Lung Flashcards
lining epithelium of lung structures
upto lobular bronchiole: pseudo stratified ciliated columnar epithelium
terminal and respiratory bronchiole: low columnar or cuboidal with cilia
rest of the part: simple squamous cell epithelium
histological classification of lung cancer broadly
**Epithelial tumors:** --adenocarcinoma --squamous cell carcinoma --adeno squamous carcinoma --neuro endocrine tumors --large cell --sarcomatoid Mesenchymal tumors Lymphohistiocytic tumors Tumors of ectopic origin Metastatic tumors
Classification of adenocarcinoma
lepidic acinar papillary micro papillary solid colloidal fetal adenocarcinoma enteric
squamous cell carcinoma classification
keratinizing
non keratinizing
basaloid
SCC in situ
types of sarcomatoid carcinoma in lung
pleomorphic carcinoma spindle cell carcinoma giant cell carcinoma carcinosarcoma pulmonary blastoma
types of mesenchymal tumors
pulmonary hamartoma chondroma pecomatous tumors synovial sarcoma pulmonary artery intimal sarcoma pulmonary myxoid sarcoma myoepithelial tumor
Lymph node zone of lung: N2
1=low cervical, supraclavicular 2=upper paratracheal 3=pre vascular, retro tracheal 4=lower paratracheal 5=sub aortic 6=para aortic 7= sub carinal 8=para esophageal 9= pulmonary ligament
Lymph node zone of lung N1
10=hilar nodes 11=inter lobar 12=lobar 13=segmental 14=sub segmental
Endocrine PNS of lung cancer
SIADH cushing syndrome carcinoid syndrome hypercalcemia hypercalcitonemia hyperthyroidism hypoglycemia gynecomastia
Neurologic PNS
Encephalopathy sub acute cerebellar degeneration progressive multifocal leukoencephalopathy peripheral neuropathy autonomic neuropathy Lambert Eaton syndrome
SIADH diagnostic Criteria
serum osmolarity: < 275 mosm/kg
urine osmolarity >100 mosm/kg
clinical euvolemia
urine Na> 30 mmol/L with normal dietary salt and water
absence of adrenal, thyroid, pituitary or renal insuff
no recent use of diuretics
Chemotherapy causing SIADH
cisplatin cyclophosphamide ifosfamide vincristine vinorelbine vinblastine MTX imatinib
Pancoast tumor
it is the tumor that arises from apex of lung
Pancoasts syndrome
this is characterized by the pain in the shoulder or inner aspect of arm along the ulnar nerve distribution due to the involvement of lower part of brachial plexus. (C8, T1, T2)
Horners syndrome
it is a combination of S/S caused by disruption of cervical sympathetic nerve pathway as it passes through T1 root and characterized by ptosis, miosis, enopthalmus, ipsilateral anhydrosis.
Maker IHC for adenocarcinoma
TTF 1 +ve
Napsin a +ve
Ck 7+ve
Ck 20-ve
Sq cell carcinoma IHC
TTF1 -ve
p40 +ve
p63 +ve
ck 5/6 +ve
Small cell lung cancer IHC
NSE > 100 mcg/dl(+ve) CD 56 +ve chromogranin +ve synoptophysin +ve ki 67 (50-100%)
Mesothelioma IHC
To confirm: WT1, calretinin, D2-40
To exclude: CEA, TTF1, Claudin-4
BAP-1 IHC specific marker to distinguish mesothelioma from reactive mesothelial proliferation
Dose limitation for lung
mean <20 gy
combined volume of both normal lung v20<35%
Heart dose limitation
V40<80%
v60 <30%
mean <35 gy
Prognostic factors of lung cancer
patient age, sex, weight loss and performance stats
staging
tumor histology:sqcc better prognosis
LDH, Albumin, Hb
five year survival of NSCLC
stage I: 68-92%
Stage II: 53-60%
stage III: 13-36%
stage IV: 0-10%
Nodal disease estimation:
EBUS: Stations
EUS : stations
Ebus: 2r/l, 4R/L, 7, 10 R/L
EUS: 5,7,8,9
TTNA(anterior mediastinotomy): 5,6
method of pathological mediastinal lymph node evaluation
mediastinoscopy mediastinotomy EBUS EUS CT guided biopsy
Stage IV a , C/L lung nodule: how to treat
treat as two primary lung tumors if both curable
Follow up protocol: Stage I and II
H&P , contrast CT chest+-contrast 6 monthly 3 yrs
than H&P and low dose ct scan contrast annually
follow up for stage I-II(if rx with RT)
stage III IV (definitive intent treatment)
H&P, contrast CT +- 3-6 monthly 3 yr than H&P , chest CT +-contrast 6 monthly 2 yr than LDCT annually smoking cessation pet/CT & brain MRI cancer survivor ship
Lung cancer prognostic factor
Female sex
Ps
Wt loss
Staging ( rakib sir favrt question)
lung lymph node station: N1
10: hilar
11: interlobal
12: lobar
13. segmental
14. subsegmental
lung lymph node station: N2
supraclavicular zone:
1. low cervical, supraclavicular
superior mediastinal:
2R,L: upper paratracheal
3a: prevascular
3p: Retrotracheal
4R: lower paratracheal
4L: lower paratracheal left
5: Sub aortic
6: para aortic
7. Sub carinal
8. paraesophageal
9. pulmonary ligament
Squamous cell carcinoma lung : curative dose
Curative:
55gy in 20 fractions 2.75 gy in 4 weeks
64-66 gy in 32-33 daily fractions given in a six and a half weeks
Nsclc sbrt dose
60 gy in 8 fractions on a alternate days
60 gy in 5 fractions weekly ( nazir sir)
Curative small cell lung dose
40 gy in 15 fractions 2.67 gy bid 6 hours gap in 3 weeks
45 gy in 15 fraction 1.5 gy BID 6 hours apart over 3 weeks (nazir mollah favorite)
PCI dose in ca lung
25 gy in 10 daily fractions of 2.5 gy given in 2 weeks
PCI used in
Small cell lung carcinoma
Leukemia
Difference between pleural effusion due to carcinoma or infective cause
The characteristics of pleural fluid can help differentiate between malignant and infective causes. In general, malignant pleural effusions tend to have higher protein and lactate dehydrogenase (LDH) levels than non-malignant effusions 2. Additionally, malignant effusions are more likely to be exudative, meaning that they contain high levels of cells and other substances 2. In contrast, transudative effusions are more commonly associated with non-malignant causes such as heart failure or liver disease 2
Complication of RT in lung
COMPLICATIONS
Acute
esophagitis, dermatitis, cough, fatigue.
Subacute/late
radiation pneumonitis, pulmonary fibrosis, esophageal stricture or perforation, pericarditis, coronary artery disease, brachial plexopathy, rib fracture. 2nd malignancy
How smoking cause lung cancer
Cigarette smoking is by far the leading cause of lung cancer, accounting for approximately 80% to 90% of cases. Combustion of tobacco produces multiple known carcinogens, with the most important including polycyclic aromatic hydrocarbons, tobac- co-specific nitrosamines, and nitrates
Sensitivity and specificity of CT scan and PET CT for identifying lung lesion
CT scan
Sensitivity: 55%
Specificity: 81%
PET CT
Sensitivity 80%
Specificity 88%
Common paraneoplastic syndrome of lung
Hypercalcemia
SIADH
Cushing syndrome
Lambert eaton myasthenic syndrome
Paraneoplastic encephalitits
Unexplained hematologic abnormalities
Hypercoagulability with venous thromboembolic disease
Hypertrophic pulmonary osteoarthropathy
Dermatomyositis and polymyositis
