Lung Cancer Flashcards
most common cancer worldwide
bronchogenic carcinoma
bronchogenic carcinoma
malignancies that originate in airways or pulmonary parenchyma
Solitary Pulmonary Nodule (SPN)
coin lesion, <3cm, isolated, rounded opacity not a/w infiltrate, atelectasis or adenopathy , mostly benign
benign SPN
smooth, well-defined edeges, dense central calcification
watchful waiting for SPN
only if low risk, otherwise biopsy
> 3cm SPN
mass, usually malignant , CA until proven otherwise (mass or nodules)
Benign SPN
infectious granulomas (TB, cocci), hamartoma, pulm abscess, vasculitic lesion, pulm dirofilariasis
Malignant SPN
bronchogenic CA, bronchoalveolar CA, carcinoid tumor, Mets
PE findings of SPN
wt loss, lymphadenopathy (supraclavicular/scalene nodes), fixed/localized wheeze, joint tenderness
fixed or localized wheeze a/w
endobronchial tumor
Lab findings of SPN
no specific findings
abnl labs w/
paraneoplastic syndrome
why review of old films
malignant nodules double in 20-400 days -minimal growth= benign
no calcification=
elevated risk of CA
poorly defined irregular spiculated shape=
elevated risk of CA
the larger the lesion=
greater risk of malignancy >5cm
indication for referral SPN
- lesion is unstable, noncalcified, not rounded, >3cm 2. new or enlarging 3. indeterminate lesion with at risk pt
lung malignancy cell types
- small cell carcinoma 2. non-small cell types : a.adenocarcinoma b.squamous cell carcinoma c. large cell carcinoma
most common type of lung malignancy
adenocarcinoma
occurs centrally - bronchial origin
small cell carcinoma
small cell carcinoma
narrows bronchi by extrinsic compression, metastasizes aggressively, not amenable to surgery, micrometastases are present at time of dx
most prevalent lucg CA in both sexes
adenocarcinoma
adenocarcinoma arises from
mucous glands
occurs in lung periphery
adenocarcinoma
present as nodules or masses and metas. to distant organs
adenocarcinoma
occurs centrally
squamous cell carcinoma
squamous cell carcinoma arises from
bronchial epithelium
seen as an intraluminal growth in the bronchi
squamous cell carcinoma
may be able to detect by sputum cytology
squamous cell carcinoma
more likely to cause hemoptysis
squamous cell carcinoma
likely to metastasize to regional lymph nodes
squamous cell carcinoma
can cavitate
squamous cell carcinoma
large cell carcinoma occurs in
lung periphery and metas. to distant organs
lung CA symptoms result from
- primary lesion 2. intrathoracic spread : a.pleural effusion, pericardial effusion, hoarseness b. SVC syndrome c. pancoast syndrome 3. paraneoplastic syndromes 4. mets w/no lung complaints
most common symptom
cough
primary lesion symptoms
cough, sputum, dyspnea, hemoptysis, chest pain, unilateral localized wheezing, wt loss
most common cause of hemoptysis
bronchitis
unilateral localized wheezing a/w
suspect bronchogenic CA causing obstruction of major airway
pleural effusion due to
- direct pleural extension 2. mediastinal node involvement & lymphatic obstruction
pericardial effusion due to
direct extension of tumor into pericardium
hoarseness due to
compression of recurrent layngeal nerve
hoarseness more common with
Left side tumors
SVC (superior vena cava) syndrome due to
compression or direct invasion
SVC syndrome most commonly a/w
small cell carcinoma
SVC syndrome symptoms
ha, dyspnea, facial/ UE edema, plethora, dilated neck veins, prominent venous pattern on chest
pancoast syndrome
tumor involving superior sulcus of lung compresses brachial plexus and cervical sympathetic nerves
Horner’s syndrome
part of pancoast -injury to sns of face, signs of ipsilateral side of tumor
symptoms of Horner’s syndrome
miosis, anhidrosis, ptosis, sinking of eyeball
symptoms of pancoast syndrome
ipsilateral: rib destruction, atrophy of hand muscles, pain C8,T1,T2 nerve roots
paraneoplastic syndrome
disorders arises from tumor secretions (hormones, peptides, cytokines)
constellation of paraneoplastic syndrome
anorexia, st loss, cachexia, fever, suppressed immunity
hematologic symptoms of paraneoplastic syndrome
- carcinogenic thrombophlebitis (trousseau’s syndrome) 2. malignancies often a/w hypercoaguability
carcinogenic thrombophlebitis (trousseau’s syndrome) is most commonly a/w
adenocarcinoma
endocrine symptoms of paraneoplastic syndrome
PTH like substance, Xs HCG production, SIADH, Cushing’s (ectopic ACTH)
PTH like substance is a/w
NSCLC squamous
Xs HCG is a/w
large cell
SIADH is a/w
Small cell
Cushings a/w
small cell
neurologic symptoms of paraneoplastic syndrome
eaton-lambert syndrome, peripheral neuropathy
eaton-lambert a/w
small cell
most common sites of distant met.
liver, bone, brain, adrenal gland
primary site for majority of cancers that present as symptomatic brain mets
lung
lung CA tissue dx
- sputum culture 2. bronchoscopy w/biopsies 3. thoracentesis 4. fine needle aspiration/CT guided needle biopsy 5. transbronchial aspiration (VATS)
best tissue dx for central lesions
sputum culture
stages of SCLC
- limited dz 2. extensive dz (80%)
SCLC extensive dz
beyond hemithorax, includes pleural effusions
tx of non small cell lung CA
surgical resection in localized dz
tx of small cell lung CA
regardless of stage : chemo, prophylactic WBRT (brain)
management of malignant effusions
thoracentesis, pleurodesis, pleurx catheters
screening for lung CA
not recommended
zyban
for smoking cessation- SE: seizure
