Lung Flashcards by Dr.Maruf Radonco

lining epithelium of lung structures

upto lobular bronchiole: pseudo stratified ciliated columnar epithelium
terminal and respiratory bronchiole: low columnar or cuboidal with cilia
rest of the part: simple squamous cell epithelium

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histological classification of lung cancer broadly

**Epithelial tumors:**
--adenocarcinoma
--squamous cell carcinoma
--adeno squamous carcinoma
--neuro endocrine tumors
--large cell
--sarcomatoid
Mesenchymal tumors
Lymphohistiocytic tumors
Tumors of ectopic origin
Metastatic tumors

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Classification of adenocarcinoma

lepidic
acinar
papillary
micro papillary
solid
colloidal
fetal adenocarcinoma
enteric

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squamous cell carcinoma classification

keratinizing
non keratinizing
basaloid
SCC in situ

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types of sarcomatoid carcinoma in lung

pleomorphic carcinoma
spindle cell carcinoma
giant cell carcinoma
carcinosarcoma
pulmonary blastoma

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types of mesenchymal tumors

pulmonary hamartoma
chondroma
pecomatous tumors
synovial sarcoma
pulmonary artery intimal sarcoma
pulmonary myxoid sarcoma
myoepithelial tumor

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Lymph node zone of lung: N2

1=low cervical, supraclavicular
2=upper paratracheal
3=pre vascular, retro tracheal
4=lower paratracheal
5=sub aortic
6=para aortic
7= sub carinal
8=para esophageal
9= pulmonary ligament

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Lymph node zone of lung N1

10=hilar nodes
11=inter lobar 
12=lobar
13=segmental
14=sub segmental

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Endocrine PNS of lung cancer

SIADH
cushing syndrome
carcinoid syndrome
hypercalcemia
hypercalcitonemia
hyperthyroidism
hypoglycemia
gynecomastia

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Neurologic PNS

Encephalopathy
sub acute cerebellar degeneration
progressive multifocal leukoencephalopathy
peripheral neuropathy
autonomic neuropathy
Lambert Eaton syndrome

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SIADH diagnostic Criteria

serum osmolarity: < 275 mosm/kg
urine osmolarity >100 mosm/kg
clinical euvolemia
urine Na> 30 mmol/L with normal dietary salt and water
absence of adrenal, thyroid, pituitary or renal insuff
no recent use of diuretics

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Chemotherapy causing SIADH

cisplatin
cyclophosphamide
ifosfamide
vincristine
vinorelbine
vinblastine
MTX
imatinib

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Pancoast tumor

it is the tumor that arises from apex of lung

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Pancoasts syndrome

this is characterized by the pain in the shoulder or inner aspect of arm along the ulnar nerve distribution due to the involvement of lower part of brachial plexus. (C8, T1, T2)

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Horners syndrome

it is a combination of S/S caused by disruption of cervical sympathetic nerve pathway as it passes through T1 root and characterized by ptosis, miosis, enopthalmus, ipsilateral anhydrosis.

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Maker IHC for adenocarcinoma

TTF 1 +ve
Napsin a +ve
Ck 7+ve
Ck 20-ve

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Sq cell carcinoma IHC

TTF1 -ve
p40 +ve
p63 +ve
ck 5/6 +ve

Small cell lung cancer IHC

NSE > 100 mcg/dl(+ve)
CD 56 +ve
chromogranin +ve
synoptophysin +ve
ki 67 (50-100%)

Mesothelioma IHC

To confirm: WT1, calretinin, D2-40
To exclude: CEA, TTF1, Claudin-4
BAP-1 IHC specific marker to distinguish mesothelioma from reactive mesothelial proliferation

