lung cancer

symptoms of lung cancer

-most common symptoms: coughing, shortness of breath, chest pain and hemoptysis

-general symptom: fatigue, weight loss and night sweats

paraneoplastic syndrome

-hypertrophic osteoarthropathy (clubbing)

-hypercalcemia

more commonly seen in squamous cell

due to production of PTH-like hormone

-SIADH: most common syndrome in small cell carcinoma

-Cushing syndrome

-Eaton-Lambert syndrome

-does not preclude curative therapy

adenocarcinoma

most common form in nonsmokers

peripheral lesion

-bronchoalveolar cell carcinoma/ adenocarcinoma in situ: subtype of adenocarcinoma

solitary nodule, lobar consolidation or multiple nodules

slow growing with late metastases

lower likelihood of + PET scan

squamous cell carcinoma

2nd most common form of non-small cell carcinoma

found in smokers

associated with hypercalcemia and hypertrophic osteoarthropathy

less likely to metastasize than adenocarcinoma

centrally located and can cavitate

large cell carcinoma

-poorly differentiated non-cell carcinoma that are not classified by light microscopy

-prognosis closely resemble adenocarcinoma

-frequently shows necrosis

small cell carcinoma

10-15% of lung cancers

associated with smokers

central location, metastatic at time of presentation

***If you had to choose a paraneoplastic syndrome related to lung cancer, CHOOSE SMALL CELL (except hypercalcemia)

staging for lung cancer

-non-invasive staging: CT, PET

-invasive staging

non-surgical: EBUS/ bronchoscopy, toracentesi, needle biopsy

surgical: mediastinoscopy, anterior mediastiinotomy (Chamberlain procedure), VATS

Positron emission tomography (PET) scan

marker of active glucose metabolism and will accumulate in metabolically active tumor cells

90% sensitivity, 85% specificity

-false negative: small nodule < 8mm, carcinoid, BAC

-false positive: granulomatous infection/inflammation

video flexible bronchoscopy

excellent to evaluate endobronchial disease

-brushing and bronchial biopsies are high yield for visible lesion

-evaluate of obstruction for stent