SM_277b: Lung Cancer Flashcards
___ has worst survival of major cancers because ___
Lung cancer has worst survival of major cancers because most aptients present with advanced disease
___ is main risk factor for lung cancer
Tobacco is main risk factor for lung cancer
- However, not all lung cancer patients are smokers
Describe presentation of early stage lung cancer
Early stage lung cancer
- Often asymptomatic: found incidentally or through lung cancer screening
- May cause cough, hemoptysis, or dyspnea
Superior vena cava syndrome due to lung cancer presents with ___, ___, ___, and ___
Superior vena cava syndrome due to lung cancer presents with facial plethora, dilated collateral veins along chest, extremity edema, and headaches
- Vessel obstruction
Pancoast tumor due to lung cancer can present with ___, ___, and ___
Pancoast tumor due to lung cancer can present with shoulder pain, brachial plexus, or Horner’s syndrome
- Nerve impingement - symptoms depend on site of involvement
Horner’s syndrome is ____, ____, and ____
Horner’s syndrome is constricted pupil (miosis), drooping of the upper eyelid (ptosis), and absence of sweating of the face (anhidrosis)
- Due to pancoast tumor (lung cancer)
Lung cancer can cause ___
Lung cancer can cause hoarseness due to impingement of laryngeal nerves
Most common sites of lung cancer metastasis are ___, ___, ___, ___, and ___
Most common sites of lung cancer metastasis are pleura, brain, bone, adrenal, and liver
Describe SVC syndrome
SVC syndrome
- Obstruction of SVC
- Facial plethora, dilated collateral veins along chest, extremity edema, headaches
Lung cancer is associated with ___
Lung cancer is associated with paraneoplastic syndromes
- Ectopic production of hormone
- ADH (SIADH): hyponatremia
- ACTH: Cushing’s syndrome
- PTHrP: hypercalcemia, hypophosphatemia
- Development of antibodies
- Lamberton-Eaton: antibodies that block presynaptic Ca channels in synapse to block ACh release, muscle weakness
Paraneoplastic syndromes are most commonly associated with ____
Paraneoplastic syndromes are most commonly associated with small cell lung carcinoma
Describe SIADH
SIADH
- Ectopic production of ADh
- Euvolemic hyponatremia
- Low serum osmolality
- High urine osmolality
- Usually associated with small cell lung cancer
Cushing’s syndrome can result from ___
Cushing’s syndrome can result from ectopic production of ACTH from tumor
Hypercalcemia presents with ___, ___, ___, and ___
Hypercalcemia presents with stones, bones, groans, and overtones
- Bone metastases: bone destruction and Ca release into blood
- Paraneoplastic: production of PTHrP: elevated Ca, low P, most commonly seen in squamous cell lung cancer
Describe Lamberton Eaton
Lamberton Eaton
- Antibody against presynaptic Ca channels of NMJ -> less ACh release -> proximal muscle weakness
- Improves with repeated stimulation
- Associated with small cell lung cancer
PHTrP is most often seen with ___
PHTrP is most often seen with NSCLC (squamous cell carcinoma)
Describe types of lung cancer
Lung cancer
- Small cell lung cancer
- Non small cell lung cancer: adenocarcinoma, squamous cell carcinoma, large cell carcinoma
Describe adenocarcinoma
Adenocarcinoma
- Derived from gland cells
- Bx: glandular structures
- Central or peripheral tumors
- Seen in non-smokers as well
Describe squamous cell carcinoma of lung
Squamous cell carcinoma of lung
- Occurs in smokers
- Central tumors near hilum, cavitary lesions
- Paraneoplastic syndrome: PTHrP -> hypercalcemia
- Bx: keratin pearls
Describe small cell lung cancer
Small cell lung cancer
- Aggressive (poor prognosis)
- Neuroendocrine tumor
- Smokers
- Central tumors
- Bx: small, densely packed blue cells
- Associated with paraneoplastic syndromes
Describe central and peripheral tumors
Lung cancer
- Central: squamous cell, small cell
- Peripheral: adenocarcinoma, large cell
Describe lung cancer biopsy
Lung cancer biopsy
- Give info regarding histology (cell type), molecular analysis (what is driving cell to grow), and interaction between tumor and immune system
- Biopsies prove stage of disease
Describe treatment for NSCLC
NSCLC treatment
* Stage I (curative intent): surgery Stage II (curative intent): surgery + chemo * Stage III (curative intent where possible): combo treatment * Stage IIIC/IV (palliative): personalized
Describe systemic treatment for stage IV NSCLC
Systemic treatment for stage IV NSCLC
- Chemo: rapidly growing cells (normal and malignant)
- Targeted therapy: specific molecular targets
- Immunotherapy: does not allow tumors to hide from immune system, can also further stimulate a patient’s immune system to attack cancer cells
____ or ____ are other treatments for NSCLC
EGFR tyrosine kinase inhibitors and PD1/PDL1 inhibitors are other treatments for NSCLC
Describe small cell lung cancer
Small cell lung cancer
- 15% of all
- Smokers
- Rapid growth, aggressive disease
- Paraneoplastic syndromes
Describe staging of small cell lung cancer
Staging of small cell lung cancer
- Limited: confined to a single hemithorax and all disease encompassed in single radiation port
- Extensive stage: exents beyond single hemithorax, cannot fit into one radiation field so cannot be cured
Describe treatment for small cell lung cancer
Small cell lung cancer treatment
- Limited stage (curative intent): combo chemo and radiation
- Extensive stage (cannot be cured, palliative intent): chemo and immunotherapy
Describe carcinoid tumor
Carcinoid tumor
- Typical: well differentiated
- Atypical: intermediate grade
- Can overproduce serotonin -> carcinoid syndrome -> flushing, diarrhea
Mesothelioma is ____ often resulting from ____
Mesothelioma is disease of pleura often resulting from asbestos
Prevent lung cancer through ___
Prevent lung cancer through smoking cessation
Screening for lung cancer via ___ can reduce mortality
Screening for lung cancer via low dose CT can reduce mortality