Dose limitation for lung

mean <20 gy

combined volume of both normal lung v20<35%

Heart dose limitation

V40<80%
v60 <30%
mean <35 gy

Prognostic factors of lung cancer

patient age, sex, weight loss and performance stats
staging
tumor histology:sqcc better prognosis
LDH, Albumin, Hb

five year survival of NSCLC

stage I: 68-92%
Stage II: 53-60%
stage III: 13-36%
stage IV: 0-10%

Nodal disease estimation:
EBUS: Stations
EUS : stations

Ebus: 2r/l, 4R/L, 7, 10 R/L
EUS: 5,7,8,9
TTNA(anterior mediastinotomy): 5,6

method of pathological mediastinal lymph node evaluation

``` mediastinoscopy mediastinotomy EBUS EUS CT guided biopsy ```

Stage IV a , C/L lung nodule: how to treat

treat as two primary lung tumors if both curable

Follow up protocol: Stage I and II

H&P , contrast CT chest+-contrast 6 monthly 3 yrs | than H&P and low dose ct scan contrast annually

follow up for stage I-II(if rx with RT) | stage III IV (definitive intent treatment)

``` H&P, contrast CT +- 3-6 monthly 3 yr than H&P , chest CT +-contrast 6 monthly 2 yr than LDCT annually smoking cessation pet/CT & brain MRI cancer survivor ship ```

Lung cancer prognostic factor

Female sex Ps Wt loss Staging ( rakib sir favrt question)

lung lymph node station: N1

10: hilar 11: interlobal 12: lobar 13. segmental 14. subsegmental

lung lymph node station: N2

supraclavicular zone: 1. low cervical, supraclavicular superior mediastinal: 2R,L: upper paratracheal 3a: prevascular 3p: Retrotracheal 4R: lower paratracheal 4L: lower paratracheal left 5: Sub aortic 6: para aortic 7. Sub carinal 8. paraesophageal 9. pulmonary ligament

Squamous cell carcinoma lung : curative dose

Curative: 55gy in 20 fractions 2.75 gy in 4 weeks 64-66 gy in 32-33 daily fractions given in a six and a half weeks

Nsclc sbrt dose

60 gy in 8 fractions on a alternate days 60 gy in 5 fractions weekly ( nazir sir)

Curative small cell lung dose

40 gy in 15 fractions 2.67 gy bid 6 hours gap in 3 weeks 45 gy in 15 fraction 1.5 gy BID 6 hours apart over 3 weeks (nazir mollah favorite)

PCI dose in ca lung

25 gy in 10 daily fractions of 2.5 gy given in 2 weeks

PCI used in

Small cell lung carcinoma Leukemia

Difference between pleural effusion due to carcinoma or infective cause

The characteristics of pleural fluid can help differentiate between malignant and infective causes. In general, malignant pleural effusions tend to have higher protein and lactate dehydrogenase (LDH) levels than non-malignant effusions 2. Additionally, malignant effusions are more likely to be exudative, meaning that they contain high levels of cells and other substances 2. In contrast, transudative effusions are more commonly associated with non-malignant causes such as heart failure or liver disease 2

Complication of RT in lung

COMPLICATIONS **Acute** esophagitis, dermatitis, cough, fatigue. **Subacute/late** radiation pneumonitis, pulmonary fibrosis, esophageal stricture or perforation, pericarditis, coronary artery disease, brachial plexopathy, rib fracture. 2nd malignancy

How smoking cause lung cancer

Cigarette smoking is by far the leading cause of lung cancer, accounting for approximately 80% to 90% of cases. Combustion of tobacco produces multiple known carcinogens, with the most important including polycyclic aromatic hydrocarbons, tobac- co-specific nitrosamines, and nitrates

Sensitivity and specificity of CT scan and PET CT for identifying lung lesion

**CT scan** Sensitivity: 55% Specificity: 81% **PET CT** Sensitivity 80% Specificity 88%

Common paraneoplastic syndrome of lung

Hypercalcemia SIADH Cushing syndrome Lambert eaton myasthenic syndrome Paraneoplastic encephalitits Unexplained hematologic abnormalities Hypercoagulability with venous thromboembolic disease Hypertrophic pulmonary osteoarthropathy Dermatomyositis and polymyositis