Lung Malignancy

Question 1

most common cancers

Answer 1

men - prostate

female - breast

2nd is lung for both

Question 2

most common cancer that causes death

Answer 2

lung cancer - 25%

Question 3

gender predilection of lung cancer

Answer 3

more in males

Question 4

types of lung cancer

Answer 4

non-small cell - 85%

small cell - 15%

Question 5

lung cancer c worst prognosis

Answer 5

small cell

adenocarcinoma

squamous cell

Question 6

non-small cell cancer subtypes

Answer 6

adenocarcinoma - 40%

squamous cell - 25%

large cell - 25%

others - 20%

not specified - 5%

Question 7

compare stage 1 lung cancer to advanced

Answer 7

1 - confined to certain spot

advanced - metastatic na

Question 8

pathology of lung cancer

Answer 8

tumors sa epithelium - bronchi, bronchioles and alveoli

Question 9

4 major cell types of lung cancer according to WHO

Answer 9

squamous cell

small cell

adenocarcinoma

large cell

Question 10

discuss small cell lung CA

Answer 10

scant cytoplasm - small hyperchromatic nuc c fine chromatin

indistinct nuc

has neuroendocrine properties

more gene mutations but responsive to chemo and radiation

most relapse and becomes worse

Question 11

discuss non-small cell lung CA

Answer 11

abundant cytoplasm - pleomorphic nuc c coarse chromatin

prominent nuc

no nueroendocrine properties

fewer gene mutations - less aggresive

more local so better prog

Question 12

etiology of lung cancer

Answer 12

85% from smoking and 15% not

smokers in past 10 yrs or passive - women

inc c more pack yrs

environment, pollution and genetics

Question 13

etiology of adenocarcinoma

Answer 13

lifetime non smokers

women

< 45 yo

Question 14

general clinical manifestaitons

Answer 14

local tumor growth

invasion or obstruction of structures

growth in lymph nodes

growth in distant sites via BF

remote effects - paraneoplastic syndrome

5-15% asymptomatic

cough, pain in chest or back

Question 15

central or endobronchial growth

Answer 15

sa mga bronchioles or alveoili ba

cough

hemoptysis

wheeze and stridor

dyspnea

postobstructive pneumonitis

Question 16

peripheral growth

Answer 16

pain from chest wall or pleura

dyspnea - restrictive

lung abscess from tumor cavitation

Question 17

growth in thorax

Answer 17

tracheal obstruction

esophageal compression - dysphagia

laryngeal nerve paralysis

phrenic nerve paralysis - elevation and dyspnea

SY nerve paralysis - horner’s syndrome

Question 18

horner’s syndrome

Answer 18

enophthalmos - eye depressed into socket

ptosis - drooping

miosis - uneven pupil opeing

ipsi anhidrosis

Question 19

malignant pleural effusion

Answer 19

lead to dyspnea kasi compress lungs di maka expand

Question 20

pancoast’s syndrome

Answer 20

superior sulcus tumor - apex of lung and C8-T2 nerves

shoulder pain that that radiates to ulnar distribution

c destruction of 1st and 2nd ribs

can exist c horner’s

Question 21

superior vena cava syndrome

Answer 21

impingement of SVC by tumor

wala venous return from head, UE, neck and torso

plethora

distended neck veins and ant chest veins

Question 22

pericardial or cardiac extension

Answer 22

tamponade - too much fluid cant pump

arrhythmia

cardiac failure

Question 23

lymphatic obstruction

Answer 23

pleural effusion since tumor can obstruct lymphatic flow

fluid seeps out to lungs or heart

Question 24

LYMPHANGITIC spread though lunfs

Answer 24

hypoxemia and dyspnea

Question 25

extrathoracic metastatic disease

Answer 25

> 50% c squamous carcinoma 80% of adenocarcinoma and large cell > 95 % of small cell basta may BF pwede mag spread dun

Question 26

brain metastases

Answer 26

worse that could happen HA nausea and vomiting neuro deficits seizures

Question 27

bone metastases

Answer 27

bone eaten by cancer cells pain pathologic fx SCI

Question 28

bone marrow invasion

Answer 28

develop another cancer and anemia cytopenias Leukoerythroblastosis

Question 29

liver metastases

Answer 29

most diff site to handle liver dysfunction biliary obstruction anorexia pain - most diff to handle in stage 4

Question 30

lymph node metastases

Answer 30

supraclavicular region alw check axilla and groin for lymph nodes

Question 31

spinal cord compression

Answer 31

cancer eats vertebral bones epidural metastases bone metastases

Question 32

adrenal metastases

Answer 32

common but rarely cause pain or insufficiency unless super laki

Question 33

paraneoplastic syndromes

Answer 33

common in SCLC mimics metastatic disease presenting or first sign of recurrence anorexia cachexia weight loss fever suppresed immunity

Question 34

enodcrine syndromes

Answer 34

12% of patients hypercalcemia and hypophosphatemia, PTH brittle bones hyponatremia c SIADH atrial natriuteric factor and ectopic secretion by small cell

Question 35

skeletal connective tissue syndromes

Answer 35

clubbing - NSC hypertrophic pulmonary osteoarthroplasty - adenocarcinoma psin and tenderness over affective bones

Question 36

nuerogenic myopathic syndromes

Answer 36

only 1% myasthenic LEMS and retinal blindness in SC peripheral neuropathies, subacute cerebellar degen, cortical degen and polymyosistis in all types

Question 37

coagulation, thrombotic and hematologic manifestations

Answer 37

1-8% trousseau's - migratory venous thrombophlebitis nonbacterial thrombotic endocarditis c arterial emboli disseminated intravascular coagulation c hemmorrhage, anemia, granulocytosis and leukoerythroblastosis

Question 38

cutaneous manifestations

Answer 38

1% dermatomyositis acanthosis nigricans

Question 39

renal manifestations

Answer 39

1% nephrotic syndrome glomerulonephritis

Question 40

dx for cancer

Answer 40

CXR - mc CT scan MRI PET scan radionuclide scan biopsy screening

Question 41

discuss staging lung cancer

Answer 41

lower better prog last stages are worse

Question 42

T1 tumor

Answer 42

≤3 cm, surrounded by lung or pleura no tumor more proximal than lobe bronchus

Question 43

T2 tumor

Answer 43

>3 cm involving main bronchus ≥ 2 cm distal to carina invading pleura; atelectasis or pneumonitis extending to hilum but not entire lung

Question 44

N1

Answer 44

ipsilateral peribronchial or hilar nodes and intra, pulmonary nodes by direct extension

Question 45

T3 tumor

Answer 45

chest wall, diaphragm, mediastinal pleura, pericardium, main bronchus <2 cm distal to carina; atelectasis or pneumonitis of entire lung

Question 46

N2

Answer 46

ipsilateral mediastinal or subcarinal nodes

Question 47

N3

Answer 47

contralateral (lung) nodes or any supraclavicular node

Question 48

T4

Answer 48

mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; separate tumor nodules; malignant pleural effusion Distant metastasis

Question 49

tx for cancer

Answer 49

chemo radio surgical resection palliative care