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38 Cards in this Set
- Front
- Back
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What are the 3 highest incidencez of cancer in men?
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25% - Prostate
15% - Lung and Bronchus 10% - Colon and Rectum |
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What are the 3 highest incidences of cancer in women?
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27% - Breast
14% - Lung and Bronchus 10% - Colon and Rectum |
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What are the 3 highest mortality causing cancers in men?
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30% - Lung and Bronchus
9% - Prostate 9% - Colon and Rectum |
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What are the 3 highest mortality causing cancers in women?
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26% - Lung and Bronchus
15% - Breast 9% - Colon and Rectum |
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What was the delay between cigarette consumption decrease and death rate decrease (in the male population)?
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20 years
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Etiology of Lung Cancer
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Tobacco
- active: 85-87% - passive: 3-5% Radon: 3-5% Industrial Pollution (asbestos): 0-5% Other: 0-9% |
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What are the big categories of lung cancer?
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Small Cell Lung Cancer (20%)... but on the decline
Non-Small Cell Lung Cancer (80%)... 70% of these are Stages III/IV |
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What age groups are getting lung cancer?
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58% >= 70 y/o
42% < 70 y/o (but approaching 50/50) |
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Clinical Presentation of Lung Cancer
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Local symptoms
- cough (that does not clear) - dyspnea (worsening) - obstructive pneumonitis (s/p obstructiv pneumonia) - hemoptysis - superior vena cava syndrome - chest pain General Symptoms - weight loss - fatigue Symptoms secondary to distant metastases |
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Is hemoptysis more common in small cell or non-small cell?
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non-small cell
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Horner's Syndrome and Lung Cancer
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Ptosis, Miosis, Anhidrosis
could also complain of severe pain radiating into the arm (from interaction with brachial plexus) Secondary to Pancoast Tumor (a.k.a. Superior Sulcus Tumor) |
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Superior Vena Cava Syndrome and Lung Cancer
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Facial and upper extremity swelling… SVC is obstructed by lung cancer
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Presenting Signs and Symptoms in Lung Cancer with Locoregional Disease
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Cough
Wheezing Stridor Hemoptysis Atelectasis/Pneumonia Pleural Effusions Pleuritic Pain Shortness of Breath |
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Presenting Signs and Symptoms in Lung Cancer with Advanced Disease
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Fatigue
Cough Dyspnea Decreased Appetite Weight Loss Bone pain (from bone mets) CNS symptoms (from brain mets) |
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Subjective History/Symptoms of Lung Cancer
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Family History (does not usually contribute much)
Smoking History Change in Cough (in sputum) Hemoptysis Chest Pain Recurrent/Refractory Infections Environmental Exposures |
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Objective Signs of Lung Cancer
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Airway Obstruction
Pneumonia Atelectasis (confirm with CXR/CT) Recurrent Nerve Palsy - Hoarseness from recurrent laryngeal nerve - SOB with phrenic nerve and elevated diaphragm Superior Vena Cava (SVC) Syndrome Pleural Effusions |
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Initial Step in Diagnosis of Lung Cancer
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Sputum Cytology x 3
only if the patient is coughing A LOT |
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Imaging Studies in Diagnosis of Lung Cancer
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CXR
CT chest and abdomen PET Scan (ordered for staging) Brain MRI with gadolinium contrast (preferred to CT scan b/c much more information about small mets) |
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Laboratory Tests in Diagnosis of Lung Cancer
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CBC with diff (look for anemia, thrombocytosis - poor prog., leukocytosis - poor prog.)
Serum Calcium (hypercalcemia seen with squamous cell CA) AST (sign of spread to liver) Alkaline Phosphatase (sign of liver or bone involvement) LDH (elevated in SCLC... higher LDH = worse prognosis) |
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Pathology in Diagnosis of Lung Cancer
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Bronchoscopy
Fine needle aspiration |
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Hypertrophic osteoarthropathy
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is a syndrome characterized by abnormal proliferation of the skin and osseous tissue at the distal parts of the extremities
it appears swollen and is painful Complain of severe bone pain… often in shins, hands… immediately resolves with resection of lung CA |
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Small Cell Paraneoplastic Syndromes
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Syndrome of Inappropriate ADH secretion
Ectopic ACTH production (cushingoid appearance) Gynecomastia Lambert-Eaton Syndrome Thrombocytopenia Hypercoagulable disease |
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Large Cell Paraneoplastic Syndromes
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Gynecomastia
Hypercalcemia (not bone met related) Hypertrophic pulmonary osteoarthropathy Thrombocytopenia Hypercoagulable disease |
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Squamous Cell Paraneoplastic Syndromes
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Hypercalcemia (not bone met related... can be ectopic parathyroid hormone)
Hypertrophic pulmonary osteoarthropathy Thrombocytopenia Hypercoagulable disease |
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Adenocarcinoma Paraneoplastic Syndromes
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Hypertrophic pulmonary osteoarthropathy
Thrombocytopenia Hypercoagulable disease |
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Lambert-Eaton Syndrome
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Syndrome of the large, proximal muscles
movement is initially hard in the morning, but gets easier as you use your muscles |
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NSCLC Prognostic Factors
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Age
Female > male Physical strength loss - performance status Weight loss < 5% versus > 10% Stage (most important) Metastatic sites (number, location) |
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NSCLC Surgical Treatment
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Segmentectomy/wedge resection (Only recommended if pt cannot have lobe- or pneumo-)
Lobectomy Pneumonectomy (need if it crosses a fissure) * you will have decreased PFTs after surgery .: before surgery you need to assess PFTs to see if they even qualify for surgery |
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Treatment for NSCLC Stage IV
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Palliative chemotherapy
Best supportive care Cannot be cured |
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Treatment for NSCLC Stage III
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Combined modality treatment program including:
surgery, radiation, and chemotherapy |
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Treatment for NSCLC Stages I and II
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Surgical resection
Adjuvant chemotherapy for stage II (pts with hilar nodal involvement) |
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Small Cell Lung Cancer
(SCLC) |
Most tightly linked to smoking
Most aggressive lung cancer type Median Survival without treatment = 2-4 months More responsive to chemotherapy and radiation than NSCLC |
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Small Cell Lung Cancer:
Prognostic Factors |
Performance Status
Stage - Limited [if can fit into a radiation field] vs - Extensive [if cannot fit into radiation field]) LDH |
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Small Cell Lung Cancer
Stage at Diagnosis |
One third limited stage (stage I-III)
Two thirds extensive stage (stage IV) |
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Small Cell Lung Cancer:
Role of Surgery |
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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Treatment for SCLC
Limited Stage |
Chemotherapy concurrent with thoracic radiation therapy
(both at the same time for synergistic response) |
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Treatment for SCLC Extensive Stage
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Chemotherapy
Radiation to special sites (i.e., brain metastases, painful bone metastases, spinal cord compression) |
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Prophylactic Cranial Irradiation in Patients with SCLC and Response to Chemotherapy ± Thoracic Radiation
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Increases brain metastasis-free interval
Increases disease free survival Reduces mortality Increases overall survival |
