Lung CA Flashcards
what is the most common cause of cancer death in US>
lung
what is the major carcinogen in cigarettes?
Benzyopyrene
what are some occupation and environmental hazards of smoking>
asbestos, benzene, nickle, radiation
Genetic risk factors for lung CA?
Oncogenes and suppressor genes (P16 cell cycle regulator-can be detected in sputum, if gene is present they have a 50/50 chance of developing cancer in the future)
-EGFR
what are some paraneoplastic syndromes common to all pathologic types?
anemia, DIC, esosinophilia, thrombocytosis, acanthosis nigricans
Small Cell Carcinoma
25-35% –> 100% are associated w/ smoking
What are some histological features of Small Cell Carcinoma?
Oat cell
what are some paraneoplastic syndromes associated w/ small cell carcinoma?
SIADH, Cushing’s, Myopathy, Neuropahty (Eaton-Lambert)
CNS dysfxn
where is Small Cell Carcinonoma most likely to be found in lungs?
hilar and mediastinal origin
-tends to originate in the central bronchi
other clinical features of small cell carcinoma?
very early metastasis to regional lymph nodes and distant sites
**assume metastasis at presentatio
tx of small cell
chemo, surgery is not beneficial, mostly used to relieve sx
Types of non-small cell carcinomas
Squamous, Adenocarcinoma, Large cell
Clinical features of NSCLC
grows more slowly, more amenable to surgery
squamous cell carcinoma
25-35% of the cases
more likely to present w/ hemoptysis
squamous cell carcinoma location
brochial in orgin, most likely to be dx via suptum cytology
adenocarcinoma
most common type of bronchogenic carcinoma
- typically metastatic to distant organ
where does adenocarcinoma cancers arise?
mucus glands, and usually appars in the periphery of the lung (early detiction no available throuh sputum exam)
CF associated with adenocarcinoma?
may be associated w. thrombophlebitis
etiology of adenocarcinoma?
most common cell type in females
- weakest association w. tobacco
- *bronchoalveolar subtype may no be associated w/ smoking at all
bronchoalveolar subtype?
may resemble PNA
histology of adenocarcinoma?
Glandular foramation
- series of cells try to form a lumen of a gland
- large nuclei, hetrogenous, large amount of cytoplasm
Large cell carcinoma
heterogenous group of undifferentiated types
CF of large cell carcinoma
rapidly growing, usualy peripheral in origin
resectable if caught early, resistant and recurrent, metastasis is early
- may occur w. gyneocomastia (paraneoplastic syndrome)
- poorer prognosis than others
histology of large cell
- “hard cytoplasm”, darker
- large cells
where are the most common metastasis of LCA?
Breast, GI, Melanoma, sarcoma
-generally unreectable
what types of metastisis can be resected?
sarcoma and renal cell
what is the most common presentaton of metastasis?
peripheral nodule
why do cancers like to metasize to the lung?
large capillary bed!!!
what are other types of lung neoplasms?
- carcinoid
- primary pulmonary lymphomas
- Bronchoalveolar ca
- mesotheliomas
sx of a primary tumor?
- cough
- SOB
- hemoptysis
- wheezing/stridor
- post-obstructive PNA
- chest wall pain or sensation of chest tightness
sx of regional spread (nodal)
- Tracheal / esophageal obstruction (mediastinal mass)
- Hoarseness (compressed recurrent laryngeal nerve)-
Paralyzed hemidiaphragm (compressed phrenic nerve)
SVC syndrome (obstruct superior vena cava : face swelling, plethora, headache, mental status changes)
sx of local spread
- Chest wall pain
- Pleural effusion (very common presentation, exudative)
- Pancoast’s Tumor (tumor of the lung apex, causes Horner’s syndrome and shoulder pain, affects brachial plexus and cervical sympathetic nerve)
- Horner’s syndrome (ptosis, miosis, unilateral facial anhidrosis = invades the spine)
- Brachial plexopathy (C8, T1, T2
- Endocrine (carcinoid syndrome – flushing, diarrhea, telangiectasias)
what is carcinoid syndrome?
sx secondary to a carcinoid tumor- causes the release of serotonin and killikyrin (which is then made into bradykin-super potent vasodilator)
Pancoast’s tumor
most non-small cell, found in apex of lung
Horner’s syndrome
ptosis, miosis, unilateral facial anhidrosis=invaes the spine)
small cell paraneoplastic syndromes?
Cushing syndrome, SIADH, Peripheral neuropathy, myesthenia (Eaton-Lambert), Cerebellar degeneration
Large cell paraneoplastic?
gynecomastia
squamous cell paraneoplastic syndrome?
hypercalcemia
adenocarcinoma paraneoplastic sydrome?
thrombophebitis
what paraneoplastic syndromes ares seen in all typse?
Anemia, DIc, eosinophilia, throbocytosis, Acnthosis nigricans
brain mets sx?
sz, ha, aphasia (can’t express speech), paresis
Bony mets sx?
pathologic frx, spinal cord compression, bone marrow invastion
adrenal mets:
addisons, SIADH, Cushing
how are lung CA initially seen?
10%- incidental
55%- local/regional sx
35%- due to distant/paraneoplastic sx
dx approach
step 1: CXR
step 2: CT (low dose helical)
step 3: bronchoscopy
Trans-thoracic needle aspiration (TTNA) -rarely indicatd for hilar mass
Step 4: sugery
complications of TTNA
Pneumothorax! (1/3 pts undergoing prodcedure
what type of surgery is indicated for bx of the lug?
mediastinoscopy- incision is made in the suprasternal notch and bx is taken via a mediastinoscope
tx of NSCLC
surgery!
stage 1 & II NSCL
resection, chemo
5 yr survival ~50%
Stage IIIA NSCLC
resection if possible
neoadjuvant chemo often used
stage IIIB NSCLC
high dose radiotheraphy, chemo often given in conjuction
5% 5 yr survival in those w/ dz confined to chest
stage 4
radiation ot symptomatic sites
small cell tx
combined chemo
limited small cell
- combo chemo/XRT
- prphylactic brain irradiation
extensive small cell
- combo chem
- radiation for brain if mets
- 5 yr survival < 5%
