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Lecture 5

Pulmonary V - Neoplasia

Most common cancer found in the lung Metastatic carcinoma
Characteristics of metastatic carcinoma found in the lung (1) multiple nodules (2) occurs bilaterally
Most common cause of cancer deaths in both sexes Lung cancer
(T or F) The incidence of lung cancer is rising in both males and females. True. Rates of lung cancer are rising in both sexes, but the rate of growth has been much faster for women than men. The number of women dying from lung cancer has been rising whereas the number of men dying from lung cancer has declined.
What percentage of lung cancer patients are determined to have operable lesions? 60% are determined to have operable lesions, but only 8 to 15% are cured.
Carcinogens in cigarette smoke (1) Dimethyl nitrosamine (2) benzopyrene (3) arsenic
(T or F) Passive smoking has not been shown to increase the incidence of lung cancer in non-smokers False. Passive smoking has harmful effect. It increases the incidence of developing lung cancer in non-smoker whose spouse smokes. Children raised in a household with smokers have increased incidence of respiratory illness and abnormal lung function.
Etiology of Lung Cancer (1) Tobacco (2) Irradiation (3) Chemicals (4) Air pollution (5) Lung scars
What is the relationship between asbestos exposure and cigarette smoking? Asbestos + smoking increases risk of lung cancer by 55 times than that of non-smoking/non-exposed person. There is a 5-fold synergistic effect of asbestos and tobacco.
Location of Squamous Cell Carcinoma of the Lung Central or segmental bronchi
Type of primary lung tumor that appears as a hilar mass. 80% of the cases are male. Frequently results in necrosis and cavitation. Tumor is capable of PTH production resulting in hypercalcemia. Squamous Cell Carcinoma of the Lung
A type of primary lung tumor that makes of 50% of lung cancers found in women. Associated with lung scars. Capable of vascular invasion. Disease usually metastatic at the time of diagnosis. Adenocarcinoma of the lung
Location of Small cell (oat cell) Carcinoma of the lung Central or major bronchi
Type of primary lung tumor made of primitive neuroendocrine cells, typically not amenable to surgery and chemotherapy is the first line therapy. Has a very poor prognosis. Associated with ectopic hormone production and paraneoplastic syndromes. Small cell (oat cell) carcinoma of the lung
Ectopic hormones produced by Small cell Carcinoma of the lung (1) Serotonin (2) ACTH (3) ADH (4) MSH (5) Calcitonin
Location of Large Cell Anaplastic Carcinoma of the Lung 50% occur centrally in the major bronchi; others occur more peripherally
Type of primary lung tumor that is an undifferentiated tumor that may have squamous or adenocarcinoma differentiation or a mixture of both. Neuroendocrine differentiation also occurs. Electron microscopy is necessary to distinguish these features. Large Cell Anaplastic Carcinoma of the Lung
Location of Bronchioloalveolar Carcinoma Tumor typically occurs at the periphery
Type of primary lung tumor that is not associated with cigarette smoke/inhaled carcinogens. Can present as multifocal lesions or as a solitary lesion. Bronchioloalveolar Carcinoma
Characteristics of Mucinous subtype of Bronchioloalveolar Carcinoma Lesions are multifocal and diffuse. 5-year survival of this tumor is 0%.
Characteristics of Papillary non-mucinous subtype of Bronchioloalveolar Carcinoma Lesions are typically solitary. 5-year survival is 28-69%.
Location of Carcinoid tumor of the lung 90% grow within the major bronchus
A well-differentiated neuroendocrine lung tumor with low malignancy. Although the tumor is capable of ectopic hormone production, most patients do not have symptoms of an endocrine disorder. Carcinoid tumor of the lung
Secretory Products of Carcinoid Tumors (1) 5-hydroxytryptophan (2) ACTH (3) MSH (4) MSH (5) Insulin (6) ADH (7) Growth hormone (8) Glucagon (9) Catecholamines (10) Kinins
Symptoms of Carcinoid Syndrome Flushing, Diarrhea, Abdominal Pain, Peptic ulcers, and right-sided CHF
(T or F) All patients with nonmetastatic carcinoid tumors have carcinoid syndrome. False. Carcinoid syndrome only occurs when the tumor metastasizes (usually to the liver). Clinical disease due to vasoactive peptides/amines, and serotonin secreted by the tumor.
