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126 Cards in this Set
- Front
- Back
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Etiology of Lung Cancer
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*tobacco smoking
*can be initiated in scarred area of lung from prior inflammatory process (usually adenocarcinoma) *air pollution and genetics are likely involved, but have a difficult to define role |
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Occupational Hazards for Lung Cancer
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*asbestos
*uranium radiation *radon exposure *coal tar fumes *petroleum *chromates *nickel *arsenic *mustard gas |
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Male to Female Ratio for Lung Cancer Diagnoses
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1.2:1, was 6:1 in 1950
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Peak Age at Diagnosis of Lung Cancer
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55-65 years
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Ranking of Lung Cancer
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*second to breast and prostate cancers in incidence
*leading cause of cancer deaths |
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Estimated Number of Lung Cancer Diagnoses in 2007
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*213,380
*114,780 men *98,620 women |
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Estimated Number of Lung Cancer Deaths in 2007
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160,390
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Signs and Symptoms of Lung Cancer
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*cough most common symptom
*hemoptysis *wheezing *dyspnea *hypoxemia *chest pain *hoarseness *unexplained weight loss *dysphagia *weakness *anorexia *malaise |
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Means By Which Lung Cancer Signs and Symptoms Arise
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*local tumor growth
*invasion of adjacent structures *distant metastatic sites *paraneoplastic syndromes |
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Superior Vena Cava Compression Syndrome
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enlargement of the neck with venous distention caused by compression or invasion of the superior vena cava
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Pancoast's Syndrome
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apical tumors cause shoulder pain radiating to the arm along the ulnar nerve as a result of cervical and thoracic nerve involvement
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Horner's Syndrome
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*enophthalmos (backward displacement of the eye)
*ptosis (eyelid droop) *ipsilateral loss of sweating *hoarseness as a result of recurrent laryngeal nerve involvement and paralysis |
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Number of Patients Who Develop Paraneoplastic Syndromes
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2%
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Ways to Diagnose Lung Cancer
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*chest x-ray (simplest, but cannot see most tumors until seven months after symptoms begin)
*CT *MRI *angiography *sputum cytology *bronchoscopy |
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Methods to Stage Lung Cancer
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*TNA (transthoracic needle aspiration) indicated when a diagnosis of a centrally located small-cell carcinoma has been made
*pulmonary function tests and cardiac evaluation can determine whether a patient can be treated with surgery or radiation therapy *CBC *liver function tests |
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Origination of Histology for Lung Cancers
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all histologic types thought to originate from the basal cells of the bronchal epithelium
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Categories of Lung Carcinomas
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*Small Cell Lung Carcinomas
*Non-Small Cell Lung Carcinomas |
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Location of Small Cell Lung Carcinomas
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80% are centrally located
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Features of Small Cell Carcinoma
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*rapid growth rate
*usually fatal progression *commonly associated with paraneoplastic syndromes |
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Sites of Common Metastasis for Lung Cancer
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*brain
*adrenals *liver *lung *skeleton *kidney |
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Types of Lung Cancer with Highest Incidence of Distant Metastasis
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*oat cell carcinoma
*adenocarcinoma |
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Percentage of Patients Who Are Candidates for Surgery
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15-20%
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Treatment Methods for Lung Cancer
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*surgery for small, localized lesions
*RT as adjunct to surgery or for curative treatment |
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Indications for Using Radiation to Treat Lung Cancer
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*medically or technically unresectable squamous cell, large cell, or adenocarcinomas
*with chemotherapy for small cell carcinoma *adjunct to surgery *prophylactic *palliative |
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Margins for Treatment of Lung Cancer
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1.5-2 cm margin around all known tumor
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Fields for Treatment of Lung Cancer
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*custom cerrobend blocks
*MLCs |
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Dose for Treatment of Small Cell Lung Carcinoma
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180-200 cGy/4500-5400 cGy with chemotherapy
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Dose for Treatment of Non-Small Cell Lung Carcinoma
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180-200 cGy/6000-7000 cGy with or without chemotherapy
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Fractionation of Regular Treatment and Boost for Lung Cancers
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*AP/PA treated to 4500 cGy
*boost with lateral fields or an oblique pair to cover the anterior mediastinum (anterior to the vertebral bodies) |
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Method of Treating Posterior or Lateral Fields for Lung Cancer
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*shallow obliques are used when the spinal cord cannot be excluded
*no posterior cord block used *split course of treatment can account for shrinking tumor volumes for the later course |
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Dose for Treatment of Prophylactic Cranial Irradiation
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250 cGy/2500 cGy or 200 cGy/3600 cGy
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Features of Large-Cell Undifferentiated Lung Cancers
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*often disseminate early
*poor prognosis |
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Features of Squamous Cell Lung Carcinomas
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*closely correlated with smoking history
*most common lung cancer found in males |
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Location of Lung Adenocarcinomas
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common in the periphery of the lung
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Percentage of Lung Cancers That Are Adenocarcinomas
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35%
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Percentage of Lung Cancers that are Squamous Cell Carcinomas
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35%
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Percentage of Lung Cancers That Are Large-Cell Undifferentiated Cancers
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15%
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Location of Squamous Cell Lung Carcinomas
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commonly originate in a central or hilar location
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Pattern of Spread for Squamous Cell Lung Carcinomas
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may remain confined to the thorax
