Pulmonary Malignancies Flashcards
RF for pulmonary malignancies
smoking/ second hand smoke- synergistic with all other RFs
radon, radiation
asbestos- more bronchogenic cancers than mesothelioma
Presentation of pulmonary malignancy
There are no early symptoms Common- cough, hemoptysis, weight loss (cacexhia), chest pain, metastasis SVC syndrome Pancoast tumor paraneaplastic syndrome
SVC- syndrome
tumor blocks SVC drainage from head –> facial redness and swelling, HA, cyanosis, dilation of veins
Pancoast tumors
tumors in lung apices- affects nerves
brachial plexus- pain in arm or shoulder
recurrent laryngeal nerve- hoarseness of voice or vocal paralysis
sympathetic ganglia- Horners syndrome (Ptosis, Miosis, and Anhydrosis)
Paraneaplastic syndromes
SCLC- cushing syndrome (ACTH), SIADH
SqCC- hyperparathyroidism (hyperCa and Fractures)
Carcinoid- serotonin syndrome
Pulmonary Malignancy- Dx
CXR- coin lesions and compare to old CXR
CT scan- get a better look, nodal mets
Sputum cytology- look for malignant cells in sputum
Biopsy-
-bronchoscope for central tumors
- mediastinoscope for metastases to nodes
- percutaneous CT guided for peripheral tumors
Thoracotomy or wedge resection for non diagnostic biopsy
How are bronchogenic carcinomas divided
small cell vs non small cell
What is the key difference between SCLC and NSCLC
Treatment modality
SCLC will mets more quickly so is not amenable to Surgery or radiation, so tx with chemo
NSCLC- tx with surgery or radiation
Squamous cells carcinoma (SqCC)- location and size
Central and large
SqCC- RF
99% smoking related
SqCC- paraneoplastic syndrome
hyperparathyroidism
inc PTrH, hyperCa, and fractures
SqCC- microscopy
Normal microscopy for SqCC= Squamous cells, keratin pearls, intracellular bridges
SqCC- Tx
surgery or radiation
Adenocarcinoma- location, size
peripheral, small coin lesion
Adenocarcinoma- RF
Most common LC or non smokers
75% smoking associated
Adenocarcinoma- tx
surgical resection or radiation
Adenocarcinoma- bronchioalveolar subtype
spreads along the alveoli using the BM as scaffolding so its not a solid mass but rather looks like diffuse pneumonia on CXR
Large cell carcinoma (LCC)- location, size
central or peripheral
large
this is a wastebasket categories for other tumors
LCC- RF
99% smoking related
LCC- Tx
surgery or rads
Small cell carcinoma (SCLC = small cell lung cancer) = oat cell carcinoma- location
central
SCLC- mets
metastasizes early normally via hematogenous route
brain is common place it goes- not from TA notes
SCLC- RF
99% smoking related
SCLC- paraneoplastic syndromes
Cushing syndrome (ACTH) SIADH