Type of lung mass that appears as “coin lesions”. Can consist of cartilage, fat, and epithelial cells. Pulmonary Hamartoma
Diagnostic Methods for Lung Cancer Cytology from sputum samples, bronchial brushings/wash, fine needle aspiration. Transbronchial biopsy, mediastinosccopy or Scalene Lymph node biopsy, surgical resection (wedge<lobectomy<pneumonectomy)
When is bronchial brushing/washings most useful? Used to obtain cytology samples from centrally located lung tumors. Diagnostic yield is 79-90%
When is fine needle aspiration most useful for diagnosis of lung disease? Used to obtain cytology samples of lung tumors located in the periphery or the mid-lung. Diagnostic yield is 75-90%.
TX staging of lung cancer Tumor proven by the presence of malignant cells in bronchopulmonary secretions, but not visualized roentgenogrphically or bronchoscopically, or any tumor that cannot be assessed as in retreatment stages.
T0 staging of lung cancer No evidence of primary tumor
What is T stage would classify a recurrent lung carcinoma occurring after treatment? TX
TIS staging of lung cancer Carcinoma in situ
T1 staging of lung cancer Tumor size: <3.0 cm. No evidence of invasion to surrounding structures. Must be found proximal to a lobar bronchus at bronchoscopy
T2 staging of lung cancer Tumor size: >3.0 cm OR Any size tumor that either 1) invades the visceral pleura or 2) has associated atelectasis or obstructive pneumonitis. At bronchoscopy, the proximal portion of the tumor must be w/in a lobar bronchus or >2.0 cm distal from carina.
T3 staging of lung cancer 1) Any size tumor with direct extension into the chest wall, diaphragm, or mediastinal pleura or pericardium without involvement of the heart, great vessels, trachea, esophagus, or vertebral body OR 2) Tumor in the main bronchus within 2cm of the carina
T4 staging of lung cancer (1) Any size tumor that invades the mediastinum or involving the heart, great vessels, trachea, esophagus, vertebral body or carina OR (2) Presence of malignant effusion
N0 staging of lung cancer No demonstrable metastasis to regional lymph nodes
N1 staging of lung cancer Metastasis to lymph nodes of Peribronchial or ipsilateral hilar region or both, including direct extension.
N2 staging of lung cancer Metasis to ipsilateral Mediastinal lymph nodes and subcarinal lymph nodes
N3 staging of lung cancer Metastais to contralateral mediastinal lymph nodes, contralateral hilar lymph nodes, ipsilateral or contralateral scalene or supraclavicular lymph nodes
5 year survival rates for stage I lung cancer 48%
5 year survival rates for stage II lung cancer 28%
5 year survival rate for stage III lung cancer 12%
5 year survival rate for stage IV lung cancer <5%
Clinical presentation of more centrally located lung tumors Cough, hemoptysis due to disruption of bronchial mucosa by endobronchial neoplasm. Stridor due to bronchial luminal narrowing. Post obstructive pneumonia/atelectasis due to bronchial luminal narrowing.
Clinical presentation of more peripherally located lung tumors. Typically asymptomatic until tumor becomes necrotic (fever or hemoptysis). Dyspnea when sufficient lung parenchyma is involved.
Clinical presentation of intrathoracic spread of lung neoplasm Pleuritic chest pain, intense bone or chest wall pain, dysphagia, hoarseness, CHF, SVC syndrome, Pancoast Syndrome
Superior Vena Cava Syndrome Edema and swelling of the head, eyes, and upper extremities with resultant plethora and headache.
Pancoast Syndrome Shoulder and arm pain and weakness due to involvement of c8 and t1 nerve roots. Also may have Horner’s syndrome if sympathetic chain is involved.
Horner’s Syndrome Ptosis, miosis, and anhidrosis due to involvement of the cervical sympathetic plexus.
Common sites of Metastasis of Lung Cancer Lymph nodes, brain, liver, bone, and adrenal glands
Paraneoplastic syndromes of lung cancer Clubbing of nailbeds, Dermatomyositis, Neuropathy, Encephalopathy, Coagulopathy, Migratory thrombophlebitis, polymyositis, Cushing’s syndrome (due to ACTH activity of small cell carcincoma)
Created by: UVAPATH2