Lung Cancer Flashcards
Lung Cancer
Lung Cancer is the leading cause of cancer death in the United States and accounts for 27% of all cancer deaths
1/4 of patients don’t have symptoms at diagnosis
3/4 of patients have a cough with blood or rust colored sputum
Diagnosis of lung cancer
Typically seen on a chest X-ray
Cough with rust or bloody sputum
Histological Types of lung cancer
Squamous cell (epidermoid)- bronchial lining
Small cell (oat cell) carcinoma
Large cell carcinoma
Adenocarcinoma-most prevalent carcinoma
Small cell lung carcinomas
SCLC
OAT CELL, intermediate and combined
Very small cells with scant cytoplasm
Very rapid growing that usually metastasizes
Epidemiology
86 percent of lung cancer patients die within 5 years Death peaks in ages 55-65 Men have higher incidence African-American men have higher risk 
Causes
Smoking
Environmental and occupation exposure to carcinogens
Pathophysiology
Carcinogenic agents are deposited in the epithelial lining
Repeated carcinogenic insults to the bronchial epithelium may cause increased rates of cellular replication which result in hyperplasia dysplasia carcinoma in situ and invasive carcinoma
Small Cell Lung Cancer
15 percent of lung cancers
Invades the submucosa and is centrally located, developing around a main bronchus as a whitish-gray growth that compromises surrounding structures
Grows more rapidly
Metastasizes earlier
More responsive to chemotherapy than NSCLC
SCLC
Oat cell carcinoma- tumors are soft in consistency and have shiny gray cut surfaces on exam
Intermediate- cells with larger more vesicular or spindles nuclei
Combined- combination of small cell and other cell. Lacks sensitivity to radiation and chemotherapy
NON SMALL CELL LUNG CANCER
85 percent of all primary lung carcinomas
P53 gene in about 60% of cases
Squamous cell carcinoma
2nd most common lung cancer
Arose from basal cells of epithelium
Mass in segmental, lobar , or mainstem bronchi
Common in men
Three types well differentiated, moderately well differentiated, and poorly differentiated tumors
Metastasis in mediastinal lymph nodes, liver, adrenals, bones, and brain
Adenocarcinoma
Most prevalent carcinoma
In non smokers
Slow growing
May invade lymphatic and blood vessels
Metastasizes in brain, liver,bone, and adrenal glands
Those with lung disease at increased risk
Large cell carcinoma
Undifferentiated carcinoma
Least common lung cancer
Clear cell and giant cell
Large tumors, peripherally, very aggressive, highly malignant and usually found at later stages
Clinical presentation
History of chronic lung problems
Exposure to environmental carcinogens
Smoking history( age, packs per day, how many years , type of tobacco)
Family history
Signs and symptoms
Cough, sputum production, dyspnea, chest pain, hemoptysis, wheezing, pneumonia, pleural effusions,stridor, hoarseness, atelectasis, pericardial effusion, superior vena cava syndrome
Horners syndrome
Unilateral ptosis, miosis, and ipsilateral anhidrosis (lack of sweating). Caused my tumor suppression of the cervical sympathetic nerve plexus
Often associated with the radiographic evidence of destruction of the first and second ribs
Pancoast syndrome
Arm and shoulder pain Do you to invasion of the brachial nerve plexus by a superior sulcus tumor
Nonspecific system signs and symptoms
Generalized weakness, fatigue, anorexia, cachexia, weight loss, and anemia fever
Extra-thoracic involvement
Bone pain, headache, dizziness, lymphadenopathy, CNS disturbances, GI disturbances, jaundice, hepatomegaly, abdominal pain.
Spreads most often occur in the lymph nodes, brain, bones, liver, and super renal glands
Brain metastasis can cause Hema plegia, epilepsy, personality changes, confusion, speech deficits, gait disturbances and or only nonspecific headache
Diagnostic test
CBC, CMP( Sodium, potassium, calcium, liver enzymes, prothrombin time, PTT), CHEST X-RAY, CT, Sputum sample (early morning), fine need aspiration, thorascopic surgery for staging, head ct and abdomen to rule out metastasizes
Management
Annual screening for those with lose dose ct aged 55-80 who have a 30 pack year smoking history and currently smokes or quit within 15 years
Surgery
Pneumonectomy- removed whole lung
Lobectomy- remove single lobe (most common)
Sleeve resection- main bronchus included in resection
Segmenectomy- removal of lung segment
Wedge resection- removal of small vshaped wedge of lung
Lumpectomy-lesion in lung removed by laser or cautery
NSCLC chemo
Improves medial survival not curative
Multi drug based chemo
Widely used in stage 2-3
Improves survival 3 months at 5 years
SCLC CHEMO
Combination chemo
Effective mostly in SCLC
80-100% response in limited stage disease
60-80 in extensive
Remission last 6-8 months
If cancer reoccurs survival is 3-4 months