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Growth Rate of Squamous Cell and Adenocarcinomas of the Lung
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adenocarcinomas have a faster growth rate than squamous cell carcinomas
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Pattern of Spread for Adenocarcinomas of the Lung
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*spreads through submucosal lymphatics to the regional lymph nodes
*often metastasizes to the brain or other distant organs by vascular invasion |
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Vertebrae Where Trachea Bifurcates
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T5
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Lymphatic Drainage for Lung Cancers
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lymph nodes predominantly in mediastinum and surrounding bronchi
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Pattern of Spread for Lung Cancers
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*frequent extrathoracic dissemination
*local spread *regional spread *lymphatic metastasis *distant metastasis |
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Dose for Treatment of Superior Vena Cava Syndrome
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*350-400 cGy for 3-4 days
*then 180-200 cGy/6000-7000 cGy |
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Dose for Treatment of Lung Lymphomas
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*4000-5000 cGy
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When Radiation Pneumonitis Occurs
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3-6 months following irradiation
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Factors Incidence of Radiation Pneumonitis Depends On
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*total radiation dose
*radiation fractionation *lung volume irradiated |
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Symptoms of Radiation Pneumonitis
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*dyspnea
*cough *fever *nightsweats |
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Treatment of Radiation Pneumonitis
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*corticosteroids may be used in more severe cases
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Side Effects of Lung Irradiation
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*radiation pneumonitis
*pulmonary fibrosis *esophagitis |
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Prognosis for Lung Cancer
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*5-year overall survival: 13%
*localized disease 35% *regional lymph node involvement 33% |
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Percentage of Thymus Cancers Associated With Myasthenia Gravis
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50%
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Virus Associated with Thymus Cancers
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reported association with Epstein-Barr virus
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Myasthenia Gravis
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*autoimmune disease of neuromuscular fatigue
*ocular muscles involved in 90% of cases |
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Age of Diagnosis for Thymus Cancers
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*median age 50 years
*may be seen at any age |
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Number of Cases of Thymus Cancer
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500-700 annually
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Sex Predilection for Thymus Cancers
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occur equally in males and females
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Methods of Detection for Thymus Cancers
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30% of cases are asymptomatic at diagnosis and are found on routine chest x-ray
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Symptoms of Thymus Cancers
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*may result from impingement of surrounding structures
*chest pain *dyspnea *hoarseness *superior vena cava syndrome *dysphagia *fever *weight loss *anorexia |
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Diagnostic Procedures for Thymus Cancers
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*chest x-ray
*CT *barium swallow *mediasinoscopy |
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Percentage of Thymus Tumors That Are Benign
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60%
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Thymus Tumors in Children
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*extremely rare
*more malignant |
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Factors that Determine the Outcome and Treatment of Thymus Cancers
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*encapsulated versus invasion
*associated syndromes such as myasthenia gravis |
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Staging for Thymus Cancers
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based on the degree of invasion
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Purpose of the Thymus
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*critical in cell-mediated immunity
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Result of Irradiating the Adult Thymus
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*may result in decreased circulating lymphocytes
*can be the result of treatment for Hodgkin's disease, breast cancer, or malignant lymphoma *no evidence of immune alteration independent of the disease itself |
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Patterns of Spread for Thymus Cancers
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*rarely metastasizes
*liver *lung *bone |
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Treatment for Thymus Cancers
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*complete resection
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Indications for Radiation Treatment for Thymus Cancers
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*invasive tumor
*incomplete resection *tumor recurrence |
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Treatment Fields for Thymus Cancer
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*include entire mediastinum, both hila, and pleural implantation
*in cases of adenopathy, supraclav fields should be considered |
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Dose for Treatment of Thymus Cancer
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*4500-5000+ cGy for cases that are totally resected
*6000 cGy for cases that are partially resected |
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Side Effects Following Radiation for Thymus Cancer
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*radiation pneumonitis
*pericarditis |
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Prognosis for Patients Treated for Thymus Cancers
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*0% 5-year survival without radiation treatment
*45% 5-year survival with radiation treatment |
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Number of Cases of Skin Cancers
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1 million diagnoses annually
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Number of Deaths From Skin Cancers
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1,000-2,000 deaths annually
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Percentage of Skin Cancers that are Basal Cell Carcinomas
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75-90%
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Percentage of Skin Cancers that are Squamous Cell Carcinomas
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10-25%
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Treatment Fields for Skin Cancers
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*400 cGy/4000 cGy for ports less than 2 cm
*250 cGy/4500-5000 cGy for ports between 2-3 cm *240 cGy/6000 cGy for ports around 6 cm *250 cGy/6700-7500 cGy for 8-12 cm port |
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Technique Adjustment for Electron Beams When Treating Skin Cancers
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10-15% addition
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Margins for Skin Cancer Treatment
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*5-10 mm margins for small lesions
*larger margins for large, recurrent, or infiltrative lesions |
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Acute Side Effects From Skin Cancer Treatment
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*dry desquammation at 2-3 weeks
*erythema at 3-5 weeks *epilation *sweat and sebaceous gland dysfunction *moist desquammation *epidermal sloughing |
