clinical lung neoplasms

the majority of pts who present with clinical signs and symptoms due to lung cancer have ____

advanced disease (basically you usually don’t know until its late)

what are the 4 most common symptoms of lung cancer?

cough, hemoptysis, dyspnea, and chest pain

we see bronchorrhea (excessive sputum) with what type of lung cancer?

broncho-alveolar carcinoma

_____ in smokers should raise suspicion of lung cancer

recurring common colds

what are the 5 most common risk factors for lung cancer?

smoking

radiation therapy

environmental toxin exposure

pulmonary fibrosis

HIV

lung cancer should always be suspected in a current of former smoker with new _______ or ____

new onset of cough or hemoptysis

what type of lung cancer?

disorganized lung tissue and cartilage (with scattered calcifications); “coin lesion”; well circumscribed, usually peripheral, benign

hamartoma

besides getting the chest xray what is another important part o imaging?

obtain any prior chest imaging studies

what should you order if there is no previous xrays or there are new nodules/changes to old nodules?

CT scan of chest (also upper abdomen including liver and adrenal glands)

what are 3 signs of malignancy?

irregular margins, spicules, absent or irregular calcifications

We get a bronchoscopy with transbronchial biopsy for ____ nodules

we get a CT-guided transthoracic biopsy for ____ nodules

transbronchial: central

transthoracic: peripheral

what imaging can identify metabolic activity of the tumor, mediastinal involvement, and distant metastases?

whole body PET-scan

what is this?

presentation: sensation of fullness in head, dyspnea, dilated neck veins, prominent venous pattern on chest, facial edema, and plethoric appearance (redish)

superior vena cava (SVC) syndrome

What is this?

shoulder pain is the most common symptoms

pancoast tumor

what is this?

can see ptosis, miosis, and anhidrosis

pancoast tumor: horner’s syndrome

What cancer?

hypercalcemia: PTH-related protein

squamous cell

what cancer?

SIADH- hyponatremia

small cell

what cancer?

Lambert-Eaton

small cell

what cancer?

cushing syndrome - ectopic ACTH

small cell

what cancer?

hypertrophic osteo-arthropathy- clubbing and periosteal proliferation of tubular bones

adenocarcinoma

small cell or non-small cell?

smokers, fast growing → early metastasis, central, not amenable to surgical resection → treated with chemo → poor prognosis

small cell

small cell or non-small cell?

smokers or nonsmokers, can be resected in early stages, better prognosis

non-small cell

if we see multiple lesions in the lung we should think?

metastasis to the lungs from other location

what do we look at for staging of non-small cell lung cancer?

size and extent of the main tumor, number of lymph nodes involved, and presence of distal metastasis

once distant metastases are detected, the cancer is classified as

stage IV

What do we look at to stage small cell lung cancer?

whether the tumor is limited to one hemithorax or has spread beyond the hemithorax (limited or extensive)

treatment:

NSCLC: stage 1, 2, 3a: ____

NSCLC: stage 3b, 4: _____

SCLC: limited ____

SCLC: extensive _____

curative

palliative

curative

palliative

How do we screen for lung cancer?

low-dose CT