Lung Malignancy Flashcards
most common cancers
men - prostate
female - breast
2nd is lung for both
most common cancer that causes death
lung cancer - 25%
gender predilection of lung cancer
more in males
types of lung cancer
non-small cell - 85%
small cell - 15%
lung cancer c worst prognosis
small cell
adenocarcinoma
squamous cell
non-small cell cancer subtypes
adenocarcinoma - 40%
squamous cell - 25%
large cell - 25%
others - 20%
not specified - 5%
compare stage 1 lung cancer to advanced
1 - confined to certain spot
advanced - metastatic na
pathology of lung cancer
tumors sa epithelium - bronchi, bronchioles and alveoli
4 major cell types of lung cancer according to WHO
squamous cell
small cell
adenocarcinoma
large cell
discuss small cell lung CA
scant cytoplasm - small hyperchromatic nuc c fine chromatin
indistinct nuc
has neuroendocrine properties
more gene mutations but responsive to chemo and radiation
most relapse and becomes worse
discuss non-small cell lung CA
abundant cytoplasm - pleomorphic nuc c coarse chromatin
prominent nuc
no nueroendocrine properties
fewer gene mutations - less aggresive
more local so better prog
etiology of lung cancer
85% from smoking and 15% not
smokers in past 10 yrs or passive - women
inc c more pack yrs
environment, pollution and genetics
etiology of adenocarcinoma
lifetime non smokers
women
< 45 yo
general clinical manifestaitons
local tumor growth
invasion or obstruction of structures
growth in lymph nodes
growth in distant sites via BF
remote effects - paraneoplastic syndrome
5-15% asymptomatic
cough, pain in chest or back
central or endobronchial growth
sa mga bronchioles or alveoili ba
cough
hemoptysis
wheeze and stridor
dyspnea
postobstructive pneumonitis
peripheral growth
pain from chest wall or pleura
dyspnea - restrictive
lung abscess from tumor cavitation
growth in thorax
tracheal obstruction
esophageal compression - dysphagia
laryngeal nerve paralysis
phrenic nerve paralysis - elevation and dyspnea
SY nerve paralysis - horner’s syndrome
horner’s syndrome
enophthalmos - eye depressed into socket
ptosis - drooping
miosis - uneven pupil opeing
ipsi anhidrosis
malignant pleural effusion
lead to dyspnea kasi compress lungs di maka expand
pancoast’s syndrome
superior sulcus tumor - apex of lung and C8-T2 nerves
shoulder pain that that radiates to ulnar distribution
c destruction of 1st and 2nd ribs
can exist c horner’s
superior vena cava syndrome
impingement of SVC by tumor
wala venous return from head, UE, neck and torso
plethora
distended neck veins and ant chest veins
pericardial or cardiac extension
tamponade - too much fluid cant pump
arrhythmia
cardiac failure
lymphatic obstruction
pleural effusion since tumor can obstruct lymphatic flow
fluid seeps out to lungs or heart
LYMPHANGITIC spread though lunfs
hypoxemia and dyspnea
extrathoracic metastatic disease
> 50% c squamous carcinoma
80% of adenocarcinoma and large cell
> 95 % of small cell
basta may BF pwede mag spread dun
brain metastases
worse that could happen
HA
nausea and vomiting
neuro deficits
seizures
bone metastases
bone eaten by cancer cells
pain
pathologic fx
SCI
bone marrow invasion
develop another cancer and anemia
cytopenias
Leukoerythroblastosis
liver metastases
most diff site to handle
liver dysfunction
biliary obstruction
anorexia
pain - most diff to handle in stage 4
lymph node metastases
supraclavicular region
alw check axilla and groin for lymph nodes
spinal cord compression
cancer eats vertebral bones
epidural metastases
bone metastases
adrenal metastases
common but rarely cause pain or insufficiency
unless super laki
paraneoplastic syndromes
common in SCLC
mimics metastatic disease
presenting or first sign of recurrence
anorexia
cachexia
weight loss
fever
suppresed immunity
enodcrine syndromes
12% of patients
hypercalcemia and hypophosphatemia, PTH
brittle bones
hyponatremia c SIADH
atrial natriuteric factor and ectopic secretion by small cell
skeletal connective tissue syndromes
clubbing - NSC
hypertrophic pulmonary osteoarthroplasty - adenocarcinoma
psin and tenderness over affective bones
nuerogenic myopathic syndromes
only 1%
myasthenic LEMS and retinal blindness in SC
peripheral neuropathies, subacute cerebellar degen, cortical degen and polymyosistis in all types
coagulation, thrombotic and hematologic manifestations
1-8%
trousseau’s - migratory venous thrombophlebitis
nonbacterial thrombotic endocarditis c arterial emboli
disseminated intravascular coagulation c hemmorrhage, anemia, granulocytosis and leukoerythroblastosis
cutaneous manifestations
1%
dermatomyositis
acanthosis nigricans
renal manifestations
1%
nephrotic syndrome
glomerulonephritis
dx for cancer
CXR - mc
CT scan
MRI
PET scan
radionuclide scan
biopsy
screening
discuss staging lung cancer
lower better prog
last stages are worse
T1 tumor
≤3 cm, surrounded by lung or pleura
no tumor more proximal than lobe bronchus
T2 tumor
> 3 cm
involving main bronchus ≥ 2 cm distal to carina
invading pleura; atelectasis or pneumonitis extending to hilum but not entire lung
N1
ipsilateral peribronchial or hilar nodes and intra, pulmonary nodes by direct extension
T3 tumor
chest wall, diaphragm, mediastinal pleura, pericardium, main bronchus <2 cm distal to carina; atelectasis or pneumonitis of entire lung
N2
ipsilateral mediastinal or subcarinal nodes
N3
contralateral (lung) nodes or any supraclavicular node
T4
mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; separate tumor nodules; malignant pleural effusion
Distant metastasis
tx for cancer
chemo
radio
surgical resection
palliative care
