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Pulmonology (inpt) > Lung CA > Flashcards

Lung CA Flashcards

1
Q

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

A

lung

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2
Q

what is the major carcinogen in cigarettes?

A

Benzyopyrene

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3
Q

what are some occupation and environmental hazards of smoking>

A

asbestos, benzene, nickle, radiation

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4
Q

Genetic risk factors for lung CA?

A

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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5
Q

what are some paraneoplastic syndromes common to all pathologic types?

A

anemia, DIC, esosinophilia, thrombocytosis, acanthosis nigricans

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6
Q

Small Cell Carcinoma

A

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

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7
Q

What are some histological features of Small Cell Carcinoma?

A

Oat cell

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8
Q

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

A

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

CNS dysfxn

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9
Q

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

A

hilar and mediastinal origin

-tends to originate in the central bronchi

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10
Q

other clinical features of small cell carcinoma?

A

very early metastasis to regional lymph nodes and distant sites

**assume metastasis at presentatio

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11
Q

tx of small cell

A

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

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12
Q

Types of non-small cell carcinomas

A

Squamous, Adenocarcinoma, Large cell

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13
Q

Clinical features of NSCLC

A

grows more slowly, more amenable to surgery

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14
Q

squamous cell carcinoma

A

25-35% of the cases

more likely to present w/ hemoptysis

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15
Q

squamous cell carcinoma location

A

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

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16
Q

adenocarcinoma

A

most common type of bronchogenic carcinoma

  • typically metastatic to distant organ
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17
Q

where does adenocarcinoma cancers arise?

A

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

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18
Q

CF associated with adenocarcinoma?

A

may be associated w. thrombophlebitis

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19
Q

etiology of adenocarcinoma?

A

most common cell type in females

  • weakest association w. tobacco
  • *bronchoalveolar subtype may no be associated w/ smoking at all
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20
Q

bronchoalveolar subtype?

A

may resemble PNA

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21
Q

histology of adenocarcinoma?

A

Glandular foramation

  • series of cells try to form a lumen of a gland
  • large nuclei, hetrogenous, large amount of cytoplasm
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22
Q

Large cell carcinoma

A

heterogenous group of undifferentiated types

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23
Q

CF of large cell carcinoma

A

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
24
Q

histology of large cell

A
  • “hard cytoplasm”, darker

- large cells

25
Q

where are the most common metastasis of LCA?

A

Breast, GI, Melanoma, sarcoma

-generally unreectable

26
Q

what types of metastisis can be resected?

A

sarcoma and renal cell

27
Q

what is the most common presentaton of metastasis?

A

peripheral nodule

28
Q

why do cancers like to metasize to the lung?

A

large capillary bed!!!

29
Q

what are other types of lung neoplasms?

A
  • carcinoid
  • primary pulmonary lymphomas
  • Bronchoalveolar ca
  • mesotheliomas
30
Q

sx of a primary tumor?

A
  • cough
  • SOB
  • hemoptysis
  • wheezing/stridor
  • post-obstructive PNA
  • chest wall pain or sensation of chest tightness
31
Q

sx of regional spread (nodal)

A
  • 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)

32
Q

sx of local spread

A
  • 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)
33
Q

what is carcinoid syndrome?

A

sx secondary to a carcinoid tumor- causes the release of serotonin and killikyrin (which is then made into bradykin-super potent vasodilator)

34
Q

Pancoast’s tumor

A

most non-small cell, found in apex of lung

35
Q

Horner’s syndrome

A

ptosis, miosis, unilateral facial anhidrosis=invaes the spine)

36
Q

small cell paraneoplastic syndromes?

A

Cushing syndrome, SIADH, Peripheral neuropathy, myesthenia (Eaton-Lambert), Cerebellar degeneration

37
Q

Large cell paraneoplastic?

A

gynecomastia

38
Q

squamous cell paraneoplastic syndrome?

A

hypercalcemia

39
Q

adenocarcinoma paraneoplastic sydrome?

A

thrombophebitis

40
Q

what paraneoplastic syndromes ares seen in all typse?

A

Anemia, DIc, eosinophilia, throbocytosis, Acnthosis nigricans

41
Q

brain mets sx?

A

sz, ha, aphasia (can’t express speech), paresis

42
Q

Bony mets sx?

A

pathologic frx, spinal cord compression, bone marrow invastion

43
Q

adrenal mets:

A

addisons, SIADH, Cushing

44
Q

how are lung CA initially seen?

A

10%- incidental
55%- local/regional sx
35%- due to distant/paraneoplastic sx

45
Q

dx approach

A

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

46
Q

complications of TTNA

A

Pneumothorax! (1/3 pts undergoing prodcedure

47
Q

what type of surgery is indicated for bx of the lug?

A

mediastinoscopy- incision is made in the suprasternal notch and bx is taken via a mediastinoscope

48
Q

tx of NSCLC

A

surgery!

49
Q

stage 1 & II NSCL

A

resection, chemo

5 yr survival ~50%

50
Q

Stage IIIA NSCLC

A

resection if possible

neoadjuvant chemo often used

51
Q

stage IIIB NSCLC

A

high dose radiotheraphy, chemo often given in conjuction

5% 5 yr survival in those w/ dz confined to chest

52
Q

stage 4

A

radiation ot symptomatic sites

53
Q

small cell tx

A

combined chemo

54
Q

limited small cell

A
  • combo chemo/XRT

- prphylactic brain irradiation

55
Q

extensive small cell

A
  • combo chem
  • radiation for brain if mets
  • 5 yr survival < 5%

Pulmonology (inpt) (7 decks)

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