Lung Cancer

Question 1

Major Risk Factors

Answer 1

• 3 major: cigarette smoking***, radon, and asbestos

- air pollution, family history of lung cancer, previous lung diseases (COPD, lung fibrosis, previous head/neck cancer)

Question 2

Patients present with what symptoms?

Answer 2

• nonspecific: cough (specifically, a change in the cough), hemoptysis, dyspnea, hemoptysis, chest pain, weight loss, fatigue
• wheeze and stridor are UNcommon

Question 3

Causes of Benign “Coin Lesions”

Answer 3

• granulomas (due to TB or fungi)

- bronchial hamartoma (disorganized mass of normal lung tissue and cartilage)

Question 4

Small Cell Lung Carcinoma (SCLC)

Answer 4

• 15% of lung cancers
• neuroendocrine cells
• extremely aggressive and metastatic early on
• not amenable with surgical resection, so use chemo
• male smokers
• central

Question 5

Non-Small Cell Lung Carcinoma (NSCLC)

Answer 5

• 85% of lung cancers

- may be treated with surgical resection

Question 6

Adenocarcinoma (AC)

Answer 6

• makes up 40% of NSCLCs; most common lung cancer
• nonsmokers and female smokers
• peripheral
• look for glands and mucin production

Question 7

Squamous Cell Carcinoma (SCC)

Answer 7

• makes up 30% of NSCLCs
• male smokers
• central
• look for keratin pearls and intercellular bridges

Question 8

Large Cell Carcinoma

Answer 8

• makes up 10% of NSCLCs
• no defining characteristics (so if we don’t see signs of AC and SCC)
• peripheral

Question 9

Carcinoid Tumor

Answer 9

• makes up 5% of NSCLCs
• well differentiated neuroendocrine cells
• chromogranin positive
• classically forms a polyp-like mass in the bronchus

Question 10

Paraneoplastic Syndromes of SCLC

Answer 10

• Cushings Disease via ACTH secretion
• hyponatremia (low sodium in blood) via ADH secretion (SIADH = Syndrome of Inappropriate Antidiuretic Hormone)
• Eaton-Lambert Syndrome via antibody secretion

Question 11

Eaton-Lambert Syndrome

Answer 11

• autoimmune disorder where antibodies target pre-synaptic voltage gated calcium channels
• results in muscle weakness of the limbs

Question 12

Paraneoplastic Syndromes of SCC

Answer 12

• Hypercalcemia via PTHrP secretion (parathyroid hormone)

Question 13

Paraneoplastic Syndromes of AC

Answer 13

• Clubbing and HPOA (Hypertrophic Pulmonary Ostio Arthritis)
• HPOA = new bone growth (mainly in wrists and ankles), very painful, often mis-diagnosed as arthritis (it differs because it is usually symmetrical)

Question 14

Bronchio-Alveolar Carcinoma (BAC)

Answer 14

• AKA adenocarcinoma in situ (a sub-type of AC)
• columnar cells grow along the bronchioles and alveoli
• involves Clara cells (club cells)
• resembles pneumonia on CXR (differentiate because patients with BAC are not septic)

Question 15

What are the most common sources of metastatic lung disease?

Answer 15

• breast and colon carcinomas (followed by stomach, pancreas, prostate, and genital tract)
• metastatic lung cancer is more common than primary lung cancer

Question 16

Horner Syndrome

Answer 16

• results from sympathetic ganglion invasion
• enophthalmos (posterior displacement of eye), ptosis (droopy eyelid), miosis (pin-point pupil), and anhidrosis (loss of sweating)
• symptoms are unilateral to the affected side/nerve

Question 17

Pancoast Tumor

Answer 17

• apical lung tumor that invades the sympathetic plexus

- results in pain in the ulnar nerve region and Horner syndrome

Question 18

Where do lung cancers tend to spread hematogenously?

Answer 18

• adrenal gland > bone, brain, liver,

Question 19

Typical Route of Spreading Lung Cancer

Answer 19

• primary tumor –> hilar lymph nodes –> mediastinal lymph nodes –> rest of body

Question 20

If you don’t smoke and get lung cancer, what type will you get?

Answer 20

• Adenocarcinoma

Question 21

SVC obstruction

Answer 21

• most common in SCLC because of its rapid and bulky growth

- SVC syndrome: head and neck pain, facial swelling, upper limb edema, collateral vein formation

Question 22

What would cause hoarseness?

Answer 22

• interference with the recurrent laryngeal nerve

Question 23

What would cause diaphragmatic paralysis?

Answer 23

• interference with the phrenic nerve

Question 24

Staging of SCLC (and what defines each stage)

Answer 24

• limited disease (33%) or extensive disease (66%)
• limited = in one side of thorax and is within one tolerable radiation field
• extensive = everything else

Question 25

What are the three types of surgical resection for lung cancer?

Answer 25

• Pneumonectomy (removing whole lung)
• Lobectomy (removing part of a lung)
• Wedge Resection (just cutting out the tumor)