambert eaton syndrome
paraneoplastic syndrome/small cell ca
proximal muscle weakness that IMPROVES with repeated use; hyporeflexia
lambert eaton syndrome
pancoast tumor, what cancer is most common
non small cell, squamous
Pancoast tumor compression of ____ brachial plexus, ___ nerve, and central ____ nerve chain
lower brachial plexus
ulnar nerve
central sympathetic nerve chain
most common initial symptoms of pancoast tumor
shoulder and arm pain
3 tests pancoast tumor
- CXR initial test
- MRI better to assess extent of infiltration of adjacent tissues
- needle bx definitive dx
80% of chronic asbestos exposure can lead to what
mesothelioma
CXR: unilateral pleural thickening
mesothelioma
