Ipapburke Pulm Test 2- Neoplasms

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MOST IMPORTANT CAUSE OF LUNG CANCER IN US

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SMOKING

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FACTORS OTHER THAN SMOKING THAT CONTRIBUTE TO LUNG CANCER

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IONIZING RADIATION, ASBESTOS, HEAVY METALS, INDUSTRIAL CARCINOGENS

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AGE AT ONSET OF LUNG CANCER

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NORMALLY 50-70; FEW ARE BELOW 40

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FOUR MAJOR TYPES OF BRONCHOGENIC CARCINOMA

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SQUAMOUS CELL CARCINOMA, ADENOCARCINOMA, SMALL CELL (OAT CELL) CARCINOMA, AND LARGE CELL CARCINOMA

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TWO MOST COMMON BRONCHOGENIC CARCINOMAS

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SQUAMOUS CELL AND ADENOCARCINOMA (30-35% OF PRIMARY TUMORS EACH)

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WHERE DO SQUAMOUS CELL CARCINOMAS ORIGINATE?

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IN CENTRAL BRONCHI AS INTRALUMINAL GROWTH

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WHY IS IT POSSIBLE TO DETECT SQUAMOUS CELL CARCINOMA EARLY FROM SPUTUM CYTOLOGY?

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BECAUSE IT TENDS TO ORIGINATE IN CENTRAL BRONCHI AS INTRALUMINAL GROWTH

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WHERE DOES SQUAMOUS CELL CARCINOMA METASTASIZE TO?

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REGIONAL LYMPH NODES

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THIS TYPE OF BRONCHIOGENIC CARCINOMA OCCASIONALLY CAVITATES

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SQUAMOUS CELL

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WHERE DOES SMALL CELL CARCINOMA OCCUR?

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CENTRALLY AND TENDS TO NARROW BRONCHI BY EXTRINSIC COMPRESSION

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WHERE DO SMALL CELL CARCINOMAS MET?

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WIDESPREAD MET IS COMMON

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WHAT IS THE PROGNOSIS IN SMALL CELL CARCINOMA?

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UNTREATED 6 TO 17 WEEKS; TREATED 40-70 WEEKS

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THESE TWO CARCINOMAS USUALLY APPEAR IN PERIPHERY AND MET TO DISTANT ORGANS?

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ADENOCARCINOMA AND LARGE CELL

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WHERE DO LARGE CELL CARCINOMAS MET?

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TO DISTANT ORGANS

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WHERE DO ADENOCARCINOMAS ORIGINATE?

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IN THE PERIPHERY

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SIGNS AND SYMPTOMS OF CARCINOMAS

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OFTEN ASYMPTOMATIC; USUALLY NON SPECIFIC COMPLAINTS SUCH AS WEIGHT LOSS, POOR APPETITE, COUGH, DYSPNEA, HOARSENESS, AND HEMOPTYSIS; PE MAY BE NORMAL; CXR MAY OR MAY NOT SHOW LESIONS; MAY HAVE HEPATOMEGALY OR LYMPHADENOPATHY

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PANCOAST'S TUMOR

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TUMOR OF THE SUPERIOR SULCUS (AT THE EXTREME APEX OF THE LUNGS)

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PAIN FELT IN PANCOAST'S TUMOR

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SEVERE UNREMITTING PAIN IN THE LOWER PART OF THE SHOULDER AND INNER ASPECT OF THE ARM; YOU WILL SEE SENSORY LOSS AND WASTING OF SMALL MUSCLES DISTALLY

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IF THERE IS FURTHER NEUROLOGICAL INVOLVEMENT IN PANCOAST'S, WHAT CAN IT PROGRESS TO?

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HORNER'S SYNDROME WHICH IS CAUSED BY NERVE DESTRUCTION

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S/S OF HORNER'S SYNDROME IN CONJUNCTION W/ PANCOAST'S

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MIOSIS, PTOSIS, ENOPHTHALMOS, AND LOSS OF SWEATING ON AFFECTED SIDE

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WHAT IS MIOSIS?

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CONSTRICTION OF THE PUPIL OF THE EYE, RESULTING FROM A NORMAL RESPONSE TO AN INCREASE IN LIGHT OR CAUSED BY CERTAIN DRUGS OR PATHOLOGICAL CONDITIONS

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ENOPHTHALMOS

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POSTERIOR DISPLACEMENT OF THE EYE

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CUSHING'S SYNDROME, SIADH, HYPERCALCEMIA, GYNECOMASTIA, CLUBBING OF THE FINGERS, NEUROPATHIES, THROMBOPHLEBITIS, ENDOCARDITIS, ANEMIA, DIC, AND SKIN LESIONS ARE EXAMPLES OF WHAT TYPE OF CONDITIONS

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PARANEOPLASTIC SYNDROMES

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WHAT ARE PARANEOPLASTIC SYNDROMES?

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NON LUNG SYNDROMES SEEN AS A RESULT OF LUNG TUMORS

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HYPONATREMIA IS A KEY FEATURE IN WHAT CONDITION

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SIADH

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WHAT IS SIADH?

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INCREASED ADH CAUSES WATER TO BE RETAINED. THERE IS EXTRACELLULAR FLUID VOLUME EXPANSION WITHOUT EDEMA OR HYPERTENSION, WHICH LEADS TO NATRIURESIS

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WHAT IS NATRIURESIS?

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RETENTION OF WATER AND PASSING OF SODIUM IN URINE

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WHAT S/S ARE SEEN IN SIADH WHEN IT IS SEVERE OR ACUTE IN ONSET?

