pulmonary neoplastic disease Flashcards
lung cancer screening for high risk individual with negative chest x-ray
low dose chest CT detects lung cancer at earlier stage
-dx earlier allow more opportunity of effective treatment
most common type of cancer
bronchogenic cancer is most common
small cell lung cancer
nonsmall cell lung cancer
risk factors
- cigarette smoking
- occupation exposure (Asbestos, arsenic,hexavalent chromium)
- appears higher in adults who are low in fruit and veggies
- ionized radiation (miners and survivors or atom bombs)
- lung disease (COPD ect)
lung cancer presentation
cough, weight loss, dyspnea, chest pain, hemoptysis, bone pain, clubbing, fever, night sweats, weakness, anorexia
central endobronchial growth of primary tumor symptoms
cough, hemoptysis
dyspnea, wheeezing
peripheral growth of primary tumor symptoms
pain from pleura or chest wall involvement
dyspnea
lung abscess from tumor cavitation
regional spread of tumor in thorax symptoms
tracheal obstruction, esophageal compression, laryngeal paralysis (hoarseness)
horner’s syndrome: ptosis, endopthalmos, miosis & anhydrosis
malignant pleural effusion symptoms (advanced disease)
pain, dyspnea or cough
primary tumor
tumors arising from the respiratory epithelium bronchi, bronchioles and alveoli
NSCLC primary tumor most common
adenocarcinoma 42%
mucous glands or epithelial cells within/distal/terminal bronchials
NSCLC primary tumor second most common
squamous cell carcinoma 22%
bronchial epithelium- most common presentation hemoptysis
small cell lung cancer percentage and origin
13% bronchial origin begins centrally
locations of lung cancer metastisis
regional lymph nodes
liver
bone and bone marrow
central nervous system
5 mechanisms for metastasis
- pulmonary or bronchial artery
- lymphatic system
- pleural space
- airway
- direct neoplastic invasion
most common route for metastasis is
hematogenous
reaching arterioles and capillary beds
horners syndrome
miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face)
imaging for lung cancer dx
CXR: initial diagnosis
CHEST CT: aids in confirmation of suspected lesion
PET scanning: defines the nature of primary lesion and extent of disease
other methods of dx for lung cancer
Sputum cytology: 25-75% sensitive
Percutaneous transthoracic fine needle biopsy: 30% risk of pneumothroax
Video-assisted thoracoscopic surgery: for pts not tolerating pneumothorax
TNM lung cancer staging
Tumor: Size of the tumor
Node: Regional node involvement
Metastasis: The presence or absence of distant metastasis
non-small cell lung cancer treatment
surgery: 35-45% have resectable disease
radiation used preoperatively with chemo
small cell lung cancer treatment
more sensitive to chemo and thoracic radiation
surgery usually not possible in 85% with extensive disease
surgery is only an option in early stages
types of NSCLC
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
patters of adenocarcinoma and prognosis
Lepidic predominant - has favorable prognosis
Acinar & Papillary - have intermediate prognosis
Solid predominant -has a poor prognosis
squamous cell carcinoma
centrally located 2nd most common lung cancer
morphology similar to extrapulmonary squamous cell. tumors show karatinization and or intercellular bridges that arise from bronchial epithelium
tumors consist of sheets
squamous cell is associated with
tobacco use and is usually centrally located and producing bronchial obstruction
large cell carcinoma
frequently located in periphery
tumors lack cytologic and architectual features of small cell carcinoma and grandular and sqamous
large cell carcinoma tends to
metastasize hematogenously in early stages of disease which leads to bone, liver and brain disease
small cell lung cancer can produce ectopic hormone production leading to
cushings
inappropropriate secretion of ADH
small cell lung cancer is strongly associated with
heavy tobacco use and accounts for 15% lung cancer
rapid and aggressive cancer
small cell lung cancer
50-75% patients present with metastatic presentation
carcinoid tumors arist
from the small bowel (53%), colon (12%), esophagus through duodenum (6%), or lung (bronchial carcinoid [5%]).
carcinoid symptoms
symptom complex characterized by paroxysmal vasomotor disturbances, diarrhea, and bronchospasm
bronchial carcinoid tumors dx
fiberoptic bronchoscopy
These lesions have a well-vascularized stroma, and biopsy may be complicated by significant bleeding.
bronchial carcinoid tumor symptoms
Common symptoms include hemoptysis, cough, focal wheezing, and recurrent pneumonia.
Carcinoid syndrome (flushing, diarrhea, wheezing, hypotension) is rare.
benign pulmonary nodules
- lack of growth for 2 yrs
- calcification within the nodule
- 99% of noncalcified lesions less than 4 mm
- 94% of noncalcified lesion 4-8 mm
malignant pulmonary nodules
- growth of 1-18 months
- 50% of lesions greater than 8mm are malignant
- CT finding of small ground glass opacities
malignant mesothelioma
A neoplasm that originates from the mesothelial surfaces of the pleural cavities - 80%
Or peritoneal cavities – 20%
Both related to asbestos exposure from 20-40 years after asbestos
malignant mesothelioma presentation
Dyspnea *, Cough , Nonpleuritic chest pain
Fever, Weight Loss, Sweats, Fatigue, Anorexia
Horner syndrome in advances stages
Auscultation may reveal unilateral loss of breath sounds
Dullness to percussion
malignant mesothelioma produces a
pleural fluid accumulations (effusion)
Fluid may be bloody & often contain malignant cells
Right sided involvement is more common
diagnosis of malignant mesothelioma
CXR: pleural plaques or calcification in the diaphragm
CT: chest and abd use to assess extent of disease
BONE SCAN: used to assess extend of disease
superior sulcus tumors
pancoast tumors
arist from the apex of the lung and may invade the second or third rib, the brachial plexus, the subclavian vvessels, the stellate ganglion and adjacent vertebral bodies
superior sulcus tumors
pancoast syndrome: characterized by pain that arise in the shoulders or chest wall and radiates to the neck
radiates to the ulnar surface of the hand
