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25 Cards in this Set
- Front
- Back
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Lung cancer: epidemiology
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Second largest number of US cancer cases (second to prostate in men and breast in women)
Largest percentage of cancer deaths Highly associated with tobacco use. Also associated with radon and industrial pollution (asbestos) |
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Lung cancer screening
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Beginning at age 55 with ≥ 30 pack year history of smoking
Computertomogram (CT) |
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Lung cancer: clinical presentation
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Local symptoms
-cough, wheezing, hemoptysis -dyspnea, stridor -obstructive pneumonitis, atelectasis -superior vena cava syndrome -chest wall pain, pleuritic pain General Symptoms -decreased appetite, weight loss, fatigue Symptoms secondary to distant metastatic disease -bone pain, CNS symptoms |
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Horner's syndrome
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Ptosis, Miosis, Anhidrosis
From a pancoast tumor in the superior sulcus of lung |
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Superior vena cava syndrome
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Swelling in head
Blood draining from face and arms tries to reach inferior vena cava -Venous engorgement in chest wall |
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Lung cancer: symptoms and signs
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Subjective History/Symptoms
-Family history -Smoking history -Change in cough -Hemoptysis -Chest pain -Recurrent/refractory infections -Environmental exposures -Hoarseness Objective Signs -Airway obstruction -Pneumonia -Atelectasis -Recurrent laryngeal nerve palsy -Superior vena cava syndrome -Pleural or pericardial effusions |
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Lung cancer: imaging, lab, and pathology tests
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Imaging:
-CXR -CT -PET -Brain MRI Lab -CBC w/ dif -Serum calcium -AST -Alkaline phosphatase -LDH Pathology -Sputum cytology x3 -Bronchoscopy -FNA |
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Small cell paraneoplastic syndrome
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Inappropriate ADH secretion
Ectopic ACTH production Gynecomastia Lambert-Eaton Syndrome Leukocytosis or thrombocytosis Hypercoagulable disease |
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Large cell paraneoplastic syndrome
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Hypertrophic pulmonary osteoarthopathy
Hypercalcemia Leukocytosis or thrombocytosis Hypercoagulable disease Gynecomastia |
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Squamous cell paraneoplastic syndrome
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Hypercalcemia
Leukocytosis or thrombocytosis Hypercoagulable disease Hypertrophic pulmonary osteoarthopathy |
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Adenocarcinoma paraneoplastic syndrome
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Hypertrophic pulmonary osteoarthopathy
Leukocytosis Hypercoagulable disease |
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Lung cancer common metastatic site
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Draining lymph nodes (CT)
Liver (CT) Adrenals (CT) Bone (PET) Brain (MRI) |
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Lung cancer prognostic factors
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Age
Physical strength - performance status Weight loss < 5% versus > 10% Metastatic sites (number, location) TNM (tumor/node/metastasis) stage |
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Non-small cell lung cancer: stage at diagnosis
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Stage IV (40%)
Stage IIIB (15%) Stage IIIA (15%) Stage II (20%) Stage I (10%) ~70% diagnosed at advanced stage. This is why it is so fatal |
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NSCLC: Stages I and II treatment
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Surgical resection (lobectomy is most common)
Adjuvant chemotherapy for stage II |
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NSCLC: Stage III treatment
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Combined modality treatment program including surgery, radiation, and chemotherapy
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NSCLC: Stage IV treatment
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Palliative chemotherapy
Best supportive care |
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Small cell lung cancer: epidemiology
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<15% of all patients with lung cancer have SCLC
Most tightly linked to smoking Most aggressive lung cancer type Median Survival without treatment = 2-4 months Responsive to chemotherapy and radiation |
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Small cell lung cancer: prognostic factors
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Sex (females do better than males)
Performance Status Stage (limited versus extensive) LDH |
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Small cell lung cancer: stage at diagnosis
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One third limited stage (stage I-III)
Two thirds extensive stage (stage IV) |
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SCLC: limited disease vs extensive disease
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Limited:
Radiation field -Ipsilateral lymph nodes up to supraclavicular Extensive: Metastases Pleural effusion |
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SCLC: role of surgery
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Only indicated for single pulmonary nodule without lymph node or distant metastasis
Patients with surgically resected tumors benefit from adjuvant chemotherapy |
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SCLC: limited stage treatment
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Chemotherapy concurrent with thoracic radiation therapy
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SCLC: extensive stage treatment
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Chemotherapy
Radiation to special sites (i.e., brain metastases, painful bone metastases, spinal cord compression) |
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SCLC: prophylactic cranial irradiation
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In patients with SCLC that has responded to chemotherapy with or without thoracic radiation
Increases brain metastasis-free interval Increases disease free survival Reduces mortality Increases overall survival |
