Lung CA Flashcards
epi of lung CA
common and deadly
- more women than men
connection to smoking
- smoking is #1 cause
- 90% of Ca caused by smoking
- increases with duration and amount
- second hand smoke is a 30% increased risk
4 other env. factors
- tar and soot
- metals
- asbestos
- radiaton
5 main epitheliod CA of lung
- SCC
- small cell carcinoma
- adenocarcinoma
- large cell
- carcinoid
what is old practical diff.
- small cell
2. non small cell
4 reasons they were separated
- clinical behav.
- liklihood of mets
- mol. genetics
- response to current therapies
what is importance of promary or secondary
lung common met locations
- diff. tumor behav.
- diff. prognosis
- diff therapy
incidence of different types
SCC - M>F
adeno - F>M
def. SCC
malig. epithelial tumor of squamoud cells showing keratinization and intercellular bridges
- strongly assoc. with smoking
location of SCC
central hilar lesions
+/- caviations
precursor to SCC
- squamous metaplasia and dysplasia of the bronchial epi
def. adeno
malig. epithelia tumor with glandular diff. +/- mucin
- usually peripheral
- less assoc. with smoking
2 adeno precursor lesiosn
- atypical adenomatous hyperplasia
2. bronchiolaveolar carcinoma
what is bronchiolaveolar carcinoma
- specific in-situ form that may precede the dev. of adenocarcinoma
- non-invasive, but may spread aerogenously (cough)
histo of small cell
- malignant tumor of neuroendocrine origin
- small cell with scant cytoplasm
- mitoses and necrosis are common
what is grade of small cell
high automatically
- extremely aggressive
where is small cell
- typically central
- from neuroendocrine cells of bronchial epi
- able to secrete hormones
what is large cell
garbage bag
- undifferentiated malignant tumor that lack squamous or glandular looks
what are carcinoid
1-5%
- low grade malignant neuroendocrine tumors
- under 40 yo and M=F
where are carcinoid
central or periphery
histo of carcinoid
- nest of uniform regular cells
2 types of carcinoid
typical - mitotic count
what are genes in small cell
Myc, Rb, p53, BCL 2
- overexpress c-kit
- increased telomerase expression
what are dominant genes in non-small cell
EGFR, K-ras, p53, p16
- more telomerase
**what are 2 important genes for adeno
EGFR and k-ras
what are 2 targets for gene therapy
- EGFR have better survivial with inhibitors
- k-ras mutations correlate wit worse outcome and resisstance to EGFR inhibitors
grading of CA
non-small cell - based on histo
small cell - automatically high
3 general cats. that cause Sx in Ca
- mets
- tumor
- paraneoplastic
tumor Sx
- cough
- dyspnea
- hemoptysis
- pain
- hoasrseness - recurrent laryngeal
- Horner’s
Sx of horners
- miosis
- ptosis
- anhydrosis - lack of sweat
4 Sx of mets
- liver enzymes
- bone - pain, alk phos, hypercalcemia
- adrenal
- brain - HA, N/v, focal weakness
what is hypertrophic osteoathropathy
clubbing
- periostreal new bone formation in long bones
- most common in adenocarcinoma
what is used for diagnosis
CT
biopsy
bronchoscopy
PET
what is biopsy
perc. transthoracic lung biopsy
- best for peripheral lung lesions
- aspiration and/or core
what is bronchoscopy
best for central lesion on bronchus
- can use biopsy foceps to take pieces of tissue
6 possible benign causes of solitary lung nodule
- infectious granuloma
- other infection
- benoghn neoplasm
- vasc. malformation
- congenital
- inflamatory
2 main patient factors
- age
2. presence of risk factors
4 features that make a nodule suspicious
- borders - irregular or spiculated
- size - bigger is worse
- calcification - stipled
- growth - very fast or slow is more likely benign
what does PET do
measure metabolic activity with radioactively labelled glucose
- malignant cells tend to take up more of the glucose
how to stage non-small cell
- size and location of the tumor
- nodal involvement
- mets
how to determine the nodal involvment
CT and PET
- transbroncoscopic needle aspiration
define stages
1 and 2 - T 7cm , and or nodes
4. any pleural involvement or M
Tx for non- small cell
1 and 2 - surgical resection
- need to assess medical suitablity first
- post-op estimated FEV1 and DLCO must be at least 40%
- adjuvant chemo may be given for stage 2
3 - chemo, rads, maybe surg
4 - no surg - chemo, maybe rads
Tx for small cell
- limited to ispilateral hemothorax - chemo or rads
- extensive - chemo alone
- generally not surgery
