Lung Tumors Flashcards by Alex Stein

What is lung cancer

tumors that originate from the epithelium of the respiratory tract

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Lung cancer is AKA

bronchogenic carcinoma

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How many people are diagnosed - how many new cases per year

226, 160

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How many people are diagnosed - lung cancer is the most common fatal neoplasia in both sexes 50-65 yrs old - T or F

TRUE

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How many deaths in 2010 from lung cancer

157,300

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female vs. male lung cancer incidence throughout time

Used to have increase in females

2000-2008 see a dec in males and females stayed about the same

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Highest incidence in what sates

arkansas, delaware, indiana, kentucky, louisiane, maine, mississippi, missouri, oklahoma, rhode island, tennessee, west virginia

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Incidence rates by race - mos prevalent in

blacks have higher incidence primarily in males
female - blacks and whites are about the same
Hispanics have lower compared to overall population

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What causes lung cancer

Environmental disease (secondhand smoke, radon, hydrocarbons...)
Active smoking 90% of cases
Occupational exposure (asbestos)
Current studies indicate genetics make play role

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Are some lung cancers worse than others?

YES

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WHO classification is based on

cell type

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WHO classification includes

Epidermoid (squamous) carcinoma (17%)
Small cell carcinoma including oat cell (25%)
Adenocarcinoma (40%) - they are glandular carcinomas and can produce substances
Large cell carcinoma (15%)

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Other way of classifying lung tumors

Small cell lung cancer (20%)

Non small cell lung cancer (80%) - this includes squamous cell, adenocarcinoma, large cell carcinoma

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Squamous cell carcinoma - closely correlated to

cigarette smoking

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Squamous cell carcinoma - usually located where

centrally located near the hilus - projecting into the bronchi

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Squamous cell carcinoma - tends to spread by

direct extension

LATE METASTASIS

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Squamous cell carcinoma - initial presentation

shortness of breath early on because the tumor is in some of the bronchi so air exchange is difficult

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Adenocarcinoma - located where

peripherally - smaller lesions

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Adenocarcinoma - smoking

Not associated with smoking

Most of the cancers in non-smokers are adenocarcinomas

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Adenocarcinomas tend to invade

blood and lymph vessels leading to early metastasis

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Adenocarcinomas - because the tissue is sometimes functional tissue there might be

different hormones produced by the tumor itself

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Large cell carcinoma - highly ___ and ___

highly undifferentiated and anaplastic
If you were looking at this cell it would not look like any parent cell - it would be hard to classify and say what type of cell it was

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Large cell carcinomma - tends to develop where

in the periphery

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large cell carcinoma - tend to grow

rapidly and spread early and extensively

Large cell carcinoma - incidence

decreased in because there is improved detection

Small cell carcinoma - usually located

centrally - some of the worst to have!

Small cell carcinoma - cells often resemble

oat seeds - so AKA oat cell carcinoma

Small cell carcinoma - prognosis

Fastest doubling time and worst prognosis of all bronchiogenic carcinomas

Small cell carcinoma - metastasis

early metastasis to adjacent tissues as well as distal spread occurs easily 70% of patients have extensive spread before dx is made

Small cell carcinoma - diagnosis

diagnosis is usually made because they have a metastasis that has produced some other physiological dysfunction

Pancoast tumor located where

apex of the lungs and often spreads to the ribs and vertebrae

Pancoast tumor - some of the first s/s are what

thoracic and scapular pain

Pancoast tumor - makes up what percent of lung tumors

1-3%

Pancoast tumor - are mostly what type

squamous or adenocarcinoma | NSCLC

Pancoast tumor - s/s

brachial plexus - ulnar n distribution TOS, cervical, thoracic/scapular pain Horner's syndrome

Pancoast tumor - diagnosis

tends to be diagnosed late

Pancoast tumor - PT referral

pt may present at first with shortness of breath or ulnar nerve distribution and get referred to PT but they may present later with some of the other s/s and then we would need to refer back to physician

Horner syndrome - what type of dysfunction

sympathetic nerve disorder

Horner syndrome - three neuron arc

first order neuron - descend from lat hypothalamus to brainstem and into cervical cord and then up thoracic one level and synapse and exit cord to travel to sympathetic chain as 2nd order neurons - then those go up the chain and synapse in post ganglion on sympathetic fibers to become third order neurons

Horners syndrome - s/s

miosis (constricted pupil) partial ptosis loss of hemifacial sweating (anihidrosis)

Metastatic lung cancers - how common

much more common than primary cancers | most common type of neoplasia we see in the lung

most common primary cancers to metastasize to the lungs in descending order

``` breast GI female genital tract kidneys melanomas male genital tract ```

s/s for diagnosis

often mimic other resp. disorders | can be contributory to the development of other resp disorders too

Diagnosis can be made from

``` cytology sputum samples bronchial brushings biopsy - bronchoscope, mediastinoscopy, transthoracic needle biopsy Radiology, CT scan, chest x-ray, MRI ```

Treatment for non small cell lung cancer

surgery - stage 1, 2, and some 3 radiation chemotherapy

prognosis for non small cell lung cancer

30% if resectable | 6% if not resectable - median survival of less than a year

Prognosis over the years

has not improved with the exception of large cell tumors

treatment for small cell lung cancer

- treated primarily with chemo if not responsive with surgical resection - radiation might be used to limit cerebral metastasis and reduce pain - palliative to reduce cerebral metastasis and reduce pain

Prognosis - small cell lung cancer

40-70 weeks with treatment | 6-17 weeks without

Overall imrpovements in survival?

10% for males | 5% for females

Overall prognosis - dependent on

cell type and stage

Stage is indicated by

location - where we see the tumors

Stage at diagnosis can be

localized regional distant unknown

Localized - 5 yr survival rate

``` is high (52%) if spreads to lymphnodes though (regional) dramatically drops to 25% and then if distant drops to 4% ```

Paraneoplastic syndrome

remote effects of neoplasm occur in 20% often appear before primary tumor has been diagnosed

Paraneoplastic syndrome very common for what types

small cell lung tumors

Cushing syndrome

changes in blood flow, edema, facial edema, truncal edema, changes in skin quality, inc infection, cardiac arrhythmias

primary s/s for paraneoplastic syndrome (cushings?)

LE weakness - usually what will take someone to a physician

Cancer and POC

``` 1 scheduling in relation to tx they are getting 2 monitor platelet, Hct, Hb, WBC 3 pain meds 4 nutrition 5 pulmonary issues 6 energy conservation! ```