Lung Cancer Flashcards
What is the most common cause of lung cancer
smoking
What are the most important contents of cigarettes
-tar
-nicotine
-CO
What is the histological type of lung cancer that is exclusively caused by smoking
-SCC
What are the risk factors that lead lung cancer
-passive smoker
-air pollution (urban>rural)
-pulmonary fibrosis (tb and fibrosing alveolitis)
What is the clinical manifestation occurs in 5% of patient
-asymptomatic
-thus the patient needs routine CXR
What is the clinical manifestation occurs in 95% of patient
-respiratory
-distant metastases
-paraneoplastic
What is the early manifestations of hilar tumour
-productive cough (cupful of frothy sputum)
-hemoptysis
-pleuritic chest pain
What is the late manifestations of hilar tumour
(note: late means the hilar tumor is large thus causing compression)
-obstuction that leads to:
-collapse (full)
-pneumonia, lung abscess, bronchioectasis (partial)
In case of lung abscess, why bronchioscopy is done
-to exclude lung cancer
In peripheral tumors, what is commonly known
adenocarcinoma
What is the manifestations of peripheral tumours
-massive hemorrhagic pleural effusion
Why the plural effusion in peripheral tumours don’t shift to the opposite side
-due to the underlying collapse
What structures infiltrated in pancoast syndrome
-sympathetic trunk
(Horner’s syndrome)
-bronchial plexus
(Shoulder pain, muscle atropy)
-posterior ribs
(Ribs erosions and dull kronig’s isthmus)
What is the cause of superior mediastinum syndrome
-venous engorgement
-compression to the venous return
What is the fate of superior mediastinum syndrome
-facial, conjunctival, laryngeal edema (hoarsness due SVC)
-headache
-nonpulsating external jugular vein
What are the sites of metastasis in lung cancer
-hilar lymph nodes
-liver
-brain
-bone
What is the most common metastatic manifestations of lymph nodes
-lymphagitis carcinomatosis
What is the characteristic of lymphagitis carcinomatosis in case of:
-diffuse or localized
-most common condition
-clinical
-radiological
-diffuse
-adenocarcinoma
-diffuse interstitial pulmonary syndrome
-septal nodular
What is the most common metastatic manifestations of liver
-irregular enlargement
-increase ALP with absent alpha-protein
What is the most common metastatic site of bone metastases
-ribs
What is the most common paraneoplastic syndrome
-clubbing
-pulmonary osteoathropathy
What is the cause of metabolic syndrome
-due to the secretion of antimetabolite polypeptide
What is the example of metabolic syndrome
-loss of weight
-anorexia
-cachexia
What is the example of endocrine symptoms with cause
-cushing (<K, small cell carcinoma)
-SIADH (<Na, small cell carcinoma)
-hypercalcemia (constipation, polyuria, stones, squamous cell carcinoma)
-carcinoid (>serotonin, bronchial carcinoid)
-gynecomastia
-polycythemia
What is the example of neuromyopathy syndrome and characters
-encephalopathy; (dementia, secondary to ADH, cushing)
-subacute cerebellar degeneration; (bilateral, severe dysarthria but no nystagmus)
-myelopathy
-neuropathy (triads; ganglioreticulitis, peripheral neuropathy, GB)
-myopathy
What is the characteristic of ganglioreticulitis
-distal sensory loss
What are the examples of myopathy and its characteristics based on
-cause
-affected area
-polymyositis (adenocarcinoma; proximal)
-dermatomyositis (adenocarcinoma; proximal with violet rash)
-myasthenia syndrome (small cell carcinoma; proximal; dryness of the mouth and PP)
What is the most important vascular syndrome and its cause
-DVT
-adenocarcinoma
(notes; venous gangrene, thrombotic endocarditis)
What is the most important cutaneous syndrome and its cause
-erythema multiform
-adenocarcinoma
What are the noninvasive modalities done in lung cancer
-chest x ray
-sputum cytology
-CT
-MRI
-PET
-Bone scan
What is the characteristic of ssc in x-ray
-cavitation
-central (lobar and segmenta collapse)
What is the characteristic of adenocarcinoma in x-ray
-peripheral
-leads to hilar and mediastinum affection
What is the characteristic of adenocarcinoma in CT
-ground glass (slow; doubling >1)
-solid mass (rapid; doubling <1)
What is the characteristic of bronchioalveolar carcinoma in x-ray
-single mass (the most common)
-diffuse multicentric
-localized consolidation
What is the characteristic of bronchioalveolar carcinoma in CT
-bubble like areas in low attenuation
What is the characteristic of small cell cancer in x-ray
-bulky hilar and mediastinal lymph node
What is the location carcinoid tumor
-central
What are the differences between typical and atypical carcinoid tumours based on;
-character
-mitoses
-necrosis
-character:endobronchial growth and obstucted pneumonia ; large size (>2.5)
-mitoses:<2; 2-10
-necrosis: 0, may presence
Repeat radiograph should be performed at
2-6 weeks
What are the characters of benign tumors
-age <35
-no history of smoking or metastasis
-calcification pattern and fat
-no growth compared to old film in 2 years
What is the main invasive modality used in lung cancer
-bronchoscopy
-used to take sample for biopsy
What is the best modalities for staging
-cervical mediastinoscopy
What is the function of extended cervical mediastinoscopy
-left upper lobe cancer investigation
