Lung Cancer Flashcards
Risk factors
Smoking if most importnat
15 years of non-smokers, risk declines to twice that of non smokers
Weaker link for non-cigarette smoking n
Chronic cough
Seen more in squamous and small cell carcinomas
New cough in a smoker without clinical signs of pneumonia should raise suspicion for lung cancer
Hemoptysis
Most common cause is bonchitis
In smokers iwth lack of infectious sx, warrants airway insepection via bronchoscopy
Chest pain
Generally dull, aching non-resolivng on the same side as the cancer
PLeuritic sharp pain may be present if direct pleural metastasis, post-obstructive pneumonia, or PE
Hoarseness, dyspnea, wheezing
In smokers, indication of cancer…from involvement of laryngeal nerve
Dyspnea - could be due to anything
Wheezing - unilateral should rasie suspicion of mass in approrpitate setting of lung cancer
Pleural involvement
Malignant pleural effusions are considered metastatic and managed palliatively
Not ALL effusions are malingnat (post-obstructive pneumonits, lymph obstruction, atelectasis)
Malignant effusions
Typically exudative
high protein/LDH
Lymphocytic predominant
Hig hin eosinophils
Must confirm - may need to perform 2 or 3 to increase the yield (surgical thorascopy or medical pleuroscopy)
SVC syndrome
More common in SCLC than NSCLC
Sx generally resolve after tx of tumor
Radiograph shows widening of mediastinum or right hilar mass
Fullness in head, couhld hae trouble swallowing
Dilated neck veins, prominant venous pattern on chest, facial edema, plethoric appearance
Pancoast tumor
Pain in the shoulder
Superior sulcus tumor
Ptosis, myosis, anhydrosis
Bondy destruction and atrophy of hand muscles
Pancoast most commonly caused by NSCLC (squamous cell)
Extra-throacic
Liver (LFT elevation)
Bone (pain, elevated serum alkaline pohspatase)
Adrenals
Brain
Hypercalcemia
PTH, calcitrol, osteoclst acctivating factors
Anorexia, polyuria, dispsi, dehydration
Tx with hydration and bisphosphonates
SIADH
Causes hyponatremia
Anorexia, cerebral edema
Tx - chemo, saline, fluid restriction, demeclocycline, vasopressin-receptor antagonist
Cushings
ACTH production
Muscle weakness, weight loss, HTN, hypokalmeic alkalosis
SCLC and carcinoid tumors
Hypertrpohic osteoarthropathy
Clubbing and periosteal proliferation of tubular bones
Symmetrical and painful arthropathy
Sx may resolve after tumor resection..NSAIDs or bisphosphonates
Hematologic complications
May see leukocytosis
Thrombocytosis
Trousseaus syndrome - hyper coag…big one causing DVTs
Dermato and polymyosistis
Muscle weakness, rash, gottron papules
Neurologic
Typically with SCLC
Lambert-eaten
Mostly immune mediated with presence of ABs
Lambert eaton
Most common
AutoABs against presynaptic calcium channels
Symmetrical slowly progressive proximal muscle weakness…muscle use IMPROVES
Screening
Low dose CT scan in high risk individuals
NOdules<3cm
Mass>3cm
Mediastinal lesions - LAP
Extra-pulm lesions - metastasis
What makes a nodule concerning
At end of vascular bundles, peripheral, or varying size
Nodule characteristics
Size, rate of grwoth, calcification, location (upper and middle lobe location)
Risk of nodule and dx
Low - monitor with serial imaging
Intermediate - may want PET scan
High - biopsy
PET scan
Best above 8-10 mm in size
Higher activity in cancer
Biopsy options
Bronchoscopy - low risk of pneumothorax, best for parenchymal lesions and lymph nodes
CT guided FNA - higher risk of pneumothorax…best for pleural based
Surgical - highest risk of comps, best specificity, and gold std
Small cell lung cancer staging
LImited 0 confined to hemithorax or orogin, mediatinum or supraclavicular nodes
Extensive-stage dz - beyond supraclaviculsr areas or distant
SCLCA tx
Platinum based alkylating agent (cytopenia, renal failure, neuropathy)…cisplatin and carboplatin
Topoisomerase inhibs (cytopneia, secondary cancer)…irinotecan and etoposide
