Lung Cancer Flashcards
General Lung Cancer (Bronchogenic Carcinoma) Etiology:
Malignancy that originates in the airways or pulmonary parenchyma
General Lung Cancer (Bronchogenic Carcinoma) Diagnosis:
- Order a CXR
- Further define w/ CT
- If suspicious, refer for biopsy
- Most diagnoses made via biopsy (transbronchial needle aspiration, thoracotomy, etc.)
General Lung Cancer (Bronchogenic Carcinoma) Common Clinical presentation:
Cough, hemoptysis, dyspnea, chest pain (pleuritic)
Paraneoplastic syndrome Etiology:
Cross reactivity between malignant cells and normal tissue (WBCs attacking normal cells), caused by a substance secreted by tumor/metastases. SCLC or mediastinal masses (thymoma). poor prognosis
Paraneoplastic syndrome Symptoms:
Endocrine - SIADH, Hypercalcemia
Neuro - Eaton-Lambert Syndrome
Myasthinia Gravis
Paraneoplastic syndrome treatment:
Treat the cancer
Suppress the substance causing it
Squamous cell lung cancer Etiology:
Generally comes from cells in proximal airways.
Squamous cell lung cancer symptoms:
May cause airway obstruction leading to atelectasis or pneumonia. May cavitate. Highly vascular. Usually spreads intrathoracic rather than distant metastasese
Squamous cell lung cancer treatment:
Stage I-II: Surgery - good prognosis
Stage IIIb-IV: no surgery, try XRT/Chemo - poor prognosis
Stage IIIa: may try surgery, try XRT/Chemo - poor prognosis.
Adenocarcinoma Etiology:
Often arises as a solitary peripheral pulmonary nodule, generally localized. may arise in an old parenchymal scar. NSCLC
Adenocarcinoma clinical presentation:
Spreads to hilar and mediastinal nodes, and to distant sites
Adenocarcinoma treatment:
Stage I-II: Surgery - good prognosis
Stage IIIb-IV: no surgery, try XRT/Chemo - poor prognosis
Stage IIIa: may try surgery, try XRT/Chemo - poor prognosis.
Large Cell lung cancer etiology:
similar to adenocarcinoma
Often arises as a solitary peripheral pulmonary nodule, generally localized. may arise in an old parenchymal scar. NSCLC
Large Cell Lung cancer clinical presentation:
Spreads to hilar and mediastinal nodes, and to distant sites
Large Cell lung cancer treatment:
Stage I-II: Surgery - good prognosis
Stage IIIb-IV: no surgery, try XRT/Chemo - poor prognosis
Stage IIIa: may try surgery, try XRT/Chemo - poor prognosis.
Small Cell Lung Cancer etiology
Arise in proximal airways
SCLC clinical presentation:
Commonly produce polypeptide hormones that mimic normal hormones.
Hilar and mediastinal involvement.
Early distant metastasis.
SCLC treatment:
No surgery
Limited (unilateral) and Extensive (bilateral) may benefit from XRT/chemo.
Poor prognosis
Pancoast (superior sulcus) tumor etiology
NSCLC, usually squamous cell or adenocarcinoma.
Pancoast tumor diagnosis:
First try needle biopsy, sputum, bronchoscopy.
If no diagnosis, then VATS or thoracotomy.
Pancoast tumor clinical presentation:
Involves cervical and thoracic nerves (brachial plexus), causes shoulder pain with ulnar distribution. Can lead to muscle weakness/wasting, ulnar paralysis, Horner’s syndrome.
Pancoast tumor treatment:
Try presurgical radiation and chemo to try to shrink the tumor back from the brachial plexus.
THEN do surgery 2-4 weeks after.
Then more chemo or radiation, based on the success of the surgery.
Mesothelioma etiology:
malignancy of pleural space.
Caused by sustained asbestos exposure. Cancer may develop 30-50 years later!
Mesothelioma diagnosis:
Thoracotomy with biopsy
Mesothelioma clinical presentation:
Pleuritic pain and Dry cough most common!
SOA, weight loss…
Mesothelioma treatment:
Radiation, surgery, or both
Carcinoid tumors etiology:
Can be found in lung, GI tract, and rarely in the ovaries/testes.
Develop primarily in neuroendocrine cells
Carcinoid tumors diagnosis:
Sometimes difficult to distinguish from SCLC on small tissue samples.
Carcinoid tumors clinical presentation:
Cough, hemoptysis, and asthma-like symptoms. Very slow growing. Is typically seen in 40-60 year olds, BUT is the most common pulmonary neoplasm in children and adolecents
Carcinoid tumors treatment:
Surgery with 10 year survival rate of 90-95%!
Anterior Mediastinal Mass etiology
Could be thyroid tumor, thymus tumor, teratoma, or lymphoma
Middle Mediastinal Mass etiology:
Could be vascular aneurysm, lymph node metastasis, cyst…
Posterior Mediastinal Mass etiology:
Could be a neurogenic tumor, aneurysm, paraspinal mass (tumor or infection)
Mediastinal masses diagnosis:
Order CXR
Further define with a CT
If suspicious, refer for biopsy
most diagnoses made with biopsy
Mediastinal masses clinical presentation:
Weight loss, anemia, asymptomatic, cough, fever…
Mediastinal masses treatment:
Treat underlying cause.
Surgery if needed and possible
Pulmonary nodules etiology:
Includes infection (TB, histoplasmosis), lung irritants, abnormal blood vessels, inflammatory conditions, and lung cancer
Pulmonary nodules diagnosis:
Determine growth and size, rule out benign lesions first (serial CXRs)
Then consider fungal test, percutaneous biopsy, bronchoscopic evaluation with biopsy, thoracotomy, sputum cytology (not great). Size and border is KEY (>8 cm and speculated is worst)
Pulmonary nodules treatment:
Treat underlying condition
Surgery if needed
Horner’s syndrome triad
Miosis, partial ptosis, anhidrosis
Eaton-Lambert Syndrome
muscle weakness, depressed tedon reflexes
Myasthenia Gravis symptoms
Muscle weakness affecting occulofacial muscles, proximal limbs, and in severe cases respiratory muscles.
Histoplasmosis etiology
Widely distributed infectious disease caused by histoplasma, commonly found in soil. Associated with bird droppings.
Compression/obstruction of the superior vena cava resulting in facial swelling.
Superior Vena Cava Syndrome
