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Clin Med II > lung cancer > Flashcards

lung cancer Flashcards

1
Q

smoking increases risk for which cancers?

A
  • lung
  • nasopharyngeal
  • esophageal
  • laryngeal
  • stomach
  • pancreatic
  • colorectal
  • bladder
  • breast
  • uterine
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2
Q

risk factors for lung cancer

A
  • smoking*
  • occupational/ envir expsoures- esp radon
  • genetics/ family hx
  • benign lung disease
  • ionizing radiation
  • second and third hand smoke
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3
Q

second hand smoke

A
  • 250 toxic gases, chemicals, and metals
  • causes lung cancer in non-smokers
  • assoc with heart disease, SIDS, ear infections, asthma
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4
Q

what is a biomarker for smoke exposure

A
  • cotinine
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5
Q

third hand smoke

A
  • smoke lingers even after cigarette is extinguished
  • young kids esp at risk
  • clings to walls, ceilings, carpets, draperies, furniture
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6
Q

clinical presentation of lung cancers

A
  • usually asymptomatic until advanced or metastatic
  • cough- dry or productive
  • DOE
  • hemoptysis
  • recurrent pneumonias
  • weight loss
  • atypical chest pain
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7
Q

sx of more extensive lung cancer

A
  • bone pain
  • dysphagia
  • hoarseness
  • neurologic abnormalities
  • horner’s syndrome
  • superior vena cava syndrome
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8
Q

horner’s syndrome

A
  • ptosis
  • anhidrosis
  • miosis
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9
Q

paraneoplastic syndromes

A
  • sx of cancer downstream from primary source
  • unprovoked DVT or PE
  • SIADH or hyponatremia
  • clubbing
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10
Q

lung cancer staging

A
  • need biopsy first to dx
  • metastatic work up
  • mediastinoscopy
  • TNM staging
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11
Q

clinical stage

A
  • work up and LN biopsy to determine prognosis
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12
Q

pathologic stage

A
  • dissect out tumor and lymphatics

- better and more accurate extent of disease and prognosis

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13
Q

methods for biopsy

A
  • CT guided needle biopsy
  • bronchoscopy- good for endobronchial lesions
  • endobronchial US biopsy (EBUS)
  • video-assisted thoracoscopic surgery biopsy (VATs)
  • thoracentesis if effusion present
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14
Q

what is included in the metastatic work up

A
  • HMRI and PET/CT if lung lesion > 2 cm

- if any extrathroacic lesions are detected then further work up required

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15
Q

where do lung cancers tend to spread to

A
  • brain
  • bone
  • liver
  • adrenal glands
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16
Q

EBUS

A
  • bronchoscopy with specialized tip

- tip has doppler capabilities to be sure you’re not poking a vessel

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17
Q

VATs surgery

A
  • 3 port sites
  • pinch off a piece of the lung
  • can be wedge or lobectomy depending on size and location of nodule
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18
Q

mediastinoscopy

A
  • used for LN staging if abnormal LN on CT
  • use rigid steel scope
  • if LN are negative then resect lungs and skip mediastinoscopy
  • if LN are positive it means cancer has spread, goal of tx is prevent systemic spread
19
Q

treatment recommendation for stage I and II lung cancers

A
  • surgical resection

- good progosis

20
Q

treatment recommendation for stage III and IV lung cancers

A
  • chemo and radiation
  • possible surgery after
  • stage IV- cisplatin based chemo
21
Q

surgical management for lung cancer

A
  • VATs resection
  • segmentectomy
  • lobectomy
  • pneumonectomy
  • robot lobectomy
  • sleeve lobectomy- good for carcinoid tumors
22
Q

nonsurgical management for lung cancer

A
  • radiofrequency ablation

- photodynamic therapy

23
Q

segmentectomy

A
  • between wedge resection and lobectomy

- need to localize vessels unlike wedge- more complicated procedure

24
Q

lobectomy

A
  • removal of an entire lung lobe

- high rates of post op pain d/t incisions

25
Q

pneumonectomy

A
  • removal of entire lung

- generally try to avoid in order to preserve as much lung function as possible

26
Q

two major classes of lung cancer

A
  • small cell

- non- small cell

27
Q

non-small cell cancers

A
  • majority of non-small cell cancers
  • tend to be more treatable
  • adenocarcinomas- most common
  • squamous cell carcinomas
  • large cell carcinomas
28
Q

types of small cell carcinoma

A
  • classic small cell
  • large cell neuorendocrine
  • combined type
29
Q

large cell carcinoma

A
  • malignant epithelial neoplasms
  • dx of exclusion
  • usually large peripheral masses with prominent necrosis
30
Q

squamous cell carcinoma

A
  • occur centrally
  • classically associated with hx of smoking
  • central and peripheral SCC may show extensive central necrosis
31
Q

adenocarcinomas

A
  • most common type of lung cancer, esp in never smokers
  • usu found in periphery but can occur centrally
  • subsolid nodules
  • very slow growth rate
  • classified as in situ, minimally invasive, invasive
32
Q

small cell carcinomas

A
  • poorly differentiated neuroendocrine tumor
  • usu large hilar mass with bulky mediastinal LAD
  • rapid doubling time
  • very aggressive with early metastasis
  • almost exclusively in heavy smokers
  • classified as limited or extensive disease
33
Q

prognosis of small cell carcinomas

A
  • very poor and most pts present with extensive disease
  • limited disease- 15-20 mo
  • extensive disease- 8-13 mo
34
Q

carcinoid tumors

A
  • not common
  • neuroendocrine differentiation
  • can arise anywhere, more common in GIT
  • typical vs atypical carcinoid cells
  • usually in proximal airways
35
Q

what is the most common primary lung neoplasm in kids

A
  • carcinoid tumors
36
Q

typical carcinoid tumors

A
  • excellent prognosis

- much more common than atypical

37
Q

atypical carcinoid tumors

A
  • more likely to metastasis

- less common

38
Q

si/sx of carcinoid tumors

A
  • bronchial obstruction
  • recurrent pneumonia
  • cough
  • wheeze
  • hemoptysis
39
Q

pancoast tumors

A
  • aka superior sulcus tumor
  • located at pulmonary apex
  • mostly SCC but can vary- NEED biopsy
40
Q

where do pancoast tumors spread to

A
  • ribs
  • vertebrae
  • vessels
  • brachial plexus
  • may involve recurrent laryngeal n, vagus n, and sympathetic ganglion
41
Q

clinical presentation of pancoast tumor

A
  • shoulder pain

- horner’s syndrome

42
Q

treatment and prognosis of pancoast tumor

A
  • chemo/radiation then surgical excision

- 5 year survival is 30%

43
Q

cancers that spread to the lungs

A
  • malignant melanoma**
  • sarcomas
  • breast
  • kidney
  • bladder
  • colon
  • prostate
44
Q

lung cancer in non-smokers

A
  • 10-15% of all lung cancers
  • mostly in young women
  • usually adenocarcinomas
  • may be linked to estrogen
  • treatment- EGFR inhibitors

Clin Med II (16 decks)

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