Carcinogenesis & Lung Cancer Flashcards Preview

CVPR: Pulmonary > Carcinogenesis & Lung Cancer > Flashcards

Flashcards in Carcinogenesis & Lung Cancer Deck (18)
1

Major signs/symptoms of Lung Cancer

  • Worsening or chronic cough, SOB,
  • anorexia, weight loss
  • weakness, fatigue
  • hemoptysis
  • pain @ thoracic site or metastasized site
  • sx of metastatic disease: i.e. to adrenal glands, liver, brain, bone.
  • paraneoplastic syndrome

     

2

Dx test results in lung cancer

  • CXR results:
    • nodule, enlarging mass
    • persistent/non-resolving infiltrate,
    • atelectasis
    • mediastinal or hilar adenopathy
    • pleural effusion
  • patients may present with manifestations of metastatic disease (ex. cachexia, seizures secondary to CNS metastases).
  • histologic confirmation on biopsy
    • endobronchial or transbronchial biopsy
    • transbronchial needle aspiration

3

Lung cancer epidemiology

  • leading cause of cancer death
  • 5 year survival = <15%
  • majority of cases attributable to smoking

4

Major environmental risk factors for developing lung cancer

  • tobacco use + environmental tobacco smoke
  • radon gas
  • asbestos
  • metals
  • industrial
  • polycyclic aromatic hydrocarbons

5

Diseases/other factors associated w/lung cancer risk

  • COPD secondary to smoking
    • dose-response = more severe (lowest FEV1 ==> highest risk)
  • sarcoidosis and pulmonary fibrosis/ILD
  • hx of previous lung cancer, head and neck cancer, tobacco-related aerodigestive cancer
  • lung cancer in a first degree relative = independent risk factor

6

Major types of lung cancer

  • non-small cell carcinoma (NSCLC)
    • squamous cell carcinoma = bronchial epithelium; central
    • adenocarcinoma = mucous glands; peripheral
    • large cell carcinoma = heterogenous group
  • small cell carcinoma = bronchial origin ==> central lesions narrow/obstruct bronchi

7

Common genetic alterations in NSCLC and targeted therapy

  • adenocarcinoma ==> Kras, EGFR (epidermal growth factor receptor), EML4-Alk (fusion protein), Braf
    • targeted treatments towards neutralizing the effects of these mutations

8

Staging lung cancer process

  • thorough history and physical
  • all pts: electrolye testing, liver fxn tests, CXR
  • SCLC staging (more micrometastases early in disease) = limited disease (tumor is ipsilateral hemithorax) ==> extensive disease (tumor extends beyond hemithorax)
  • NSCLC staged using TNM (Tumor size, Nodal involvement, Metastases)

9

SCLC treatment

  • chemotherapy = cisplatin & etoposide
  • radiation ==> tx symptomatic metastases
  • not treated surgically 
  • targeted agents under development

10

NSCLC treatment

  • surgical resection ==> candidates thoroughly assessed based on tumor invasion and lymph node; many inoperable
    • staged/assessed via CT and PET scans
    • assesed w/PFTs tod etermine severity of any accompanying chronic lung disease
  • neoadjuvant therapy = chemo/radiation prior to surgery
  • adjuvant chemotherapy = chemo after radiation or surgery
  • targeted agents (adenocarcinoma)

11

Screening for lung cancer

  • screening not currently recommended 
    • screening studies showed some early detection/survival improvements but no overall lung cancer mortaility improvement
  • high-risk cohorts may become effective screening population
    • tobacco exposure, FHx, etc.
  • possible: low-dose, helical CT

12

Prevention of lung cancer

  • smoking cessation
  •  

13

Solitary pulmonary nodule (SPN) definition

  • < 3cm in size
  • surrounded by normal lung
  • not associated w/atelectasis or adenopathy
  • relatively common finding on CXR

14

Benign causes of solitary pulmonary nodules

Infectious granulomas

Viral infections: measles, CMV

Round pneumonia

Lung abscess

Pulmonary infarct

Sarcoidosis

Pseudotumors (collections of fluid in the lung fissures)

15

Malignant causes of solitary pulmonary nodules

Bronchogenic carcinoma

Bronchial carcinoid tumors

Other primary lung tumors – carcinosarcoma, lymphoma, hemangioendothelioma

Metastatic tumors – most commonly colorectal, breast, renal cell, testicular, malignant melanoma, sarcoma

16

Hx/Signs & Symptoms of solitary pulmonary nodules

  • malignancy risk increases with age (above 35 yo), tobacco use, occupational exposure, and hx of previous malignancy
  • on PE: lymphadenopathy may indicate malignancy
    • fixed/localized wheeze ==> endobronchial location + increased suspicion for a tumor
    • clubbing and joint tenderness

17

Imaging study results in solitary pulmonary nodules


  • CXR ==> CT for further eval ==> PET 



  • review old CXRs/CTs to determine nodule stability 

    • estimate doubling time
    • speculated appearance + irregular borders ==> malignancy signs
  • calcification presence and pattern ==> marker of benignity
    • "bull's eye" pattern = granuloma (not tumor)
    • lack of pattern/calcification at all = increased possibility of cancer

18

Goals of evaluation of solitary pulmonary nodules

  • determine benign vs. malignant
  • treat underlying cause
  • determine if nodule should be resected
  • intermediate probability of malignancy ==> video-assisted thoracoscopic surgery (VATS)