Lung Cancer

Question 1

what are the four major lung cancer types ?

Answer 1

small cell (oat cell) carcinoma

non small cell carcinoma :
squamous carcinoma
adenocarcinoma
large cell carcinoma

it is divided like this because it is important for treatmnet purposes

Question 2

what are the charachteritscs of long cancer ?

Answer 2

small cell and squamous - central masses as endobronchial growth

adenocarcinoma and large cells - peripheral nodules or masses with pleural involvement

Question 3

etiology of lung carcinoma ?

Answer 3

smoking

cigarette pack years

number of pack years = packs smoked per day x number of years smoked

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hereditary as first degree relative

air pollutants

radon

Question 4

clinical manifestations of lung cancer ?

Answer 4

local tumor growth :- central and endobronchial

cough 
hemoptysis 
wheezing 
dyspnea 
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peripheral tumor growth :
pleural chest pain

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regional spread
tracheal obstruction

dysphagia

hoarseness of voice

phrenic nerve paralysis -

sympathetic nerve invasion - horner syndrome - mitosis and drooping of the eyelids and sweating

superior vena cava syndrome resulting in venous congestion in the head, neck, and upper extremities.

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pan cost tumor
located in the superior sulcus of the lung; often involves the cervical sympathetic nerves and brachial plexus.

Severe, localized pain in the axilla and shoulder
Horner syndrome
Atrophy of arm and hand muscles
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metastatic
brain metastases with neurologic deficits

bone metastases with pain and pathologic fractures

bone marrow invasion with cytopenia or leukoerythroblastosi

liver metastases : ascitis , jaundice ,

lymph node metastases in the supraclavicular region and occasionally in the axilla and groin

Question 5

what are the paraneoplastic syndromes

Answer 5

for both : dermatomyocytosis
hypercoagubility
cachexia

for non small cell carcinoma : squamous cell : hypercalcemia due to PTH
hypertrophic osteoarthropathy

small cell carcinoma :
cushing syndrome - acth

antibodies are formed against presynaptic voltage-gated calcium channels in neuromuscular junction :lambert eaton syndrome
causing muscle weakness

Question 6

diagnosis of lung cancer ?

Answer 6

1) chest x ray 
nodules 
oocaity of lungs 
atlectasisi 
pleural effusion 
mediastinal lymphadenopathy 

2) CT scan
3) PET/CT scan
4) fiberoptic bronchoscopy and biopsy - forceps , bruch , brochoealvaolar lavage
5) transthoracic needle biopsy under CT control
6) thoracocenteisis - pleural effusion cytology
- VATS - video asisted thoracoscopy
5) endobronchial ultrasound

Question 7

staging of lung cancer

Answer 7

tis - carcinoma in situ

t1 - tumor is less than 3 cm diabetes

t2 - tumor is more than 3 cm in diameter or metastasis to helium

t3 - tumor extends to pleura , chest wall , diaphragm and pericardium

t4 - tumor invades the mediastinum (the heart , great vessels , trachea , esophagus)
malignant pleural effusion present

no
n1 - bronchopoulmonary or ipsilateral lymph nodes
n2 - ipsilateral or subcarinal lymph nodes
n3 - contralateral mediastiain or hilar lymph nodes
or to any scalene

stage 1 - t1-t2 no mo
stage 2 - t1-t2,n1,mo

stage 3a - t3 , n0/1 ,m0
T1-3 ,N2 , Mo

stage 3b - any T4 , or any T3 , Mo

stage 4 - any m1

Question 8

what is the staining present with small cell carcinoma ?

Answer 8

limited stage
confined to one hemithorax and regional lymph nodes (contrasted , ipsilateral r mediastinal)

extensive stage
beyond one hemithorax

Question 9

what is the treatmnet management of lung carcinoma ?

Answer 9

stage 1 and 2
curative
lobectomy + adjuvant chemotherapy ( cisplatin + cytostatic drugs docetaxel)

stage 3 A
polychemotherpy and radiation therapy
and we consider surgery if the tumor size decreases

stage 3B and 4
palliative
polychemotherapy and can have target therapy
radiation therapy considered for manegmnet of metastasis and its complications

but

Pancoast tumors up to stage IIIB
curative
Neoadjuvant radiation therapy + polychemotherapy
Surgery

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small cell carcinoma

limited disease - curative
polychemotherapy (etoposide plus cisplatin)
and radiation therapy
Prophylactic cranial irradiation in patients who respond to initial chemotherapy

extensive - palliative
Polychemotherapy
Radiation therapy if the patient responds well to initial chemotherapy
Prophylactic cranial irradiation if the patient responds to the initial chemotherapy