Lecture 47: Lung Cancer

Left-sided Pleural Effusion

1. Smoking

2. Second hand smoke

3. Radon

4. Industrial pollution

5. Radiation (asbestos, radon, radiation, silicosis, beryllosis, arsenic)

top risk factors for lung cancer

Men

rates of lung cancer has rapidly gone up in ___________, but the rate is now decling

Female

____________ mortality by lung cancer began to rise in 1960

higher

The later you quit smoking, the _____________ the chance of getting lung cancer

NO

is screening diagnostic?

No

if pt doesnt want treatment, should you screen for lung cancer?

Yes

Should you offer CT screening for lung cancer?

-smokers and former smokers, age 55-74, with more than a 30 pack years of smoking

No

Should you offer CT screening for lung cancer?

-pt is younger than 55

-pt is older than 74

-pt has a smoking history of less than 30-pack years

No

Should you offer CT screening for lung cancer?

-pt has a severe comorbidity that would preclude potentially curative treatment or limit life expectancy

ages 55-80 with 30 pack year smoking history and currently smokes or has quit within past 15 years

CT lung cancer screening recommendations according to the USPSTF

15 years

according to the USPSTF, lung cancer screening should be discontinued after the pt has not smoked for ______________ or develops a health problem that substantially limits life expectancy

Solitary Pulmonary Nodule

Single lesion, surrounded by lung parenchyma, size 3-4cm

Group 2

What group for lung cancer screening?

High risk

Group 1

What group for lung cancer screening?

High risk

High

according to NCCN guidelines, lung cancer screening is only recommended for ___________ risk status pts

50%

At an age >60, the risk of a solitary pulmonary nodule being malignant is greater than ___________

• Large airway obstruction

• Obstructive pneumonitis or atelectasis

• Dyspnea out of proportion to mass

• Pleural or pericardial effusion

• Hemoptysis

• Weight loss

Common Symptoms of lung cancer

Obstructive Pneumonitis

-results form compression of airway whereby bacteria or pathogens are trapped behing resulting in infection

Cough

most common symptom of lung cancer

Bronchitis

Although it is also a common symptom in lung cancer, the most common cause of hemoptysis is __________________

Recurrent Laryngeal Nerve

nerve associated with Hoarseness

Lung Cancer

• constricted pupil, partial ptosis, and loss of hemifacial sweating

-Superior Vena Cava Syndrome

-Brachial Plexus Involvement (horners syndrome, rib destruciton, upper extremity pain and weakness)

Heptatic

____________ metastases is assoc with weakness and weight loss

Brain

______________ metastases is assoc with headache, nausea and vomiting, focal neurologic symptoms, seizures, confusion, and personality changes

Leptomeningeal

________________ spread is assoc with pain, visual disturbance, and headache

Hypercalcemia

-paraneoplastic syndrome of lung cancer

-parathyroid hormone rp

-squamous cell, associated increase WBC, Not related to metastases, not prognostic of

stage or survival

HCG production

-paraneoplastic syndrome of lung cancer

-Gynecomastia, milky nipple discharge

-Hypercalcemia

-Digital Clubbing

-Syndrome Inappropriate ADH

-Hormone (SCC)

-Ectopic ACTH (SCC)

-HCG Production

-Eaton-Lambert Syndrome, Peripheral Neuropathy, CNS Syndromes

paraneoplastic syndromes of lung cancer

Syndrome of Inappropriate ADH (SIADH)

-Paraneoplastic syndrome

-hyponatremia

Ectopic ACTH

-Paraneoplastic syndrome

-cushing syndrome

Eaton-Lambert Syndrome

-Paraneoplastic syndrome

-power increases with repetition

-decreased reflexes

SVC Syndrome

-Paraneoplastic syndrome

-SVC obstruction

-dyspnea

-increased JVP

-facial swelling

Adenocarcinoma

most common type of lung cancer in US

Adenocarcinoma

-malignant epithelial tumor

-glandular differentiation or mucin production, showing acinar, papillary, bronchoalveolar, or solid with mucin growth patterns or a mix of these patterns

Large Cell Carcinoma

an undifferentiated non-small cell carcinoma that lacks the cytologic and architectural features of small cell carcinoma and glandular or squamous differentiation

Squamous Cell Carcinoma

-a malignant

epithelial tumor showing keratinization

and/or intercellular bridges that arise

from bronchial epithelium.

-These features vary with degree of differentiation, being prominent in

well-differentiated tumors and focal in poorly differentiated tumors.