Lung Cancer Flashcards
(25 cards)
Major Risk Factors
- 3 major: cigarette smoking***, radon, and asbestos
- air pollution, family history of lung cancer, previous lung diseases (COPD, lung fibrosis, previous head/neck cancer)
Patients present with what symptoms?
- nonspecific: cough (specifically, a change in the cough), hemoptysis, dyspnea, hemoptysis, chest pain, weight loss, fatigue
- wheeze and stridor are UNcommon
Causes of Benign “Coin Lesions”
- granulomas (due to TB or fungi)
- bronchial hamartoma (disorganized mass of normal lung tissue and cartilage)
Small Cell Lung Carcinoma (SCLC)
- 15% of lung cancers
- neuroendocrine cells
- extremely aggressive and metastatic early on
- not amenable with surgical resection, so use chemo
- male smokers
- central
Non-Small Cell Lung Carcinoma (NSCLC)
- 85% of lung cancers
- may be treated with surgical resection
Adenocarcinoma (AC)
- makes up 40% of NSCLCs; most common lung cancer
- nonsmokers and female smokers
- peripheral
- look for glands and mucin production
Squamous Cell Carcinoma (SCC)
- makes up 30% of NSCLCs
- male smokers
- central
- look for keratin pearls and intercellular bridges
Large Cell Carcinoma
- makes up 10% of NSCLCs
- no defining characteristics (so if we don’t see signs of AC and SCC)
- peripheral
Carcinoid Tumor
- makes up 5% of NSCLCs
- well differentiated neuroendocrine cells
- chromogranin positive
- classically forms a polyp-like mass in the bronchus
Paraneoplastic Syndromes of SCLC
- Cushings Disease via ACTH secretion
- hyponatremia (low sodium in blood) via ADH secretion (SIADH = Syndrome of Inappropriate Antidiuretic Hormone)
- Eaton-Lambert Syndrome via antibody secretion
Eaton-Lambert Syndrome
- autoimmune disorder where antibodies target pre-synaptic voltage gated calcium channels
- results in muscle weakness of the limbs
Paraneoplastic Syndromes of SCC
- Hypercalcemia via PTHrP secretion (parathyroid hormone)
Paraneoplastic Syndromes of AC
- Clubbing and HPOA (Hypertrophic Pulmonary Ostio Arthritis)
- HPOA = new bone growth (mainly in wrists and ankles), very painful, often mis-diagnosed as arthritis (it differs because it is usually symmetrical)
Bronchio-Alveolar Carcinoma (BAC)
- AKA adenocarcinoma in situ (a sub-type of AC)
- columnar cells grow along the bronchioles and alveoli
- involves Clara cells (club cells)
- resembles pneumonia on CXR (differentiate because patients with BAC are not septic)
What are the most common sources of metastatic lung disease?
- breast and colon carcinomas (followed by stomach, pancreas, prostate, and genital tract)
- metastatic lung cancer is more common than primary lung cancer
Horner Syndrome
- results from sympathetic ganglion invasion
- enophthalmos (posterior displacement of eye), ptosis (droopy eyelid), miosis (pin-point pupil), and anhidrosis (loss of sweating)
- symptoms are unilateral to the affected side/nerve
Pancoast Tumor
- apical lung tumor that invades the sympathetic plexus
- results in pain in the ulnar nerve region and Horner syndrome
Where do lung cancers tend to spread hematogenously?
- adrenal gland > bone, brain, liver,
Typical Route of Spreading Lung Cancer
- primary tumor –> hilar lymph nodes –> mediastinal lymph nodes –> rest of body
If you don’t smoke and get lung cancer, what type will you get?
- Adenocarcinoma
SVC obstruction
- most common in SCLC because of its rapid and bulky growth
- SVC syndrome: head and neck pain, facial swelling, upper limb edema, collateral vein formation
What would cause hoarseness?
- interference with the recurrent laryngeal nerve
What would cause diaphragmatic paralysis?
- interference with the phrenic nerve
Staging of SCLC (and what defines each stage)
- limited disease (33%) or extensive disease (66%)
- limited = in one side of thorax and is within one tolerable radiation field
- extensive = everything else
