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Patho 2 (Path 311) > Mod 10 Lung Cancer > Flashcards

Mod 10 Lung Cancer Flashcards

1
Q

What is the classic definition of cancer?

A

A abnormal new tissue growth characterized by the progressive, uncontrolled multiplication of cells.

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2
Q

What are abnormal growth cells called in the context of cancer?

A

Neoplasms or tumors

  • Tumors may be localized or invasive, benign or malignant
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3
Q

What is a Benign tumor?

A

Do not endanger life unless they interfere with physiological functions or negatively affect organs

  • slow growth, usually encapsulated
  • push away tissues, don’t invade normal tissue
  • They do not metastasize (spread)
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4
Q

What is a Malignant tumor?

A

Composed of embryonic, primitive or poorly differentiated cells

  • Growth is disorganized and rapid –> Lead to nutritional issues resulting in necrosis, ulceration, and cavitation.
  • They can evolve the ability to metastasize or invade different tissue
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5
Q

What is a Bronchogenic Carcinoma?

A

A term for lung cancer

  • Refers to tumors originating in the lung parenchyma or within the bronchi
  • Tumors that are specifically in the bronchial mucosa
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6
Q

What increases the risk of developing lung cancer?

A
  • Smoking and/or COPD
  • Asbestos exposure
  • Exposure to chemicals/minerals (i.e Radon, air pollution etc.)
  • Chronic illness like Pulmonary fibrosis (neck cancer and esophgus)
  • Family Hx of lung cancer
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7
Q

Why does COPD have strong evidence as a risk factor for Lung Cancer?

A

Patients with airflow limitation are more likely to develop lung cancer than those with normal airway function, independent of smoking status

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8
Q

What are 5 anatomic alterations tumors can cause because of lung cancer?

  • specifics are explored in other cards
A
  1. Tumor enlargement can cause inflammation and edema in the bronchial airways and alveoli
  2. Tumor invasion can increase mucous production and cause airway obstructions
  3. Tumors can erode surrounding tissue/vessels causing hemoptysis
  4. Tumors can invade and impinge on other structures which can lead to pleural effusions
  5. Cavity formation
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9
Q

In the context of Lung Cancer, What outcomes can be expected if a tumor enlarges?

A

Tumor enlargement can damage surrounding airways and alveoli.

  • Leads to inflammation and edema to the tissue
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10
Q

What impact can tumors have on alveoli and what is the subsequent snowball affect? (2)

A
  1. Alveoli can become injured and inflamed –> Edema
  2. Adjacent alveoli can be filled with fluid –> can consolidate or become atelectatic
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11
Q

In the context of Lung Cancer, What happens if a tumor invades the bronchi?

A

Mucous production increases –> can lead to airway obstruction

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12
Q

In the context of Lung Cancer, What happens if peripheral tumors invade the pleural space?

A

Tumors can impinge upon the mediastinum, chest wall, and/or the diaphragm

  • Could lead to a secondary pleural effusion
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13
Q

In the context of Lung Cancer, What outcomes can be expected if a tumor erodes exposed blood vessels?

A

Blood vessels could leak into the airway causing hemoptysis

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14
Q

How can Malignant tumors increase the risk of hemoptysis and pulmonary hemorrhage?

A

They can cause angiogenesis (formation of new blood vessels)

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15
Q

When can pleural effusions be expected to occur as because of lung cancer?

A

When parietal pleural and mediastinum are invaded by tumors

  • Its very common
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16
Q

What are 2 categories of Lung Cancer?

A
  1. Non small Cell Lung Carcinoma (NSCLC) (85%)
  2. Small Cell Lung Carcinoma (SCLC) (15%)
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17
Q

What are 3 subgroups of Non small Cell Lung Carcinomas (NSCLC)?

