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CVPR: Pulmonary > Carcinogenesis & Lung Cancer > Flashcards

Flashcards in Carcinogenesis & Lung Cancer Deck (18)
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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



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


Lung cancer epidemiology

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


Major environmental risk factors for developing lung cancer

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


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


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


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


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)


SCLC treatment

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


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)


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


Prevention of lung cancer

  • smoking cessation


Solitary pulmonary nodule (SPN) definition

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


Benign causes of solitary pulmonary nodules

Infectious granulomas

Viral infections: measles, CMV

Round pneumonia

Lung abscess

Pulmonary infarct


Pseudotumors (collections of fluid in the lung fissures)


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


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


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


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)