Lung Cancer Flashcards
Why do most lung cancer patients often dismiss their first symptoms?
Because they are almost all smokers! And the first symptoms (hemoptysis and cough) are usually not new to them.
Tumors that originate in the airways
squamous cell carcinoma or small cell carcinoma
Patients may also have problems related to bronchial obstruction
Tumors that originate in the periphery of the lung
Adenocarcinomas or large cell carcinomas
Patients tend not to have symptoms related to bronchial involvement, and their lesions are often found on imaging obtained for unrelated purposes
When tumors involve ___ patients may have chest pain
When tumors involve the pleural surface patients may have chest pain
Horner syndrome
Caused by disruption of the cervical sympathetic chain
Ptosis (drooping upper eyelid), miosis (constricted pupil), and anhidrosis (loss of sweat) over the forehead and face
May occur in lung cancer
Involvement of mediastinal structures near the hilar lymph nodes of the lung and produced symptoms
phrenic nerve : diaphragmatic paralysis
recurrent laryngeal nerve : vocal cord paralysis
superior vena cava : edema of the face and upper extremities
Paraneoplastic syndromes
Symptoms developing with neoplasm that are not anatomically related to the presence of the cancer
Frequently are due to either production of a hormone or a hormone-like substance by the tumor or the presence of autoantibodies stimulated by antigens on the tumor
Paraneoplasm in lung cancer
Mostly just SCLC. Here ADH and ACTH may be elevated, precipitating hyponatremia. It can also precipitate immune-mediated neuropathic paraneoplasm against voltage-gated calcium channels at the NMJ.
Rarely squamous cell, in which case it is often hypercalcemia from parathyroid hormone–related peptide
The initial test for detection and macroscopic evaluation of bronchogenic carcinoma is typically . . .
The initial test for detection and macroscopic evaluation of bronchogenic carcinoma is typically the posteroanterior and lateral chest radiograph.
On a CXR, peripheral lesions are more likely to be___, whereas central lesions are statistically more likely to be ___
On a CXR, peripheral lesions are more likely to be adenocarcinoma or large cell carcinoma, whereas central lesions are statistically more likely to be squamous cell carcinoma or small cell carcinoma
Basis for staging of non–small cell lung cancer includes the following:
- Size, location, and local complications of the primary tumor
- Hilar and mediastinal lymph node involvement
- Distant metastasis
Suprasternal mediastinoscopy
Mediastinum is visualized with a scope placed through an incision made just above the sternal notch. Biopsy specimens can be obtained by this technique
parasternal mediastinotomy
Mediastinum is examined through a small incision made adjacent to the sternum, and samples of suspicious nodes can be taken
Unlike non-small cell cancers, SCLC is typically staged as. . .
limited or extensive stage disease.
- Limited disease is defined as tumor that is limited to an ipsilateral thorax and regional lymph nodes.
- Extensive stage disease represents spread outside this region
Genetic analysis of lung cancers features two genes prominently:
EGFR and ALK
A patient may be unable to tolerate lobectomy if ____.
A patient may be unable to tolerate lobectomy if they already have extensive lung disease, i.e. if they have substantial COPD.
The four major forms of treatment available for lung cancer
- Surgery
- Radiation
- Chemotherapy
- Targeted molecular therapy
Treatment of Non–Small Cell Lung Cancer (in order of preference)
- Surgery if viable - complete resection has high cure rate
- Targeted therapies - if surgery not viable or any metastasis, including lymph nodes
- Include tyrosine kinase inhibitors for EGFR
- Chemotherapy
- Radiation - purely palliative, unlikely to ever cure
- Immunotherapy is an emerging option, but too soon to be placed within the above. Probably preferable to chemo/radiation
Treatment Small Cell Lung Cancer (in order of preference)
- Chemotherapy
- Cisplatin for early disease
- Combination regimens for more extensive disease
- Radiation
SCLC has ___ at the time of diagnosis in almost all patients
SCLC has already disseminated at the time of diagnosis in almost all patients
Restoration of Airway Patency
With either flexible or rigid bronchoscopy, using techniques such as laser, argon plasma coagulation, photodynamic therapy, cryotherapy, or electrocautery, diminish the size an endobronchial tumor and reestablish an effective lumen.
Bronchial Carcinoid Tumors
aka bronchial neuroendocrine tumors, 5% of primary lung tumors
Low-grade malignancy, classified as either typical or atypical based on histologic features. Smoking is not a risk factor and patients tend to be younger at time of presentation. Arise mostly in central airways. Accompanied by carcinoid syndrome.
Most patients with these tumors have an excellent prognosis and are cured by surgical removal.
Carcinoid syndrome
Accompanies a bronchial carcinoid tumor. A form of paraneoplastic syndrome.
Episodic flushing, diarrhea, and wheezing that results from the effects of serotonin produced by the tumor
Malignant mesothelioma
Primarily involves the pleura.
Chest pain, dyspnea, and sometimes cough. Radiograph usually is most notable for the presence of pleural fluid and often irregular or lobulated thickening of the pleura. Diagnosis requires biopsy. Prognosis is poor, usually death due to respiratory failure.
Smoking is not a risk factor. History of exposure to abestos 30-40 years prior is biggest risk.
Solitary pulmonary nodule
Common presentation of lung cancer, but has a broad differential. Estimating the likelihood of a malignant versus a benign lesion from its radiographic appearance on CT scan is based on six major factors:
- Size
- Growth
- Attenuation
- Calcification
- Border appearance
- Location (upper lobe more likely to be cancer)
The ___ recurrent laryngeal nerve is more prone to paralysis in lung cancer.
The left recurrent laryngeal nerve is more prone to paralysis in lung cancer.
Targetable mutations in lung adenocarcinoma
- EGFR
- KRAS
- ALK rearrangement
- ROS1 rearrangement
- NTRK fusion
- BRAF
Osimertinib
EGFR inhibitor that is effective even for T790M mutation. Now a first-line therapy for EGFR+ lung cancers.
___ are contraindicated for squamous cell carcinoma.
Angiogenesis inhibitors are contraindicated for squamous cell carcinoma.
They are associated with massive pulmonary hemorrhage, for unknown causes.
Most common lung metastases
Bone
Brain
Liver
Adrenal
