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17 Cards in this Set
- Front
- Back
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Lung cancer
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-most common cause of cancer deaths!
-decreasing in males -half of all cancer deaths in women -ppl get diagnosed very late -Causes: smoking, enviornmental factors, genetics |
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Smoking
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-1 ppd = 10x risk of non-smoker
-2ppd = 20x risk of non-smoker -risk after stopping decreases after 5yrs, but never decreases to the level of a lifelong non-smokers -pipe & cigar smokers have a slightly increased risk, although not equivalent to cigs -passive smok accounts for approx 2-3% of cases -damage caused by carcinogens |
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Enviornmental factors
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1. air pollution
2. arsenic 3. asbestos 4. non-neoplastic lung disease (scarring caused by things like pulmonary fibrosis, emphysema) 5. nutrition 6. radon exposure |
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Biology of lung cancer
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-Multistep carcinogenic process
-Interindividual susceptibilty differences -Activation of oncogenes (RAS, MYC) -Inactivation of tumor suppressor genes (p53, RB1) (most common cause of cancer) -Growth factors associated with cell proliferation (EGF, IGF) -Slightly increased risk in family members. |
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Pathology of lung cancer
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1. NON-SMAL CELL (NSCLC)- 80%
- Adenocarcinoma 40% - Squamous cell 30% - Large cell 2. SMALL CELL (SCLC) 20% |
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Adenocarcinoma
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-subtypes: acinar, papillary, bronchioalveolar
-most common in W, non-smokers -arises from surface epithelium, mucus glands -peripheral lesions & usually does not cavitate -assoc with scarring of lung parenchyma -bronchioalveolar may present like PNA or TB -large-cell-undifferentiated: poor prognosis |
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Squamous cells
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-smoking, more in men
-arises inproximal bronchi -perihilar masses; central lesions in proximal bronchi that may cavitate (form a little hole in tissue) -can be asymmpt. for long time -epidermoid is a subtype that recur locally (comes back where tumor was removed) |
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SCLC
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-tumor cells are small with increased necrosis
-aka Oat cell -at dx, 70% of cases have metastasized to distant sites (liver, bones, adrenal glands, pancreas, NS) -can be admixed with other cell types |
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SSX
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1. local tumor growth
2. invasion of adjacent structures 3. regional growth through lymphatic spread 4. metastatic growth through hematologic 5. remove effects for paraneoplastic syndromes |
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Bronchopulmonary symptoms
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1. cough (non-specific)- ask if they have a change in their cough (more common in squamous and small cell)-not responsive to abx
2. hemoptysis (blood tinged sputum) 3. dyspnea 4. wheezing 5. chest pain- dull intermittent |
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Extrapulmonar/intrathoracic symptoms
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1. Pancoast syndrome: shoulder and arm pain, Horner's (1 pupil constricted); tumor in the superior sulcus/apical region
2. Hoarsness 3. Pericardial effusion 4. Superior Vena Cava Syndrome- head and neck swelling distension of neck and superficial thorax veins; tumor in RUL |
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Metastatic spread of lung cancer
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1. Bone- pain (long bones), pathologic fracture
2. Spinal Cord Compression- Dejerine's sign (midline back pain when bearing down) 3. Brain- HA, seizure, personality change 4. Liver- fatigue 5. Adrenals |
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Other ssx of lung cancer
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Paraneoplastic syndrome: effects of tumor caused by proteins that mimic hormones and other substances produced in the body
1. SIADH- hyponatremia (tumor mimicing ADH) 2. Eaton-Lambert syndrome- weakness in muscles 3. Peripheral neuropathy 4. Pulmonary hypertrophic osteoarthropathy- joint pain, clubbing 5. Thrombocytosis- high plts (get lots of clots) |
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Cachexia syndrome
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-unexplained involuntary wt. loss
-dec appetite -fatigue -bitempoal wasting |
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Diagnosis of Lung cancer
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1. H&P- smoking hx, pain, wt. loss, fatigue, pulmonary exam
2. Labs- CBC, chemistry (make sure nothing going on in bones), CEA (tumor marker-not a diagnostic tool-good to monitor response to therapy) 3. Chest x-ray 4. CT scan 5. PET 6. Bronchoscopy-go in with a scope 7. Mediastinoscopy- look at mediastinal nodes, impt for staging (nodes >1cm suspicious) |
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Treatment for lung cancer
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1. Surgery: wedge resection, segmentectomy, lobectomy (remove lobe of lung), pneumonectomy, lymph node sampling
2. Radiation: SE: pneumonitis,skin can get burned, swollowing prob 3.Chemo- combination vs. monotherapy, platinum, taxanes 4. Supportive- hospice, palliative measures |
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Screening/Prevention
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1. CXR- best initial screening, can miss smaller tumors
2. Spiral CT scanning- better for small tumors, but insurance wont pay 3. Tumor markers- non diagnostic, only to follow disease 4. Pt education 5. Smoking cessation |
