Pulmonary Neoplasms Flashcards
Objectives
1
Q
Describe the incidence, risk factors, percentage of lung cancer related to tobacco use
A
- Worldwide— #1 cause of cancer death is lung cancer
- Lung cancers have been linked to a metabolite of tobacco smoke, benzo(a)pyrene, which is abnormal in 60% of primary lung neoplasms.
- 90% is found in smokers
- 2nd hand exposure does increase the overall risk of lung cancer for non-smokers, but not as much as active smoking does.
2
Q
signs and symptoms of local and metastatic lung cancer
A
- only 5% are asymptomatic and extra-pulmonary sx are 1st clue to diagnosing
- Dyspnea
- Cough, usually non-productive
- When it is productive, usually thin mucoid secretions in large amts
- Hemoptysis
- Chest pain
- Hoarseness
- Pleural effusion(s)
3
Q
Describe the diagnostic tests that should be ordered for suspected lung cancer
A
- Imaging:
- CXR- Pa/Lat- for screening purposes
- 1st choice- cheap/available
- CT scan with contrast
- 2nd study performed to evaluate lymphadenopathy
- look for: speculated, irregular, non-calcified
- 2nd study performed to evaluate lymphadenopathy
- PET for metastases (likes highly metabolic areas)
- CXR- Pa/Lat- for screening purposes
- Invasive studies:
- Bronchoscopy
- Mediastinoscopy
- EBUS- for mediastinal lymphadenopathy
- FNA- when masses cant be reached with bronchoscopy
- CT guided, needs to be greater than 2 cm
- Thoracentesis- for therapeutic and to determine if pleural effusion is malignant or not
- Open biopsy- last resort choice
4
Q
small cell lung cancer
A
- Aggressive and presents in advanced stage
- From neuroendocrine cells
- Central of lungs
- Smokers
- Can lead to:
- Hypercalcemia
- SIADH
- ACTH production
- Sensitive to chemo and radiation
- Can lead to:
5
Q
Non-small cell carcinoma
A
*80% of cases
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
6
Q
Non-small cell carcinoma: Adenocarcinoma
A
- MC type of NSCS = HYPERCALCEMIA
- From bronchial mucosal gland
- Develops peripherally
- Not associated with smoking normally
- Bronchioalveolar carcinoma:
- Subset of adenocarcinoma
- Found in alveolar walls, slow growing
- MC in non-smokers
- On imaging: ground-glass opacities or pneumonia on imaging
- Subset of adenocarcinoma
7
Q
Non-small cell carcinoma: Squamous cell carcinoma
A
- 2nd most common
- Found centrally normally within major bronchi
- Develops in squamous cells
- Can cause hemoptysis and post-obstructive pneumonia
- MC associated with hypercalcemia and tobacco abuse
8
Q
Non-small cell carcinoma: Large cell carcinoma
A
- Tobacco abuse
- Any part of lung and associated with friable tissue and hemoptysis
- Wet TP
9
Q
Pancoast tumor
A
- Superior sulcus tumors
- Extrapulmonary lung cancer
- Defined by location in lung apex
- Majority are NSCLS- squamous
10
Q
Pancoast tumor signs and symptoms
A
- Shoulder pain on affected side; more painful than others due to invasion of brachial plexus
- Horner’s Syndrome: involvement of sympathetic chain and inferior cervical ganglion
- Weakness and muscle atrophy, wt loss
- SVC syndrome (less common)
- Restriction of SVC so it cuts off blood supply from arms and head of patients causing edema of head and arms
11
Q
Pancoast etiology
A
- can be caused by lesions other than lung cancer
12
Q
Identify the pulmonary complications of lung cancer
A
- Reduced FEV1 and associated dyspnea
- Acute Hypoxemia vs. acute on chronic hypoxemia
- Recurrent pneumonias, often post-obstructive
- MC: Chronic cough and hemoptysis
13
Q
Paraneoplastic Syndrome
A
Paraneoplastic Syndrome
- A constellation of symptoms, neurologic & otherwise, not caused by a primary disorder in that system.
- Exact cause is unknown, but thought to relate to immune response to neoplastic process.
- General
- Anorexia, cachexia, and weight loss
- Cutaneous
- Itching, Flushing, Pigmented skin lesions
- Endocrine
- SIADH >hyponatremia; Ectopic production of ACTH>hyperglycemia, hypokalemia, hypertension, central obesity, moon facies; Insulin like growth factors>Hypoglycemia; parathyroid hormone-related peptide (PTHRP) >hypercalcemia
- Neurologic
- Peripheral neuropathy
- Hematologic
- RBC aplasia, anemia of chronic disease, leukocytosis, thrombocytosis, eosinophilia, basophilia, and disseminated intravascular coagulation.
- Hypercoaguable states, and thromboembolic events
- GI
- Watery diarrhea with subsequent dehydration and electrolyte imbalances
14
Q
Metastatic Disease
A
- body.
- Common sites for primary pulmonary carcinoma to metastasize to:
- Liver, adrenal glands, bone, and brain
- Liver metastases are uncommon early in the disease process. Autopsy results show liver mets in >50% of patients with both NSCLC & SCLC
- Adrenal metastases show often, but usually are asymptomatic. Approximately 2.5% of these mets are malignant in NSCLC, with up to 17% in SCLC
- Bone metastases appear often & are typically symptomatic, with back pain a frequent symptom. Other signs include hypercalcemia as a result of bone invasion. Appear in 20% of NSCLC & 30-40% of SCLC.
- Brain metastases can include paraneoplastic phenomena and tumors. Symptoms also include HA, seizures, & visual field loss. With NSCLC, is most prevalent with adenocarcinoma. With SCLC, appears in 20-30% of patients at presentation.
15
Q
Staging of Lung Cancers
A
- Difference between NSCLC & SCLC is important in multiple regards:
- Affects the staging of the respective cancer
- Affects the treatment options
- Once the diagnosis of lung cancer has been confirmed via pathology, staging begins.
- PET scan confirms any hypermetabolic areas in the body.
- Look for lymph node enlargement via imaging studies: CT with contrast, if imaging confirms lymphadenopathy, may need biopsy to confirm.
- Search for any metastases via imaging studies: CT & MRI.
