Lung Cancer, Pleural Disease Flashcards
T/F: in the lung, metastases are more common than primary lung cancer
True - breast, colon, prostate cancers
Besides cigarette smoking and secondhand smoke, what are the major risk factors for developing lung cancer?
occupational exposures (asbestos), ionizing radiation, radon
what is the most aggressive form of lung cancer and how does it typically present?
small cell lung cancer: almost exclusively smokers
commonly presents as hilar mass (central), lesions do NOT cavitate
no local treatment - only chemo
from which cells does small cell lung carcinoma originate and how can they be stained?
Kulchitsky cells: antigenic makeup characteristic of both the neural crest and epithelium and have been shown to secrete both polypeptide hormones and enzymes
positive staining with chromogranin A and synaptophysin
your patient with small cell carcinoma has abnormally high blood levels of cortisol. what is going on?
paraneoplastic syndrome - tumor is secreting ACTH, which is stimulating adrenal gland to make excess cortisol
your patient with small cell carcinoma has abnormally low serum sodium. what is going on?
paraneoplastic syndrome - tumor is secreting ADH, which is promoting water reabsorption —> low serum sodium concentration
what type of lung cancer does this describe:
- arises centrally around segmental bronchi
- associated with post-obstructive pneumonia
- characterized by keratinization (“keratin pearls”)
- cavitation of lesions is common with tumor growth
squamous cell carcinoma - STRONG association with smoking
On rounds, you encounter a patient with lung cancer. They are currently hospitalized for post-obstructive pneumonia. They have a PMH of smoking, and their CXR shows “keratin pearls.” What type of cancer do they have?
squamous cell carcinoma: STRONG association with smoking, arises centrally in lung (segmental bronchi)
associated with post-obstructive pneumonia, characterized by keratinization
cavitation of lesions is common with tumor growth
what type of paraneoplastic syndromes are associated with squamous cell carcinoma of the lung? (2)
- PTH (parathyroid hormone) secretion —> hypercalcemia
- hypertrophic osteoarthropathy: long bone pain and digital clubbing
what kind of lung cancer does this describe:
- peripheral mass
- metastasis frequent at presentation
- originates from secretory/glandular cells - mucin production
- “lepidic” growth pattern
adenocarcinoma: most common form of primary lung cancer, most common form in non-smokers
what mutation is frequently identified in patients with adenocarcinoma?
adenocarcinoma: most common form of primary lung cancer, most common form in non-smokers, originates form secretory/glandular cells
common to have GOF mutation in epidermal growth factor receptor (EGFR) or anaplastic large cell kinase (ALK)
what type of lung cancer does this describe?
- compresses brachial plexus —> shoulder pain, hand weakness
- compresses cervical sympathetic chain —> ptosis, miosis, anhidrosis
Pancoast tumor (syndrome): lung cancer located in superior sulcus of the lung, affects structures of the thoracic inlet
[miosis = constricted pupil]
with which type of lung cancer is superior vena cava syndrome associated?
small cell lung cancer —> SVC obstruction
—> face/neck swelling, JVD, upper extremity swelling, distended chest veins
from where does the lung pleura receive its blood supply?
systemic blood supply (not pleural) - intercostal arteries/veins
what are the typical symptoms of pleural effusions?
dyspnea (related to altered lung mechanics, NOT hypoxemia), non-productive cough, chest pain
restrictive ventilatory pattern (decreased FVC and TLC) - flattening/inversion of the diaphragm
PE: dullness to percussion, decreased breath sounds, decreased tactile fremitus