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SYMPTOMS OF CEREBRAL EDEMA- IRRITABILITY, CONFUSION, SEIZURES,AND COMA

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S/S IN SIADH

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HYPONATREMIA, CONCENTRATED URINE, NO SIGNS OF EDEMA OR DEHYDRATION

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WHAT DOES SUPERIOR VENA CAVA OBSTRUCTION FROM A TUMOR CAUSE?

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PROGRESSIVE OBSTRUCTION OF VENOUS DRAINAGE OF HEAD, NECK, AND UPPER EXTREMITIES

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WHAT DOES TUMOR DESTRUCTION OF THE PHRENIC NERVE CAUSE?

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PHRENIC NERVE PALSY RESULTING IN HEMIDIAPHRAGM PARALYSIS

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WHAT DOES TUMOR DESTRUCTION OF THE RECURRENT LARYNGEAL NERVE CAUSE?

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PALSY RESULTING HOARSENESS

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WHAT IS THE LAB WORKUP FOR ALL SUSPECTED CANCER PATIENTS?

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CBC, LFT'S, LYTES WITH CALCIUM; CXR WHICH WILL NORMALLY BE ABNORMAL

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WHAT IS THE DEFINITIVE DIAGNOSIS FOR LUNG CANCER?

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CYTOLOGY

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METHODS FOR OBTAINING CYTOLOGY

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FROM PLEURAL FLUID, NEEDLE BIOPSY, LYMPH NODE BIOPSY, BIOPSY OF OTHER METASTATIC SITES, OPEN THORACOTOMY, AND DIRECT VISUALIZATION TAKING A BIOPSY BY BRONCHOSCOPY

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WHAT IS ESSENTIAL IN DETERMINING STAGING, TREATMENT, AND PROGNOSIS IN LUNG CANCER

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THE SPECIFIC TYPE OF CANCER

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IMPORTANCE OF RADIOGRAPHS IN LUNG CANCER

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COMPARISON OF OLD AND NEW CXR INVALUABLE B/C PRIMARY LUNG CANCER OFTEN CREATES SUBTLE AND NONSPECIFIC ABNORMALITIES

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WHAT IMAGES ARE OFTEN HELPFUL IN STAGING OF LUNG CANCER?

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CT SCANS AND MRIS

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WHAT IMAGES ARE USEFUL IN DIAGNOSIS OF LUNG CANCER?

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CT SCANS, ULTRASOUNDS, AND MRI AS WELL AS THE ORIGINAL CXR

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WHAT IS STAGING?

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ESTABLISHING HOW ADVANCED A LUNG CANCER IS ONCE IT IS DIAGNOSED

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HOW IS STAGING OF NON SMALL CELL CARCINOMAS DONE??

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BY TNM SYSTEM (T-TUMOR, N- NODAL INVOLVEMENT, M-DISTANT METASTASES)

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HOW ARE SMALL CELL CARCINOMAS STAGED?

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AS LIMITED AND EXTENSIVE, DUE TO THEIR EARLY MET AND THE FACT THAT MOST ARE METASTATIC BEFORE THEY ARE DETECTED

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TREATMENT OPTIONS FOR LUNG CANCER

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SURGERY, CHEMOTHERAPY, AND RADIATION THERAPY

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TREATMENT OF CHOICE FOR NON SMALL CELL CARCINOMAS

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SURGERY, BUT BECAUSE OF METASTASIS OR POOR PATIENT HEALTH, ONLY 25% ARE ELIGIBLE FOR SURGERY

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WHAT TESTS MUST BE DONE BEFORE LUNG RESECTION AND WHY?

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MUST HAVE PFTs AND ABGs SO THAT WE KNOW THEIR PULMONARY STATUS BEFORE WE START REMOVING PARTS OF LUNGS

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WHAT IS A S/P PNEUMONECTOMY?

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REMOVE ENTIRE LUNG

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WHAT IS THE TREATMENT OF CHOICE FOR SMALL CELL CARCINOMA?

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COMBINATION OF CHEMOTHERAPY AND RADIATION; USUALLY AIMED AT PALLIATIVE RATHER THAN CURATIVE CARE

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PROGNOSIS FOR LUNG CANCER

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OVERALL 5 YEAR SURVIVAL RATE IS 10-15%

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MAJOR FACTORS IN PROGNOSIS OF LUNG CANCER

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CELL TYPE, AGE, AND GENERAL HEALTH

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SQUAMOUS CELL SURVIVAL WITH RESECTION DOES __________ THAN ADENOCARCINOMA OR LARGE CELL

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BETTER

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THESE PATIENTS RARELY LIVE FIVE YEARS PAST DIAGNOSIS

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SMALL CELL

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WHAT IS A SOLITARY PULMONARY NODULE?

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SINGLE ROUND OR OVAL SHARPLY CIRCUMSCRIBED PULMONARY LESION, UP TO 3 CM, SURROUNDED BY NORMAL LUNG TISSUE

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ARE SOLITARY PULMONARY NODULES MALIGNANT OR BENIGN?

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CAN BE EITHER---BENIGN CAN BE FROM FUNGAL INFECTIONS, TB, OR BENIGN TUMORS

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COMPARISON WITH OLD CHEST XRAYS IS DONE WITH SOLITARY PULMONARY NODULES TO ACCOMPLISH WHAT?

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TO DATE THE LESION AND ESTABLISH STABILITY

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SECONDARY LUNG CANCERS DO WHAT?

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THEY ARE CANCER FROM OTHER LOCATIONS THAT MET TO THE LUNG AND PULMONARY LYMPH SYSTEM, AND CAN CAUSE PLEURAL EFFUSIONS OR EMBOLISM