Lung Cancer

Question 1

Non-smoking causes of lung cancer

Answer 1

radiation, esp. from decay of 238 Ur (radon gas)
this has a long latency period, and is synergistic with smoking
asbestos: most frequent cause of occupational lung cancer with a long latency. risks are also much, much worse when combined with smoking

Question 2

What should I know about the natural history of lung cancer?

Answer 2

by the time most lung cancers are symptomatic and/or detectable, they have already metastasized

Question 3

What is the progression to lung cancer

Answer 3

often preceded by mucosal changes like hyperplasia and metaplasia. these are reversible.
dysplasia and carcinoma in situ are irreversible

Question 4

squamous metaplasia

Answer 4

reactive change seen with chronic inflammation. regresses after smoking cessation. widely dispersed cells, regular maturation, low nuclear/cytplasmic ratio

Question 5

dysplasi

Answer 5

hypercellular, incomplete maturation, invasion of capillaries, high nuclear cytplasm ratio

Question 6

carcinoma in situ

Answer 6

pleomorphism with irregularity and promienent nucleoli

Question 7

squamous cell cacinoma

Answer 7

mass in major bronchi that can block airway. obstructive pneumonitis is a common complication. doesn’t ussually develop peripherally, but when it does, you see caviation and central necrosis
may cause hemoptysis

Question 8

Adenocarcinoma

Answer 8

peripheral mass
may remain asymmptomatic until the tumor is very large
may invade blood and lymph nodes early in development and often metastasizes before the primary lesion has symptoms
most common cancer in smokers and non-smokers

Question 9

bronchioalveolar carcinoma

Answer 9

probably a variant on adenocarcinoma
it originates in terminal bronchioles and alveolar lining
may remain localized for along time
columnar cells prliferate along the framework of the alveolar space. they are relatively well-differentiated. better prognosis than most other lung cancers. more false negatives with PET

Question 10

small cell carnioma

Answer 10

seen in large bronchus and infiltrates its wall
rarely diagnosed while localized to the lung. throws very early metastases to hilar and mediastinal lymph nodes. amenable to radiation- but prognosis is still very poor.
only seen in smokers
do a PET scan and look in the brain for mets.

Question 11

carcinoid tumors

Answer 11

typical: endobronchial lesions that may cause airway obstruction. 90% survival at 5 yrs
atypical: more lymph node spread and worse long term survival.
no necrosis. peripheral types often asymmptomatic.

Question 12

types of lung cancer presentation

Answer 12

asymptomatic, problems from primary lesion, problem from metastases and intrathoracic spread, and paraneoplastic syndromes

Question 13

presentations of primary lesion

Answer 13

cough, dyspmena, hemoptysis

also chest pain, other, pneuomia, obstruction

Question 14

Presentation of intrathoracic spread of lung ca

Answer 14

dysphagia, pleural effusion, hoarseness, Horner’s, Pancoast, SVC syndrome

Question 15

Pancoast

Answer 15

due to cervical/thoracic nerve invasion. often accompanied by Horner’s syndrome

Question 16

SVC syndrome

Answer 16

superior vena cava syndrome. swollenf face, engorgement of jugalr. often responds to chemo and often due to small cell carcinoma. this is an emergency

Question 17

pericardial effusion

Answer 17

pericardial invasion by tumor causing an accumulation of fluid in the pericardium. Emergency

Question 18

Where does lung cancer metastasize to?

Answer 18

brain (70% of all brain mets are from lung), bone (esp. vertebrae), liver, adrenals, skin

Question 19

what are paraneoplastic syndromes

Answer 19

non-metastatic systemic manifestions of CA often due to broduction of bioactive stubstances by the tumor or in response to the tumor. significant in 10-20% of pts w lung CA

Question 20

Examples of paraneoplastic syndromes associated with lung CA

Answer 20

hypercalcemia
digital clubbing and hypertrophic pulmonary osteoarthropathy, esp. with adenocarcinoma
Lambert-Eaton and other neuro symptoms