Lung Cancer and Mediastinal Masses Flashcards
(92 cards)
What is the second most common type of cancer overall?
Lung cancer. Even though it is the second most common type, it is the most common malignancy that results in death in the United States and world-wide.
What is the most common cancer to metastasize to the brain?
Lung cancer.
What is the most common risk factor for lung cancer?
Smoking. Smoking is associated with an accelerated decline in pulmonary function, and smoking cessation slows this decline. Quitting smoking not only reduces the risk for chronic obstructive pulmonary disease (COPD), but also in patients with COPD, the risk for exacerbations reduce. Long-term smokers are estimated to be at a 10- to 30-fold increased risk of developing lung cancer, with the cumulative cancer risk approaching 30% in heavy smokers versus 1% in nonsmokers. The risk for lung cancer declines with cessation of smoking, and screening can be discontinued once a patient has not smoked for 15 years. Moreover, studies have shown that individuals who have not smoked for at least 15 years have an 80%-90% reduction in lung cancer risk compared to current smokers. However, the lung cancer risk remains elevated by 10%-80% in former smokers compared to individuals who have never smoked. Smoking cessation appears to be associated with a decrease in all-cause mortality rates at any age, even in long-term heavy smokers.
What is the most common lung cancer in non-smokers?
Adenocarcinoma.
What environmental exposures increase lung cancer risk?
Radon exposure (basements), secondhand smoke, and asbestos. Also chemicals like polycyclic aromatic hydrocarbons (from burning coal or wood), nickel, and chromium.
How is lung cancer screened?
Patients 50 to 80 with a 20 pack year history of smoking (or quit smoking less than 15 years ago). Screening generally should continue through age 80. However, it may be discontinued in patients who develop other conditions that significantly limit life expectancy or the ability to tolerate aggressive therapy, especially surgery, for lung cancer.
Where is small cell lung cancer typically located?
Centrally in the lung. Small cell lung cancer tends to have bulky adenopathy.
What demographic is most commonly affected by small cell lung cancer?
Older patients with a history of smoking.
Is small cell lung cancer surgically resectable?
No, it is treated with chemotherapy and radiation.
What paraneoplastic syndromes are associated with small cell lung cancer?
- SIADH (syndrome of inappropriate ADH), which leads to hyponatremia.
- Lambert-Eaton syndrome, which causes proximal muscle weakness that improves with use.
- Ectopic ACTH production (Cushing’s syndrome).
How are the MAJOR paraneoplastic syndromes secondary to small cell lung cancer managed?
Look at the image (lol).
How is SIADH managed when it is secondary to small cell lung cancer?
The hyponatremia that arises in SIADH is secondary to the combination of water retention and the loss of sodium and potassium. In chronic SIADH, the loss of sodium is more significant than the amount of water retained. Unless there are neurologic symptoms arising from the hyponatremia, it should be corrected slowly with water restriction. Once water restriction is initiated, the plasma sodium concentration will slowly begin to normalize. An ideal rate of increase is 0.5 mEq/h. Patients must be simultaneously monitored for volume depletion as a sodium deficit may become apparent, requiring concomitant administration of salt. Water restriction (with the possible inclusion of salt administration) is the preferred means of correcting mild to moderate hyponatremia associated with SIADH.
Alternative medications:
- Furosemide lowers the urine osmolality and blunts renal response to ADH, thereby increasing water excretion. Since loop diuretics decrease NaCl reabsorption in the loop of Henle, they should be administered concomitantly with hypertonic saline or salt tablets.
- Hydrochlorothiazide may induce hyponatremia, typically within a few weeks of starting therapy. Thiazides cause the loss of both sodium and water, and when the water is better replaced than the sodium, hyponatremia ensues.
- Demeclocycline and lithium work to blunt the response of the collecting tubule cells to ADH, ultimately increasing the excretion of water. These drugs are indicated in patients with persistent severe hyponatremia when water restriction, salt intake, or loop diuretics fail to resolve the condition. Although it is potentially nephrotoxic, demeclocycline is typically preferred to lithium because it is more effective and less toxic.
What oncogene is associated with small cell lung cancer?
MYC oncogene mutation. The cancer arises from Kulchitsky cells in the basal bronchial epithelium with neuroendocrine biomarkers positive for neuron-specific enolase, chromogranin A, synaptophysin and CD56.
Small cell has early metastasis to the … ?
brain, liver, and bone.
What are the major types of non-small cell lung cancer (NSCLC)?
Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
Where is squamous cell lung cancer typically located?
Centrally in the lung, arising from the bronchus.
What radiologic feature is associated with squamous cell carcinoma?
Cavitation (usually if peripheral).
What paraneoplastic syndrome is associated with squamous cell carcinoma?
PTHrP (parathyroid hormone-related peptide) leading to hypercalcemia.
What mutation is associated with squamous cell carcinoma?
p53 mutation and P450 activation.
What is the most common type of lung cancer overall?
Adenocarcinoma. Commonly occurs with females. This type of lung cancer is common is both smokers and non-smokers and is associated with EGFR, ALK, and KRAS mutations (targetable mutations in some cases).
Where is adenocarcinoma typically located?
Peripheral lung.
What is a distinct histologic subtype of adenocarcinoma with better prognosis?
Bronchoalveolar carcinoma.
What paraneoplastic syndrome is associated with adenocarcinoma?
Hypercoagulability (DVTs, thromboembolism, and migratory thrombophlebitis).
What genetic mutations are associated with adenocarcinoma?
EGFR, KRAS, and ALK mutations. Usually stain positive for mucin.
