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SMUPASPG19-MED 1 > PULMO- CA > Flashcards

PULMO- CA Flashcards

1
Q

d/t bronchial epithelium local expansion, and subsequent infiltration of adjacent tissue resulting in lymphatic, hematogenous metasases.
leading cause of cancer related deaths WW for MW
cause 80-90%smoking

Rule of 20. 90 % - smokers_pack per day 20 years = 20x risk of nonsmoker

A

Bronchogenic carcinoma

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2
Q

Loss of cilia- 2wks to recover
Increase in number of cell rows
Increased atypical cells
*metaplastic squamous epithelium” replaces columnar epithelial lining l/t atypical proliferation>dysplasia>carcinoma.

A

Physiologic changes in respiratory epithelium related to cigarette smoking:

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3
Q

Prognosis

Bronchogenic CA

A

aggressive with high mortality rate
Poor prognosis due in part to late diagnosis
Early diagnosis and resection offers some chance of cure
assooc/w 5 year survival rate of < 40 %.

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4
Q 
90% respiratory symptoms at the time of diagnosis:
Cough
Dyspnea
Chest pain
Hemoptysis
Postobstructive pneumonia
A

Clinical Presentation

Bronchogenic carcinoma

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5
Q

35% PERIPHERAL tumor from mucous secreting cells

MC females and nonsmokers

doubling time of 3-6 months.

A

Adenocarcinoma

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6
Q

invasion of tumor into GVEsympathetic chain/trunk-
Lesion in sympathetic chain head for head.
vessels to body wall (only SNS)
miosis constricted eye dialator pupillae
ptosis drooping eye (smooth ms) tarsal
enopthalmus- sunken eye
facial flushing-red inc. temp, vasodialtion
anhidrosis-dry

tumor invasion of trachea; vocal cord paralysis d/t entrapment of recurrent laryngeal nerve by mediastinal mass

tumor at apex; shoulder pain, ulnar paresthesia due to encroachment on brachial plexus.

A 
Bronchogenic carcinoma
Extrapulmonary/Mediastinum Symptoms
Horner’s syndrome
Hoarseness:
Pancoast (APICAL) syndrome
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7
Q 
Anorexia
Cachexia
Weight loss
Fever
Digital clubbing 
 (hypertrophic osteoarthropathy -combining clubbing and periostitis of the small hand joints, (adenocarcinoma))

Common metastatic sites: pleura, bone, brain, liver, adrenal glands.

A

Extrathoracic Symptoms

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8
Q

disorders that are triggered by an altered immune system response to a neoplasm

Endocrine syndromes : 10-15%

Hypercalcemia (inc. squamous cell)

Inappropriate antidiuretic hormone release (SAIDH)
Syndrome of inappropriate antidiuretic hormone secretion

Ectopic adrenal corticotropic hormone secretion (sudden-hypertension, hyperglycemia, hypokalemia, m.alkalosis)

Neurologic: Eaton-Lambert syndrome: muscle weakness mimicking myasthenia gravis.

Thromboembolic disease- sudden, randon, idopathic. DVT, PE, Stroke

A

Paraneoplastic Syndromes

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9
Q

unrevealing

Occasionally local wheezing from bronchial obstruction

Pleural effusion

Evidence of metastasis or a paraneoplastic syndrome

*Supraclavicular adenopathy

A

Physical Exam

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10
Q

Cell type:
Squamous and Small

Sx
Atelectasis
Pneumonia
Dyspnea

A

Bronchogenic carcinoma

Centrally located tumors are more likely to

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11
Q

Chest X-ray-comparison with old films rate of progression

CT Scan-

  1. anatomical extent of the disease
  2. Guides diagnostic and therapeutic procedures
  3. additional lesions not seen on chest x-ray
  4. Characterizing size, shape, and composition of lesions.
A

Bronchogenic carcinoma

Diagnostics

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12
Q

Successful diagnosis depends on the cell type and location of the tumor.

80% Squamous cell produces positive

5% Peripheral adenocarcinoma sputums positive

A

Sputum Cytology

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13
Q

diagnosis and staging

Location determine what diagnostic procedure

Visualizes the proximal extent of the tumor

distance from the carina determines surgical resectability.

Multiple diagnostic procedures:
transbronchial biopsy
Bonchoscopy: brushing for cytology, less lilke squammous
Bronchoalveolar lavage
Transbronchial needle aspiration- ins collapse

A

Bronchoscopy

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14
Q

Useful if mass or nodule is located peripherally near the pleura or in the apex of the lung

metastatic lesions (difficult by bronchoscopy)

Risk of pneumothorax; especially in patients with emphysema

A

Needle Biopsy

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15
Q

when enlarged nodes cannot be adequately sampled by less invasive techniques.

Requires hospitalization

Complications: wound infection, injury to major vascular structures, recurrent laryngeal nerve paralysis.

