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Flashcards in Lung Cancer Deck (39)
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tumor growth and clinical presentation

for a single malignant cell with a doubling itme of 3-4 months to grow to a 1 cm nodule, it would take about 7-10 years

therefore, 75% of the life history of the cancer is in the undetectable stage


major pathologic cell types of lung cancer

small cell carcinoma, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma

the latter three have overlapping clinical behaviors and are often grouped into non-small cell lung cancer (NSCLC) - 80% of all lung cancers


general characteristics of small cell lung cancer

strong relationship to cigarette smoking

only about 1% occur in nonsmokers

no known preinvasive phase or carcinoma in situ

the most aggressive of lung tumors, metastasize weidely, and are virtually incurable by surgical means


genes frequently mutated in small cell lung cancer

p53 and RB1 tumor suppressor genes

high levels of anti-apoptotic protein BCL2

low frequency of expression of the pro-apoptotic protien BAX


presentation of small cell lung cancer

central mass and lymphadenopathy

highly sensitive to chemotherapy and radiation initially - patient starts to deteriorate after 6-9 months

limited stage - lymph nodes and mass encopassable in one radiographic port

extensive stage - everything else


treatment for SCLC

LS (1/3) -> radiation/chemotherapy

ES (2/3) -> chemotherapy


T component of TNM staging

The ‘T’ component reflects the tumor size and invasiveness. T values range from 0 to 4; T0 indicates no evidence of primary tumor, while T4 indicates extensive extrapulmonary extension.


N component of TNM staging

The ‘N’ component indicates the absence or presence and extent of regional lymph node metastasis. N values range from 0 to 3; N0 indicates no regional lymph node metastasis, while N3 indicates metastasis to contralateral hilar and ipsilateral and contralateral supraclavicular/scalene lymph nodes.


M component of TNM staging

The ‘M’ component defines the absence or presence of tumor spread to distant lymph nodes or organ sites. M values range from 0 to 1; M0 disease indicates no distant metastasis, while M1 indicates the presence of distant metastasis.


strategies for screening lung cancer

chest x-rays

sputum analysis

CT scans


advantages of lung cancer CT screening

increases detection of early-stage lung cancer

improves lung-cancer specific and overall mortality in a high risk population

most realistic strategy or improving lung cancer mortality


disadvantages of lung cancer CT screening

high positive rate

benefits may not extrapolate to lower risk populations

long-term risk of repetitive radiation exposure



Stage I and treatment

tumor of any size is found only in the lung

treatment - surgery


Stage II and treatment

tumor has spread to lymph nodes associated with the lung



Stage IIIA and treatment

tumor has spread to the lymph nodes in the tracheal area, including chest awall and diaphragm

combination of surgery, radiation, and chemotherapy


Stage IIIB and treatment

tumor has spread to the lymph nodes on the opposite lung or in the neck

combination of chemotherapy and radiation


Stage IV and treatment

tumor has spread beyond the chest

chemotharapy and/or palliative (maintenance) care


criteria for surgery in stage I/II NSCLC

predicted FEV1 after pneumonectomy is 1.2L

patient is not hypercapnic

patient does not have cor pulmonale


adjuvant therapy

treatment to keep cancer from returning

patients with resectable disease are the only group likely to be cured of their cancer


pulmonary manifestations of lung cancer

cough from endobronchial erosion and irritation


chest pain


postobstructive pneumonia or pneumonitis

large tumors may cavitate and present as lung abscesses


pulmonary manifestatiosn of centrall located lung tumors





chest pain in the central location


manifestations of intrathoracic disease

hoarseness from invasion of the recurrent laryngeal nerve and resultant vocal cord paralysis

dysphagia as a result of esophageal compression

superior vena cava syndrome

shoulder arm pain from superior sulcus due to local extension of a tumor in the apex of the lung that compresses the nerves

ipsilateral Horner syndrome


superior vena cava syndrome

characterized by plethoric apperance, distension of the venous drainage of the arm and neck, edema of the face, neck and arms

collateral venous drainage may also form

dilated veins over anterior chest


ipsilateral Horner syndrome

characterized by ptosis, meiosis, and anhydrosis due to paravertebral extension and sympathetic nerve involvement of the tumors



paraneoplastic syndromes as a result of lung cancer

cytokin-mediated responses to antigens from the intrathroacic lung tumor rather than the result of distant spread of cancer

manifestations of clubbing, hypertrophic osteoarthropathy, and neurologic and hormonaal abnormalities


mainfestations of extrathoracic disease in lung cancer

most common are anorexia, weight loss, and fatigue

bone pain accompanies mets tot he bone

CNS involvement is low with cancer that has not spread to the lymph

patients with signs of mediastinal or distant involvement, the risk of occult brain mets increases

the adrenal gland is the most frequent site of distant mets of lung cancer


treatment paradigms for advanced NSCLC

2-drug platinum-based chemotherapy improves survival and quality of life in patients iwht good PS

chemo is better than supportive care

2 drugs better than 1 drug

3 drugs not better than 2 drugs

treatment should be limited to 4-6 cycles of chemo


hallmarks of cancer

self-sufficiency in growth signals

insensitiveity to antigrowth signals

tissue invasion and metastasis

limitless replicative potential

sustained angiogenesis

evading apoptosis


targeted therapy in oncology

goal is to identify anti-tumor agents that target tumor-specific molecules and spare normal cells


ideal targeted therapy drug target

drives tumor growth

turns on key mechanisms of cancer progression

reversible by inhibition

dispensable in normal cells

target is measureable in tumor tissue used for diagnosis