Lung Cancer Epidemiology, Biology, Clinical Presentation and Screening Flashcards
One in __ men is expected to
develop lung cancer during
his lifetime and one in __will
die of it.
• One in ___ women is expected
to develop lung cancer during
her lifetime and one in___ is
expected to die of it.
One in 11 men is expected to
develop lung cancer during
his lifetime and one in 13 will
die of it.
• One in 15 women is expected
to develop lung cancer during
her lifetime and one in 17 is
expected to die of it.
trend of cigarette smoking
has been going down. We’ve been seeing drops in lung cancer incidences
Composition
– 80% ___, 20% exhaled “___” smoke
– Some [carcinogens] higher in ___
Composition
– 80% sidestream, 20% exhaled “mainstream” smoke
– Some [carcinogens] higher in sidestream
Passive smokers absorb 1-15% of chemicals
• Lung cancer risk of non-smoking wives of
smokers increased 24%(13-36%)
20% of lung cancers in non-smokers is due to ___
environmental tobacco smoke
lung cancer riskks other than smoking
• Air pollution
• Radon (from mining or indoor
exposure) •
Asbestos
– In setting of asbestosis
– Without asbestosis
– Synergy with smoking
• Other “occupational carcinogens”
which vitamin deficiencies are linked to lung cancer
vitamins A, C, E and beta carotene
non neoplastic lung disesase
COPD, TB, silicosis, pulmonary fibrosis
outline a few genetic abnormalities specific in lung cancer
BRAF
EGFR
Alk fusion
P53 mutation
outline the 4 major lung cancer
- small-cell carcinoma (sclc)
- non-small cell
- squamous
- adenocarcinoma
- large cell - carcinoid
- others
types of non-small cell lung cancers
- squamous
- adenocarcinoma
- large cell
most common non-small cell (nsclc)
adenocarcinoma (40%) of lung cancer pathologies
person has long-term dyspnea. On CXR, there are large cavitary regions, with a central lesion involving major airway.
- on CT, the large cavity was surrounded by gray white granular tissue.
- this presentation is typical of ___ carcinoma
typical of squamous carcinoma.
a person’s ct demonstrates a peripheral nodule or mass. Which pattern is this consistent wiht?
adenocarcinoma
which demographics are more at risk for adenocarcinoma
Woman / non-smokers
• Associated with
mutations amenable to
sensitive to molecular
treatment modalities
- this is the most common subtype
adenocarcinoma demonstrates a ___ growth pattern. what is this?
a lepidic growth pattern.
- slow growth, airspace fisease that is misdiagnosed as pneumonia since it’s on the periphery as a nodeule or mass.
- can be multifocial, but it preserves lung architecture. might see bronchorrhea.
T/f adenocarcinoma preserves lung architecture
ture. it’s usually a peripheral nodule
Characteristic symptom of lung adenocarcinoma
bronchorrhea
___ ___ carcinoma demonstrates ___ location, ___ growth and has an increased likelihood of ___ into the hilar lymph nodes.
small cell carcinoma: central location, rapid grwoth, and +++ ADENOPATHY.
T/F carcinoid tumors ae more likely to be seen in smokers
false. young non-smokers often present with this form of lung cancer.
rate of growth in carcinoid tumor. what type of neoplasm does it grow as?
slow growting. presents as lung nodule or endobronchial lesion
carcinoid tumors are ___ growing and presents as a lung nodule and ___ lesion
slow growting. presents as lung nodule or endobronchial lesion
a ___ ___ nodule is a lung nodule under 3 cm found on routine CXR. usually asymptomatic
solitary pulmonary nodule
malignant causes of solitary pulmonary nodule (Lung nodule (<3cm) found on “routine”
CXR, usually asymptomatic)
- bronchogenic carcinoma: adenocarcinoma, squamous cell carcinoma, large cell carcinoma, small cell carcinoma
- metastatic lesions: breast, head and neck, melanoma, colon, kidney, sarcome, germ cell tumor
- pulmonary carcinoid
benign causes of solidary pulmonary nodule
- infetious granulma
- abscess/cysts
- benign neoplasms
- vascular
- wegeners granulomatosis
“clonal evolution” that causes lung canacer development
- non -malignant genetic changes that predisposes someone to cancer
- marker of diffuse tissue injury
- development of cloncal patches; bunches of cells with more mutations. sartt to grow abnormally, changes in tumor suppressor genes which become less afected.