A

Mediastinoscopy/Mediastinotomy

Lymph node biopsy

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16
Q

two goals:
determine the anatomic extent of the tumor;
determine the physiologic capacity of the patient to undergo therapy.

Tumor size
LN Nodes involved
Metastasis spread

A

Staging

17
Q 
TX:  malignant cells, but tumor not visualized 
T1:  < 3 cm diameter
T2:  > 3cm diameter  
T3 :   Invasion of chest wall
T4 : invasion of mediastinum
A

Tumor Extent ( primary tumor)

18
Q

prognosis w/ lung ca is poor.
5-year survival rate for all stages <10%, dec. w/ stage
Size and extent determinants of survival.

TNM stage at presentation in patients with NSCLC is the factor that has the greatest impact on prognosis

Stage I : Surgical resection

Stage Ib-II : Surgical resection plus adjuvant chemotherapy

Stage IIIa: combined modality approach, investigational protocol: surgical resection after initial chemotherapy, with or without radiotherapy.

Stage IIIb: palliative therapy, combined modality therapy with radiotherapy and chemotherapy.

Stage IV: chemotherapy or a palliative, symptom-based approach.

A

Treatment

19
Q

systemic chemotherapy combined w/ radiation,
based early metastatic disease.

solitary pulmonary nodule, surgical resection may be considered, in addition to systemic chemotherapy.

A

Treatment: Small Cell

20
Q
  • (SCLC) vs. (NSCLC), its rapid doubling time, early widespread metastases.

highly responsive to chemotherapy and radiotherapy, BUT relapses within two years -d/t rapid turn over

combination- prolong survival compared with chemotherapy therapy alone

Surgery - not recommended, except, in the rare patient who presents with a solitary pulmonary nodule without distant metastases or regional lymph node involvement

3 to 8 % of all patients with SCLC survive beyond five years.

A

Prognosis: Small Cell

21
Q

Surgery = MOST EFFECTIVE therapy for bronchogenic carcinoma.

recommended for NSC stages I and II (some stage III resectable)

Inoperable if 
widespread mediastinal lymph node metastases, 
SVC obstruction, 
pleural involvement, 
distant metastases.
A

What is the MOST EFFECTIVE Bronchigenic CA?

22
Q

Radiation

Pre-operative radiation does not increase survival rates

used for palliative therapy in patients with Inoperable reasons: SVC obstruction, pleural effusion, brachial plexus involvement, or hemoptysis.

A

What treatment is considered when surgical treatment contraindicated

23
Q

Chemotherapy- drug therapy

also used w/ radiation therapy

Increases survival rates, but low potential for cure

Combination of several agents more effective than single drug

Chemotherapeutic agents changed whenever evidence of tumor progression

**Genetic mapping for most effective agents-helpful

A

What is the standard tx for patients with SCLC?

24
Q

spherical density < 4 cm in diameter

malignancy is 40-50%

Surgical resection possible in 80%

5-year survival rate is 40%

A

Solitary Pulmonary Nodule

25
Q

*percutaneous transthoracic needle aspiration

bronchoscopy

10% represent metastatic disease

Biopsy anyone with a hx of CA

A

How are SPN diagnosed?

26
Q

Benign

Risks factors for malignancy:
age >35

tobacco or asbestos

hx of previous malignancy

Eccentric calcification- unusual looking

size > 3 cm; irregular shape / ill defined borders

A

Is a mass that has been present and unchanged or 3year benign or malignant?

What are the risk factors for malignancy?

27
Q

NO FOLLW UP
symptomatic solid or subsolid (pure ground glass or part-solid) <6 MM

FOLLOW UP
repeat films every 3-4 months for 1 year
then every 6 months for 1 year, then yearly intervals

2 years of study adequate for patients with low suspicion.

5 years necessary for lesions with high suspicion of malignancy

solid SPNs stable on serial CT for 2 years, suggest no further diagnostic testing.

A

How should we monitor SNP?

28
Q

NOT REALLY

Diagnosis usually made after metastases has occurred

Goal- detecting lung CA at an earlier, curable stage.

Study- annual low-dose CT screening in patients demonstrated a decrease in lung cancer and all-cause mortality.

Failure of the chest x-ray as a screening tool

1cm first detectable on chest film (30 cell doublings required to reach this size)

Smoke 20+ smoking hx, CC.Cough ins. will pay for CT/Chest Xray

A

Is Chest xray sufficent screening tool?

29
Q

Never smoking or smoking cessation

beta carotene, retinoids,selenium, and multivitamins. None have been successful
beta carotene increase lung cancer risk.

Chemoprevention no benefit ,experimental.

Low dose CT screening may help identify patients with early disease

Genetic targeting for specific chemotherapy shows promise to slow progression BUT not cure.

A

Prevention

SMUPASPG19-MED 1 (27 decks)

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