primary lung tumors CCL Flashcards
Lung cancer, how common, who does it effect, causes.
2nd most common cancer
50-60 year olds
smoking, or exposure (asbestos, arsenic, chromium, radium)
raised platelets can be seen
generally a poor prognosis.
lung is most common site of metastatic tumors.
discuss adenocarcinoma,how common, where does it grow. any associations?
Most common classification
periferal smaller airways
well, moderately, poorly differentiated (gradeing)
pre-malignant lesions- atypical adenomatous hyperplasia.
ascociated with gynocomastia
small cell carcinoma,how does it act/prognosis.
associations on presentation.
extremely aggressive, poor prognosis.
presents with paraneoplastic syndrome usually
central
from neuroendocrine cells
high grade by definition, no precursor or premmalignant.
resistant to chaemo.
squamous cell carcinoma,what causes it. how does it come about and where does it form
strong assoc with smoking- most common in this pop
metaplasia of columnar glandular epithelium to squamous cell–> dysplasia–> carcinoma in situ –> invasive squamous cell carcinoma
arises near the hilum usually.
carcinoid tumor,what is it, signs and symptoms + Rx
Rare solitary lung nodule
neuroendocrine tumor - dowsnt metastasise
secretes 5-HT
presents with flushing, diarrhoa, abdo pain,cough
surgical removal/ Rx with octreotide
pathopahysiology of Lung cancer some possible receptor exressions
EGFR (transmembrane tyrosine kinase receptor) mutates–> respond to things that usually inhibit them (genfitinib, erlotinib)
PD-L1 is expressed in mutated cells, this means T reg are inhibited. some have over expression. Rx this with immunotherapy monoclonal antibody (pembrolizumab)
discuss paraneoplastic syndromes in general detail
a consequence of the tumor in the body, producing a specific set of chemical signalling due to the overexpression and growth of the tumor.
are generally specific to tumor type. endocrine, neurological, mucocutaneous, hematological.
most common is a fever.
Ix + Rx of lung cancers.
name specific lung surgeyr contraindications.
CXR, CT CAP before biopsy,
if central biopsy in bronc, is perif use CT guidance.
small cell- chaemo and radio first before becomes chaemo resistant.
non-small cell surgery if possible (depending on pstn) chemo and radio
contraindications for lung surgery: SVC obstruction, FEV<1.5, malignant pleural effusion, vocal chord paralysis.
common metastatic sites for lung cancer
superclavicular nodes–> end stage
cervical/ axiliary
adrenall glands
liver
bone
brain
complications of lung cancer
SVC obstruction- R sided small lung cell. inc venous pressure upstream –> SOB, facial swelling, head fullness, cough, etc.
pancoast tumor- lung apex- shoulder pain into ulnar dist of forearm, or horners syndrome, brachial plexus compression, horse voice.
horners syndrome– T1 nerve infiltration by tumor.
