Lung Cancer

Question 1

Lung cancer

Answer 1

Leading cause of death in US and accounts for 27% of. cancer death.
1/4 DO NOT have symptoms at diagnosis.
Cough with blood rest Color sputum

Question 2

Diagnosis

Answer 2

CRX

Cough w/ bloody rusty sputum

Question 3

4 major types

Answer 3

Squamous
Small-cell
Large-cell
Adenocarcinoma (MOST PREVALENT IN BOTH SEXES)

Question 4

Epidemiology

Answer 4

86% die within 5 year
Death peaks in ages 55 to 65
men death rate is higher
African American men have higher risk

Question 5

Causes

Answer 5

Smoking

Environmental factors.

Question 6

Pathology

Answer 6

Carcinogenic agents , tobacco smoke absorbed in these areas.

Repeated carcinogenic bronchial epithelium may causes increase risk of cellular replication.

Question 7

Small cell lung cancer

Answer 7

Accounts 15% of lung cancers
More responsive with chemotherapy 
More rapid growth white gray growth,develop the main bronchus
Grows around other structures
3 types:
Oat cell - soft

Question 8

Non-small-cell

Answer 8

85% of all lung cancer

Tumor suppressor gene p53-60%

Question 9

Squamous-cell carcinoma

Answer 9

2nd most common lung cancer
Common in men
3 subtypes :well-differentiated, moderately , poorly
Metastasis are initially to the hilar and mediastinal lymph nodes , liver, bones and brain

Question 10

Adenocarcinoma

Answer 10

35%-40%
Area of metastasis brain, liver, bone and adrenal glands
HX: chronic lung disease, Ra, recurring pulmonary-infections
*most common , NONSMOKERS

Question 11

Large-cell carcinoma

Answer 11

Aka:undifferentiated carcinoma 
Least common
Large
Highly malign
Found in later stages

Question 12

Clinical presentation

Answer 12

Smoking HX
Location of tumor
Higher in Pt with first degree relative ‘

Question 13

Intrathroacic or local regional signs and symptoms

Answer 13

Cough 
Sputum 
SOB (26-60% of pt have)
CP
Pain is dull
Wheezing
Facial edema

Question 14

Nonspecific systematic S/S

Answer 14

Weakness
Fatigue
Anorexia (1/2 of pt)
Anemia

Question 15

S\S extrathoracic

Answer 15

Spreads to lymph nodes, brain, bones, liver and supearenal glands
Neurological - hemiplegia, epilepsy, personality changes
ABD
pain unilateral
Janice and ascites
Bone pain

Question 16

Paraneoplastic syndrome

Answer 16

Small cell- more frequently associated
Endocrine
Neurological 
Cardiovascular 
Skeletal 
Weakness
Wt loss
Hypercalcemia
Eaton-lambert myastrenic syndrome- auto immune disorder

Question 17

Diagnostic testing

Answer 17

CBC,NA,.K,Ca, liver, PTT
CXR
Tumor module 2-3 mm 
CT
sputum sample (early morning)
Needle aspiration

Question 18

Management

Answer 18

Annual screening 55-80
30 pack year hx
Discontinue once person has not smoked in 15 years

Question 19

Surgery

Answer 19

Resection 
Pneumonectomy.
Lobotomy
Sleeve resection
Lesion resection

Question 20

Non small cell chemotherapy

Answer 20

Widely used Stage II and IIIA

Improve survival rate 3months -5 years

Question 21

Small cell chemotherapy

Answer 21

Most effective 80-100%
Remission 6-8 months
If cancer reoccurs survive is 3-4 months

Question 22

non-smallcell radiation

Answer 22

Used when cancer not spread beyond thorax

Malignant plural effusion is not appropriate for definitive

Question 23

Small cell radiation

Answer 23

Chemo and radiation increase rate by 5 years.
Thoracic irradiation is local tumor control .
. Quite sensitive

Question 24

Follow-up

Answer 24

H&P every 3 months during 2 years , every 6 months for 5 years then yearly
Yearly CXR
CT ABD, bronchoscopy, CBC, liver test

Question 25

Horner syndrome

Answer 25

Unilateral prosis, mitosis, and ipsilateral

Due to radiographic evidence of destruction of the firstand second rib

Question 26

Pan-coast syndrome

Answer 26

Arm and shoulder pain invasion of the brachial plexus by a sulcus tumor

Question 27

Education

Answer 27

Support groups
Stop smoking life style modification
Hospice