lung carcinoma Flashcards
what is lung cancer ?
cancer arising from the respiratory epithelium of the bronchi , bronchioles and alveoli
4 major types -
small cell carcinoma
non small cell carcinoma
squamous cell carcinoma adenocarcinoma
large cell carcinoma
remained of undifferentiated carcinomas - carcinoids , bronchial gland tumors
rare non smokers have what typeof cancer arising from the epithelium of alveoli lung cancer
adenocarcinoma
if it is arising from the epithelium of the bronchi what is it called
squamous cell carcinoma
aetiology of lung cancer ?
smoking - pack years - how many pack per year
1 pack /day x year
chances of developing stops after cessation of smoking
air pollutants
radon
EGFR mutation
chronic bronchitis -COPD
activation of dominant oncogenes and inactivation of the tumor suppressor or recessive oncogenes.
For the dominant oncogenes these include: point mutations in the coding regions of the ras family, amplification and rearrangement, of myc family oncogene
morphology of lung cancer
small cell carcinoma of the bronchi - very aggressive
non small cell - large cell , adenocarcinoma , squamous cell cells
more easy to treat slow progressing
clinical symtpoms of lung cancer
central carcinoma / endobronchial :
hemoptusis coughing dyspnea wheezing pnemonitis from obstruction
peripheral cancer :
pain from chest wall or pleural wall involvement (osteolytic bones)
dyspnea
cough
lung abcess
regional spread of tumor :
trachea obstruction-breathing problems
recurent laryngeal nerve paralysis - hoarsness paralysis of the left vocal chord
esophageal cpmpression - dysphagia
PANCOST tumor - local extension of the squamous cell tumorto eighth cervical nervee and second thoracic nerves - with shoulder pain which radiates to the ulnar distribution of the arm
and radiological destruction of the first ad second ribs
superior vena cava syndrome :
compression of the superior vena cava
head ache , difficulty breathing ,
horner syndrome - paralysis with sympathetic nerve invasion
pericardial and cardiac extension - tamponade arrythmia
lymphatic obstruction - pleural effusion
neurological myopathic syndrome 0 eaton lambert syndrome - retinal blindness with small cell carcinoma
cerbellar degeneration , cortical degeneration - seen in all cancer types
trousseaus syndrome - migratory venous thrombosis
nonbacterial thromboctic endocarditis with arterial emboli
diagnosis of lung cancer
NICE GUIDELINE
high risk - no point in screening for sputum cytology and x ray because the tumor has been developing
clinically silent and undetected metastasis at a very early stage
cancer suspected - X RAY FIRST - nodules , infiltrative opacity , atelectasis , pleural effusion , mediastinal lymphadenopathy
then CT analysis - primary tumor size localisation local spread - pleural , mediastinum , chest wall, mediastinal lymph node involvement metastasis to liver , bone , brain
PET/Ct - gives anatomic and metabolic information - fluorodeoxyglucose is given
flexible fibrooptic bronchoscopy for central tumors - material for pathological examination
lung biopsy - forceps , brush biopsy , BAL
autofluorence bronchoscopyy - detection of premalignant and early malignant transformation
EBUS- endobronchial ultrasound
sputum cytology
peripheral tumors - transthoracic needle biopsy under ct control
what is lung cancer lung cancer staging
t- size
n - regional nodes affected
m - presence of distant metastasis
to- no presence of primary tumors
tx - malignant cells are found on histology but not on imagery or bronchoscopy
tis - carcinoma in situ
t1 - less than 3 cm
t2- more than 3 cm
t3 - extension to pleural dipahram
t4- invades mediastinum - heart , great vessels
and malignnat plerual effusion is present
n
n1- bronchopulmonary , ipsilateral hilar lymph node
N2 - ipsiltaeral mediastinal , subacarnial lymph nodes
N3 - condtralateral medistainal or hilar lymph nodes , suprcalvicular
m
stage 1 - -60-80 percent chance of surving
t1/2 , no , mo
stage 2 - T1-T2 / N1 / Mo
25 -50 percent
stage 3
3a - T3 / N1-2 / MO - 25-50 percent
stage 4
any T4 or T3 , Mo less than 5 percent
stage 5
any M1 - less than 5 percent survival
staging small cancer ?
limited stage - one hemithorax and regional lymph nodes
extensive staging
disease exceeding those boundaries
what is the management of the lung carcinoma ?
consists of two parts : anatomic staging - determine the location of the cancer - determine respectability
physiological staging - assessment of the patients ability to withstand various antitumor treatments - depends on the cardiopulmonary function of the patient
contra for surgery - metastasis superioir vena cava syndrome vocal cord , phrenic nerve paralysis malignnat pleural effusion within 2cm of the carina - radiotherapy cardiovascular - myocardial infarction within past 3 months arrythmia CO2 retension in major pulmonary hypertension
we recommend surgery after pulmonary function test
FEV1 - over 2.5L - permit pneumoectomy
treatment for non small cell lung cancer
tell them to stop smoking
nicotine replacement therapy
surgical therapy - stage 1 ,2 , and 3A
stage 1/2 surgery
wedge resection - small part of the tumor -
lobaectomy - one full lobe is taken - more preferred
pneumoectomy - full lung is taken
stage 3 / stage 1-2 refusing surgery or not suitable for pulmonary respectability :
radiotherapy - 55-60gy
side effect -radiation pneomnitis radiation esophagitis
brachytherapy
brachytherapy - placing radioactive sends in catheter to tumor bed
pancost tumor - treated with combined radiotherapy and surgery
dissemntaed non small cell carcinoma
pain medication and radiotherapy
brain and cord compressions - dexamethasone then rapidly lowered
pleural effusion - thoracocentesis
chemotherapy - if patients is fully ambulatory , has not received prior chemotherapy (neoadjuvant therapy preoperative therapy )- make the unresectable tumor small enough to be resected
carboplatin /cisplatin + 3gen cytostatic drugs - docetaxil
(granlucytopnea)
second line of chemotherapy - mono therapy with docetaxel every other three weeks
target therapy - EGFR , monoclonal antibodies - BEVACIMUAB
how can we prevent lung cancer ?
low dose CT
decreases disease related mortality
total mortality
what is the difference between small cell carcinoma and non small cell carcinoma ?
small cell carcinoma has spread beyond resectional surgery primarily managed with chemotherapy
non small carcinoma tend to be localised at time of presentation - curative attempt with surgery given
response to chemotherapy non dramatic
what are the central mass growth tumors ?
with endobronchial growth squamous cells carcinoma and small cell carcinoma
which types of tumors have peripheral nodule growth or PLURAL INVOLVEMENT ?
adenocarcinom anad large cell carcinoma
