Lung cancer Flashcards
Etiology of Lung Cancer?
– Tobacco smoke • Direct relationship between amount of exposure and risk • Filter decreases risk • Stop smoking greater than 6 years reduces risk
– Asbestos exposure • Mesothelioma
– Atmospheric pollution • Higher lung CA in urban vs. rural
– Involvement with radioactive ores
– Metals • Nickel, silver, chromium, cadmium, beryllium, cobalt, selenium
– Chemical products • Chloromethyl ethers
Signs and symptoms of lung cancer?
Signs and Symptoms
– Secondary to central or endobronchial growth or primary tumor • Cough • Hemoptysis • Wheeze and stridor • Dyspnea from obstruction • Pneumonitis from obstruction (fever, cough)
– Secondary to peripheral growth • Pain from pleural or chest wall • Cough • Lung abscess from tumor cavitation
Paraneoplastic syndromes of lung cancer?
Lesions that cause a mass on chest radiography?
What is the diagnostic assessment of mass lesions?
Histological types of lung cancer?
Squamos cell carcinoma?
– Squamous Cell Carcinoma
- Bronchial epithelium
- Centrally located – commonly cavitates
- Locally invasive (less distant metastasis)
- Responsible for 50% of pancoast tumors
- More common in males
- Associated with smoking
- Usually surgically resectable
- Produces PTH
Explain adenocarcinoma?
– Adenocarcinoma
- Bronchoalveolar epithelium
- Peripheral, small, confined to one lobe
- Prior lung injury may predispose
- More common in females
- Not associated with smoking
- Invade pleura and lymph nodes
Explain large cell carcinoma?
– Large cell carcinoma
– Bulky, peripheral or central
– Invade pleura, adjacent lung
– Anaplastic type metastases
– Can cavitate
explain bronchoalveolar carcinoma?
– Bronchoalveolar carcinoma
- Multinodular presentation
- Hard to distinguish from metastasis
- Associated with prior lung disease
- No smoking history
What are the staging procedures for lung cancer (not small cell)
– History, physical exam including ENT exam
– Chest x-ray
– CT scan if x-ray suspicious
– Complete blood counts, blood chemistries
– Complete pulmonary function studies (surgery)
– Scans of brain, liver, bone, if appropriate
– Biopsy of suspicious lesions
– Mediastinoscopy (surgery)
– Skin test for tuberculosis
Explain small cell lung carcinoma?
– Small Cell Carcinoma
- Appear submucosal
- Kulchitsky-type cells of neuroectodermal origin
- Central location – star burst picture
- Most rapidly growing lung cancer
- Early widespread metastasis (liver, bone, CNS, adrenal glands)
- Ectopic hormone production (ACTH, calcitonin, ADH)
- Associated with smoking
- Therapy is chemotherapy for all atages
Staging procedures for small cell carcinoma?
– History, physical exam
– Chest x-ray
– Blood count, blood chemistry
– Scans of liver, brain, and bone
– Bone marrow biopsy
– Liver biopsy if suspicious on exam or lab
– CSF evaluation if lab or exam suspicious
explain the standard treatment of lung cancer? small cell and others?
contraindications for surgery in lung cancer?
Signs and symptoms with regional spread in the thorax or by metastasis to regional nodes?
Signs and Symptoms
– Regional spread in thorax or by metastasis to regional nodes
- Tracheal obstruction
- Esophageal compression
- Hoarseness (recurrent laryngeal nerve)
- Phrenic nerve paralysis
- Pancoast syndrome (sympathetic nerve and brachial plexus)
- Pericardial extension
- Pleural effusions
- Superior vena caval obstruction
