lung cancer Flashcards
1
Q
smoking increases risk for which cancers?
A
- lung
- nasopharyngeal
- esophageal
- laryngeal
- stomach
- pancreatic
- colorectal
- bladder
- breast
- uterine
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
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
4
Q
what is a biomarker for smoke exposure
A
- cotinine
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
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
7
Q
sx of more extensive lung cancer
A
- bone pain
- dysphagia
- hoarseness
- neurologic abnormalities
- horner’s syndrome
- superior vena cava syndrome
8
Q
horner’s syndrome
A
- ptosis
- anhidrosis
- miosis
9
Q
paraneoplastic syndromes
A
- sx of cancer downstream from primary source
- unprovoked DVT or PE
- SIADH or hyponatremia
- clubbing
10
Q
lung cancer staging
A
- need biopsy first to dx
- metastatic work up
- mediastinoscopy
- TNM staging
11
Q
clinical stage
A
- work up and LN biopsy to determine prognosis
12
Q
pathologic stage
A
- dissect out tumor and lymphatics
- better and more accurate extent of disease and prognosis
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
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
15
Q
where do lung cancers tend to spread to
A
- brain
- bone
- liver
- adrenal glands
16
Q
EBUS
A
- bronchoscopy with specialized tip
- tip has doppler capabilities to be sure you’re not poking a vessel
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
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
pneumonectomy
- removal of entire lung
| - generally try to avoid in order to preserve as much lung function as possible
26
two major classes of lung cancer
- small cell
| - non- small cell
27
non-small cell cancers
- majority of non-small cell cancers
- tend to be more treatable
- adenocarcinomas- most common
- squamous cell carcinomas
- large cell carcinomas
28
types of small cell carcinoma
- classic small cell
- large cell neuorendocrine
- combined type
29
large cell carcinoma
- malignant epithelial neoplasms
- dx of exclusion
- usually large peripheral masses with prominent necrosis
30
squamous cell carcinoma
- occur centrally
- classically associated with hx of smoking
- central and peripheral SCC may show extensive central necrosis
31
adenocarcinomas
- 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
small cell carcinomas
- 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
prognosis of small cell carcinomas
- very poor and most pts present with extensive disease
- limited disease- 15-20 mo
- extensive disease- 8-13 mo
34
carcinoid tumors
- not common
- neuroendocrine differentiation
- can arise anywhere, more common in GIT
- typical vs atypical carcinoid cells
- usually in proximal airways
35
what is the most common primary lung neoplasm in kids
- carcinoid tumors
36
typical carcinoid tumors
- excellent prognosis
| - much more common than atypical
37
atypical carcinoid tumors
- more likely to metastasis
| - less common
38
si/sx of carcinoid tumors
- bronchial obstruction
- recurrent pneumonia
- cough
- wheeze
- hemoptysis
39
pancoast tumors
- aka superior sulcus tumor
- located at pulmonary apex
- mostly SCC but can vary- NEED biopsy
40
where do pancoast tumors spread to
- ribs
- vertebrae
- vessels
- brachial plexus
- may involve recurrent laryngeal n, vagus n, and sympathetic ganglion
41
clinical presentation of pancoast tumor
- shoulder pain
| - horner's syndrome
42
treatment and prognosis of pancoast tumor
- chemo/radiation then surgical excision
| - 5 year survival is 30%
43
cancers that spread to the lungs
- malignant melanoma**
- sarcomas
- breast
- kidney
- bladder
- colon
- prostate
44
lung cancer in non-smokers
- 10-15% of all lung cancers
- mostly in young women
- usually adenocarcinomas
- may be linked to estrogen
- treatment- EGFR inhibitors
