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Pulmonology
Malignancies
| Question | Answer |
|---|---|
| Impact | More people die from lung cancer than any other. Most common cause of cancer. 175,000 new cases/year; 165,000 deaths/year; 5 year survivial 15%(12-18 mo) |
| Warning signs | none; most often diagnosed at a late stage |
| Risk factors | smoking(80-90%); >70 yo; genetic, occupation; lung disease, COPD, IPF, sarcoidosis |
| Cigarettes | >4,000 chemicals many carcinogenic(nitrosamines and polycyclic aromatic hydrocarbons; Lung cancers of all types have nicotine receptors |
| Prevention | stop smoking; remove occupational hazards |
| Screening | CXR + sputum: no change in cure rate; ECLAP: LDCT detects 80% of Lung cancers in the most curable stage, allot of false possitives; |
| Sputum cytologic analysis | detects squamos cell carcinoma |
| CT scan | detects peripheral adenocarcinomas |
| Flourescent bronchscopy | indicated for progressive dysplasia seen on sputum cytology |
| PET scanning | Sensitivity(85-97%); specificity(70-85%); limits(lesion<1cm); expensive; diagnostic not screening |
| CXR | if pneumonia repeat after 6-8 wks for high risk patient |
| Solitary Pulmonary Nodule | coin lesion; asymptomatic; high risk for malignancy for high risk(20-30pkyear), eval to id and resect malignancy while avoiding invasive procedures for benign |
| Suspicious Pulmonary Nodules | smokers+old; change from previouis CXR(2y); increased size; 3 defined margins; pattern of calcification(stippled, spiculated, or halo margins); high concerns: CT and or PET, TTNA, bronchoscopy, VATS, open thoracotomy |
| Signs and Symptoms | depend on tumor's location and spread; cough or change in, hemoptysis; infection - (post obstruct); pleurisy; dyspnea |
| Rare Signs and symptoms | Horner's syndrome: miosis, ptosis, facial anhidrosis; pancoat syndrome: infiltration of brachial plexus - arm pain weakness; phrenic nerve innervation: diaphragm paralysis; cardiac involvement; SVC obstruct; L recurrent laryngeal nerve paralysis |
| Paraneoplastic syndromes | Nervous, muscle syndromes; ACTH secretion(common); PTH like subtances; other endocrine symptoms and hematologic symptoms |
| Bronchogenic Carcinoma | 95% of lung cancers arise from bronchial epithelial cells |
| Mesotheliomas | cancers arising from the pleura; most common with asbestos induced tumors |
| Squamos Cell Carcinoma | Primary, non small cell; centrall located endo-bronchial masses, hemoptysis, post obstructive pneumo, lobar collapse, later mestastasis, sputum cytology; better chance of survival |
| Adenocarcinoma | primary, non-small cell; heterogenous peripheral mass from mucous glands; 2% from epithelial cells distal or wtihin terminal branchioles; early mestastasis; late finding |
| Large Cell | Poorly differntiated, anaplastic(uncontrolled growth) or undeifferentiated; peripherally or centrally located; early metastasis; more aggressive |
| Small Cell(general and staging) | centrally located, usually with extensive meadiastinal involvement, aggressive, early extra thoracic mets; Limited stage disease: (30%) disease confined to one hemi-thorax and associated lymph nodes; Extensive stage disease:(70%) diease beyond limited. |
| Metastasis | process of spread |
| metastases | areas of tumor growth at distant sites |
| Differntial Diagnosis for abn CXR | FB; infection; TB; fungus; autoimmune(sarcoidosis); parasites(trich) |
| Prognosis | NSC: untreated-8 months, treated 5y survival-13%; SC:2-4 months |
| Treatment - surgery | only usefull in Stage I&II NSC; neoadjuvant chemotherapy for stage II, IIIA and IIIB, not usefull in SC |
| Treatment - chemotherapy | helpfull not curative, only option for SC, Platinum drugs 1st line(toxic), adds approx. 6-12wks in non resectable |
| Treatment - Radiation | external beam or internal placement(brachytherapy); palliative for NSCLC; brain is radiated for pre-emptive metastasis tx |
| Treatment - Palliative | all stages and cell types; only tx for stage IV; treat anxiety and pain due to bone mets; high dose morphine; hospice care |
| Experimetnal therapies | Photo-dynamic therapy: for SC, activates under certain light(laser); new chemo, immunotherapy, Molecular targeted therapy: epidermal GF inhibs, vascular endothelial GF inhibs |
Created by:
bmg4