A
  1. Squamous cell (epidermoid) carcinoma
  2. Adenocarcinoma
  3. Large Cell Carcinoma (Undifferentiated)
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18
Q

What are 2 subgroups of Small Cell Lung Carcinomas (SCLC)

A
  1. Small cell
  2. Oat cell
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19
Q

What are general characteristics of Small Cell Lung Carcinomas (SCLC) aka Oat cell

  • Affected area?
  • Growth rate?
  • Tx?
A

Respond best to chemo and radiation but has high chance of relapse within 24 months

  • Poorest prognosis
  • Usually arise centrally near the hilar region and the large airways
  • Tiny tumors (6-um) but fastest growing/spread of all cancers
  • **Strong correlation w/cig smoking
  • Responds best to chemo
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20
Q

What are general characteristics of Squamous Cell Carcinomas (NSCLC)?

  • Affected area?
  • Growth rate?
  • Tx?
A

Tumor roots from the basal cells of bronchi epithelium and grows thru the epithelium before invading surrounding tissues.

  • Pneumonia and atelectasis are common secondary complications
  • Common in central bronchus or Hila and projects into the large bronchi
  • Tx: Surgical resection if metastasis has not taken place, chemo is not effective.
  • Growth rate is slow and metastasis late
  • Cavitation and necrosis within the center of cancer is common
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21
Q

What are secondary complications of Squamous cell carcinomas?

A

Affects the central bronchus or hila.

Expected secondary complications are:

  1. Leads to obstruction (non prod cough) and hemoptypsis
  2. Atelectasis and pneumonia
22
Q

What are general characteristics of Adenocarcinomas (NSCLC)?

  • Affected area?
  • Growth rate?
  • Tx?
A

Arise from mucous glands of tracheobronchial tree that later affect the terminal bronchioles and alveoli.

  • Mod growth rate and metastasis early
  • Tx: Surgical Resection
  • Tumors (4cm) are usually found in periphery of lung parenchyma
23
Q

What form of lung cancer has the weakest association with smoking?

A

Adenocarcinomas

24
Q

What are general characteristics of Large Cell Carcinoma (Undifferentiated) (NSCLC)?

  • Affected area?
  • Growth rate?
  • Tx?
A

Found in lung periphery, but can be found centrally and often ditort the trachea and large airways

  • Rapid growth rate (more genetic damage) and early, widespread metastasis
  • Associated with chest wall pain, pleural effusion, pneumonia, hemoptysis, and cavity formation
25
Q

What are general characteristics of Lung Carcinoid Tumors?

  • Affected area?
  • Growth rate?
  • Tx?
A

Neuroendocrine cell tumors

  • Typically grow slow
  • Exception is small cell lung cancer
26
Q

What is the Growth rates for NSCLCS in order of slowest to fastests?

A
  1. Squamous cell (epidermoid) carcinoma
  2. Adenocarcinoma
  3. Large Cell Carcinoma (Undifferentiated)
27
Q

How is lung cancer diagnosed? (4)

A
  1. Routine Chest xray is the most common
  2. CT scan: Better (size, shape, location, lymph node involvement)
  3. PET scan: ID spread to lymph nodes
  4. Biopsy of tissue under a microscope: used to for a definitive dx
28
Q

Clinical manifestations of Lung Cancer?

A

Most lung cancers not diagnosed until symptoms present

  • Worsening cough -> hemoptysis
  • Chest pain
  • Hoarse voice
  • Poor appetite/weight loss
  • SOB
  • Fatigue
  • Frequent pneumonias
  • Sudden wheeziness
29
Q

What are common non respiratory clinical manifestations of Lung Cancer?

A
  • Difficulty in swallowing
  • Superior vena cava syndrome (SVC is partially blocked or compressed
    –> Neck/face swelling, cough, SOB, JVD, etc)
  • Weakness (Distention of the neck veins, Neck, chest and facial edema)
  • Electrolyte abnormalities
30
Q

What are typical CxR findings for Lung Cancer?

A

Small oval or coin lesion (circle white masses on cxr and CT)

  • Large irregular mass
  • Alveolar consolidation
  • Atelectasis
  • Pleural effusion
  • Involvement of the mediastinum or diaphragm
31
Q

How are tissue biopsies gathered? (3)

A
  1. Bronchoscopy via lavage, brushing, needle biopsy, EBUS (endotracheal ultrasounds)
  2. Mediastinoscopy (AKA Mediastinotomy) -> small neck incision, feed small light behind sternum & in front of trachea
  3. open lung biopsy
32
Q

What are methods to screen/diagnose for lung cancer?