- you then get frank malignancy. – angiogenesis, invasion, and metastasis starts to occur.
for solitary pulmonar nodule (SPN), age correlates with probability of malignancy. outline this trend. Outline other risks
50% or higher at age of 60 or above.
- risks: smoking, previous cancer
SPN often are <3cm which are less likely to be malignant, but >3cm has a higher likely hood to be malignant.
What characteristics of SPN lesion indicate a benign vs malignant SPN?
– Benign:
• Central, diffuse, popcorn or concentric calcification
– Malignant
• Irregular or spiculated, eccentric calcification
SPN type?
benign hamatoma. solitary pulmonary nodule with characteristic popcorn configuration suggestive of a hamartoma
SPN type?
– Malignant
• Irregular or spiculated, eccentric calcification
how is SPN growth characterised?
- based on tumour doubling times of 20-400 days.
- benign lesions have doubling <20 days or >450 days.
- doubling refers to volume – not diameter.
appraoch to SPN
- always get old XRAYS
- determine probability of malignancy
stability of an SPN leesion for <2 years suggests a ___ lesion
benign lesion.
approach and follow up of solid nodules depending on if the person is high risk or low risk
LOW RISK:if under 6mm with one single nodule, no routine follow up is needed. If larger, consider CT at 6-12 months. if over 8mm, consider CT/PET or tissue sampling at 3 months.
HIGH RISK: if under 6mm, optional CT. at 12 months. if 6-8mm, CT at 6-12, then follow up ct at 18 months. if >8mm, consider CT/PET/CT tissue smapling at 3 month
follow up/management for gound class,p art solid, or mulitple opacities (SPN)
the more solid, the faster the follow up
symptoms of lung cancer related to the primary lesion
– Cough
– Hemoptysis
– Chest pain
– Dyspnea
– Weezing
– Weight loss
mets of lung cancer
brain mets, bone mets, liver/adrenal mets
pancoast’s syndrome symptoms and causes
symptoms associated with a superior pulmonary sulcus tumor.
sx: - shoulder and arm pain, horner’s syndrome, weakness and atrophy of hand muscle
caused by: non-small cell lung cancer, other neoplasms, infectious diseases
horner’s syndrome
assocaited with pancoast’s syndome; ipsilateral ptosis, miosis, anhidrosis.
nail changes in paraneoplastic syndromes
- clubbing
- hypertropic osteoarthropathy.
paaneoplastic syndromes
- hypoercalcemia
- seen in parathyroid and squamous cell cancers.
- SIADH (small cell)
- ectopic ACTH production (small cell)
- neurological syndromes (small cell)
non-Small cell staging vs small cell staging
• Non-Small Cell
– Stage I-IV (T N M system)
• Small Cell
– Limited vs. Extensive stage
TNM staging for non-small cell staging.
T= tumor stages. T1=<3cm, T2= >3cm
N=nodes: mediastinal lymph nodes identified according to international map. N1= ipsilateral lung, N2 = ipsilateral mediastinum. N3= contralateral mediastinum
M = metastasis
limited vs extensive small cell lung cancer staging
limited= intrathoracic disease. stage IIIB or less. untreated prognosis = 6 month
extensive = extrathoracic disease. stage 4. untreated prognosis 6 weeks.
current recommendations on screening for lung cancer.
- lung cacner screening for adults age 55-74 years, with at least a 30 pack year smoking history, who smoke or quit smoking less than 15 years ago, with CT every year for up to 3 years.
T/f chest radiology with or without sputum cytology can be used to screen for lung cancer
false. only ct and only for adults 77-74 with at least 30 pack year history