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Late Side Effects From Skin Cancer Treatment
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*hyperpigmentation
*atrophy *telangiectasis *retraction *secondary skin cancers *scarring *cutaneous and bone necroses |
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Prognosis for Patients Treated for Skin Cancers
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85% 5-year survival
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Percentage of Skin Cancers that Are Melanomas
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3% of all skin cancers
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Number of Cases of Melanoma
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59,940 cases annually
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Number of Deaths From Melanoma
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8,110 deaths annually
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Age at Diagnosis of Melanoma
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*occurs in all age groups
*rare before puberty |
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Race Distribution of Melanomas
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10 times more common in whites than in African Americans
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Sex Predilection for Melanoma Occurance
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occurs equally among males and females
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Ranking of Melanoma
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5th most common cancer in the United States
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ABCD Rule for Melanoma Detection
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*Asymmetric
*Border irregularity *Color variation (blue or black) *Diameter greater than 6 mm |
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Diagnostic Procedures for Melanoma
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*complete physical including the mouth, palms of feet, finger nails, anus, and vulva
*CBC *chest x-ray *excisional biopsy with 1-3 cm margin *metastatic workup for advanced lesions |
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Cell of Origin for Melanoma
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melanocyte
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Where Melanoma Arises From
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epidermis
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Where Melanocytes Are Present
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*skin
*eyes *respiratory system *gastrointestinal tract *genitourinary tract |
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Mechanisms of Spread for Melanomas
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*intradermal lymphatic spread
*regional lymph nodes *hematogenous spread to GI, liver, brain and lung *all organs at risk |
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Sites of Distant Metastasis with Melanomas
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*GI
*liver *brain *lung |
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Treatment Methods for Stage I Melanoma
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*excision with 2 cm margin
*prophylactic lymph node dissection *radiation therapy if there are inadequate margins |
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Treatment Methods for Stage II Melanoma
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*primary and regional lymph node dissection
*adjuvant therapy with chemotherapy, immunotherapy, monoclonal antibodies, radiation therapy, Interferon, or Interleukon |
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Chemotherapeutic Agent for Treating Melanoma
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DA Carbozine
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Immunotherapy Agent for Treating Melanoma
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BCG
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Side Effects from Interleukon treatment for Melanoma
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*hypertension
*high morbidity |
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Treatment Methods for Stage III Melanoma
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palliative treatment for distant metastasis
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Forms of Radiation Treatment Used to Treat Melanoma
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*pre op
*post op *adjuvant *palliative *not curative |
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Dose Used to Treat Melanoma
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*200-250 cGy/5000 cGy
*600 cGy/3000 cGy twice a week (spinal cord cannot receive more than 2400 cGy biweekly) |
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Field Margins for Treating Melanoma
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surgical and lymph node sites with a 2 cm margin
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Prognosis for Patients Treated for Stage I Melanoma
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85-90% survival if area is superficial
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Prognosis for Patients Treated for Stage II Melanoma
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36% survival
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Average Survival for Patients Treated for Stage III Melanoma
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67 months when brain is treated palliatively
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Virus Associated with Kaposi's Sarcoma
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HHV8 (Human Herpes Virus 8)
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Etiology of Kaposi's Sarcoma
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unknown
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ELISA
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*enzyme-linked immunosorbant assay
*used to detect HIV |
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Tests to Detect HIV Infection
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*ELISA
*Western Blot Test more specific |
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Positive Tests for HIV
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HIV seropositive after two successive ELISA and one Western Blot
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Epidemiology of Epidemic Kaposi's Sarcoma
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young homosexual or bisexual males
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Epidemiology of Classic Kaposi's Sarcoma
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elderly males of Mediterranean descent
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Epidemiology of African Kaposi's Sarcoma
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*more aggressive disease than Classic Kaposi's Sarcoma
*occurs in clusters in Central Africa *region geographically similar to African Burkitt's lymphoma *fatal iin 5-8 years |
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Indications to Obtain HIV Titer
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*patient less than 60 years old
*high risk factors *extracutaneous disease present |
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Questions for History and Physical for Patients With Suspected Kaposi's Sarcoma
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*ancestry
*sexual behavior *drug use *opportunistic infection |
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Histology of HIV Infection
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retrovirus of human T-cell in the leukemia and lymphoma virus family
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Mechanism of Action for Human Immunodeficiency Virus
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*selectively affects CD4, the T4 helper/inducer subset of T lymphocytes, which causes a defect in the immune system
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Histology of Kaposi's Sarcoma
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infiltrative lesion composed of spindle-shaped endothelial cells that form poorly developed vascular slits
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Mechanisms of Spread for Kaposi's Sarcoma
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disseminated Kaposi's Sarcoma due to multiple neoplasms, not metastasis
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Reasons to Palliate Kaposi's Sarcomas
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*pain
*edema *cosmesis |
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Ways to Treat Kaposi's Sarcomas
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*liquid nitrogen
*chemotherapy *interferon |