A
  1. Bronchoscopy via lavage, brushing, needle biopsy, EBUS (endotracheal ultrasounds)
  2. Mediastinoscopy (AKA Mediastinotomy) -> small neck incision, feed small light behind sternum & in front of trachea
  3. open lung biopsy
  4. Thoracentesis –> From pleural effusion
  5. Sputum Cytology
33
Q

What is staging classification for cancer assessed by? (4)

A
  1. Cancer type
  2. Size of the tumor
  3. Level of lymph node involvement
  4. The extent to which the cancer has spread
34
Q

What is the widely used cancer staging system?

A

TNM staging system

35
Q

What staging system is used to stage NSCLC?

A

The TNM staging system

36
Q

How is the primary tumor (T) gauged by the TNM Staging system? (3)

A

Primary Tumor (T)

  • TX: Main tumor cannot be assessed or measured (find cancer cells but not the tumor)
  • T0: No evidence of a primary tumor
  • T1-T4: Refers to the size or extent of the main tumor. The higher the number, the larger the tumor or the more it has invaded nearby tissues.
37
Q

How are the Regional lymph nodes (N) gauged by the TNM Staging system? (3)

A

Regional Lymph Nodes (N)

  • NX: Nearby nodes cannot be assessed
  • N0: There is no spread to the nearby nodes
  • N1-N3: Refers to the number and location of lymph nodes that contain cancer. The higher the number, the more lymph nodes contain cancer
38
Q

How is the Distant metastasis (M) gauged by the TNM Staging system? (3)

A

Distant metastasis (M)

  • M0: No spread to distant organs or areas
  • M1a: Spread to other lung, cells found in pleural fluid or around the heart
  • M1b: Spread to other organs
39
Q

How many stage groupings are there for cancer?

A

Stages 0-4

40
Q

What is Stage 0 cancer?

A

Abnormal cells are present but have not spread to nearby tissue

41
Q

What is Stage 1-3 cancer?

A

Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues

42
Q

What is stage 4 cancer?

A

The cancer has spread to distant parts of the body

43
Q

How is the staging system of small cell lung carcinoma (SCLC) classified?

A

SCLC is classified as limited or extensive stage

44
Q

What is limited stage Small Cell Lung Carcinoma (SCLC)?

A

Cancer is confined to one lung and to neighboring lymph nodes

  • can be treated with single radiation field
45
Q

What is Extensive stage Small Cell Lung Carcinoma (SCLC)?

A

Cancer has spread beyond one lung and nearby lymph nodes

  • Metastatic SCLC
46
Q

What are the main 3 methods of treatment for Lung Cancer?

A
  1. Surgery
  2. Chemotherapy
  3. Radiation therapy
47
Q

What surgery procedures are used to treat lung cancer? (5)

A
  1. Wedge resection (partial removal of a lung lobe)
  2. Segmentectomy (removal of a lung segment or segments of the lung)
  3. Lobectomy (removal of one lung lobe)
  4. Bilobectomy (removal of two lung lobes)
  5. Pneumonectomy (removal of whole right or left lung)
48
Q

What is chemotherapy?

A

A drug treatment that uses potent chemicals to kills fast-growing cells in your body

  • can be done w/radiation and/or surgery
  • considered a systemic treatment
49
Q

What are the 3 primary goals of chemotherapy?

A
  1. Curative intent (Destroy all cancer cells)
  2. Control (Shrink tumors or stop cancer from growing and spreading)
  3. Palliation (Ease symptoms of the cancer)
50
Q

What is Radiation therapy?

A

Use of high-energy particles or waves to destroy or damaged cancer cells

  • Considered a local treatment (external radiation)
  • Radiation works by making small breaks in the DNA inside cells. These breaks keep cancer from growing and dividing and cause them to die
51
Q

What respiratory care can be provided for a pt with lung cancer? (4)

A
  • Treat hypoxemia
  • Treat hypoventilation
  • Bronchopulmonary hygiene protocols
  • Lung Expansion protocols

Patho 2 (Path 311) (15 decks)

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