most common type of bronchogenic carcinoma - typically metastatic to distant organ

Lung CA Flashcards by Bethany Eaton

what is the most common cause of cancer death in US>

lung

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what is the major carcinogen in cigarettes?

Benzyopyrene

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what are some occupation and environmental hazards of smoking>

asbestos, benzene, nickle, radiation

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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

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what are some paraneoplastic syndromes common to all pathologic types?

anemia, DIC, esosinophilia, thrombocytosis, acanthosis nigricans

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Small Cell Carcinoma

25-35% –> 100% are associated w/ smoking

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What are some histological features of Small Cell Carcinoma?

Oat cell

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what are some paraneoplastic syndromes associated w/ small cell carcinoma?

SIADH, Cushing’s, Myopathy, Neuropahty (Eaton-Lambert)

CNS dysfxn

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where is Small Cell Carcinonoma most likely to be found in lungs?

hilar and mediastinal origin

-tends to originate in the central bronchi

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other clinical features of small cell carcinoma?

very early metastasis to regional lymph nodes and distant sites

**assume metastasis at presentatio

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tx of small cell

chemo, surgery is not beneficial, mostly used to relieve sx

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Types of non-small cell carcinomas

Squamous, Adenocarcinoma, Large cell

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Clinical features of NSCLC

grows more slowly, more amenable to surgery

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squamous cell carcinoma

25-35% of the cases

more likely to present w/ hemoptysis

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squamous cell carcinoma location

brochial in orgin, most likely to be dx via suptum cytology

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adenocarcinoma

most common type of bronchogenic carcinoma

typically metastatic to distant organ

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where does adenocarcinoma cancers arise?

mucus glands, and usually appars in the periphery of the lung (early detiction no available throuh sputum exam)

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CF associated with adenocarcinoma?

may be associated w. thrombophlebitis

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etiology of adenocarcinoma?

most common cell type in females

weakest association w. tobacco
*bronchoalveolar subtype may no be associated w/ smoking at all

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bronchoalveolar subtype?

may resemble PNA

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histology of adenocarcinoma?

Glandular foramation

series of cells try to form a lumen of a gland
large nuclei, hetrogenous, large amount of cytoplasm

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Large cell carcinoma

heterogenous group of undifferentiated types

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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%