Lung Cancer Flashcards Preview

Respiratory 2 > Lung Cancer > Flashcards

Flashcards in Lung Cancer Deck (26):
1

Risk factors

Smoking if most importnat

15 years of non-smokers, risk declines to twice that of non smokers

Weaker link for non-cigarette smoking n

2

Chronic cough

Seen more in squamous and small cell carcinomas

New cough in a smoker without clinical signs of pneumonia should raise suspicion for lung cancer

3

Hemoptysis

Most common cause is bonchitis

In smokers iwth lack of infectious sx, warrants airway insepection via bronchoscopy

4

Chest pain

Generally dull, aching non-resolivng on the same side as the cancer

PLeuritic sharp pain may be present if direct pleural metastasis, post-obstructive pneumonia, or PE

5

Hoarseness, dyspnea, wheezing

In smokers, indication of cancer...from involvement of laryngeal nerve

Dyspnea - could be due to anything

Wheezing - unilateral should rasie suspicion of mass in approrpitate setting of lung cancer

6

Pleural involvement

Malignant pleural effusions are considered metastatic and managed palliatively

Not ALL effusions are malingnat (post-obstructive pneumonits, lymph obstruction, atelectasis)

7

Malignant effusions

Typically exudative

high protein/LDH
Lymphocytic predominant
Hig hin eosinophils

Must confirm - may need to perform 2 or 3 to increase the yield (surgical thorascopy or medical pleuroscopy)

8

SVC syndrome

More common in SCLC than NSCLC

Sx generally resolve after tx of tumor

Radiograph shows widening of mediastinum or right hilar mass

Fullness in head, couhld hae trouble swallowing

Dilated neck veins, prominant venous pattern on chest, facial edema, plethoric appearance

9

Pancoast tumor

Pain in the shoulder

Superior sulcus tumor

Ptosis, myosis, anhydrosis

Bondy destruction and atrophy of hand muscles

Pancoast most commonly caused by NSCLC (squamous cell)

10

Extra-throacic

Liver (LFT elevation)

Bone (pain, elevated serum alkaline pohspatase)

Adrenals

Brain

11

Hypercalcemia

PTH, calcitrol, osteoclst acctivating factors

Anorexia, polyuria, dispsi, dehydration

Tx with hydration and bisphosphonates

12

SIADH

Causes hyponatremia

Anorexia, cerebral edema

Tx - chemo, saline, fluid restriction, demeclocycline, vasopressin-receptor antagonist

13

Cushings

ACTH production

Muscle weakness, weight loss, HTN, hypokalmeic alkalosis

SCLC and carcinoid tumors

14

Hypertrpohic osteoarthropathy

Clubbing and periosteal proliferation of tubular bones

Symmetrical and painful arthropathy

Sx may resolve after tumor resection..NSAIDs or bisphosphonates

15

Hematologic complications

May see leukocytosis

Thrombocytosis

Trousseaus syndrome - hyper coag...big one causing DVTs

16

Dermato and polymyosistis

Muscle weakness, rash, gottron papules

17

Neurologic

Typically with SCLC

Lambert-eaten

Mostly immune mediated with presence of ABs

18

Lambert eaton

Most common
AutoABs against presynaptic calcium channels

Symmetrical slowly progressive proximal muscle weakness...muscle use IMPROVES

19

Screening

Low dose CT scan in high risk individuals

NOdules<3cm
Mass>3cm

Mediastinal lesions - LAP

Extra-pulm lesions - metastasis

20

What makes a nodule concerning

At end of vascular bundles, peripheral, or varying size

21

Nodule characteristics

Size, rate of grwoth, calcification, location (upper and middle lobe location)

22

Risk of nodule and dx

Low - monitor with serial imaging

Intermediate - may want PET scan

High - biopsy

23

PET scan

Best above 8-10 mm in size

Higher activity in cancer

24

Biopsy options

Bronchoscopy - low risk of pneumothorax, best for parenchymal lesions and lymph nodes

CT guided FNA - higher risk of pneumothorax...best for pleural based

Surgical - highest risk of comps, best specificity, and gold std

25

Small cell lung cancer staging

LImited 0 confined to hemithorax or orogin, mediatinum or supraclavicular nodes

Extensive-stage dz - beyond supraclaviculsr areas or distant

26

SCLCA tx

Platinum based alkylating agent (cytopenia, renal failure, neuropathy)...cisplatin and carboplatin

Topoisomerase inhibs (cytopneia, secondary cancer)...irinotecan and etoposide