Malignancies
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| 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)
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| Warning signs | none; most often diagnosed at a late stage
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| Risk factors | smoking(80-90%); >70 yo; genetic, occupation; lung disease, COPD, IPF, sarcoidosis
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| Cigarettes | >4,000 chemicals many carcinogenic(nitrosamines and polycyclic aromatic hydrocarbons; Lung cancers of all types have nicotine receptors
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| Prevention | stop smoking; remove occupational hazards
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| Screening | CXR + sputum: no change in cure rate; ECLAP: LDCT detects 80% of Lung cancers in the most curable stage, allot of false possitives;
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| Sputum cytologic analysis | detects squamos cell carcinoma
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| CT scan | detects peripheral adenocarcinomas
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| Flourescent bronchscopy | indicated for progressive dysplasia seen on sputum cytology
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| PET scanning | Sensitivity(85-97%); specificity(70-85%); limits(lesion<1cm); expensive; diagnostic not screening
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| CXR | if pneumonia repeat after 6-8 wks for high risk patient
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| 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
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| 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
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| Signs and Symptoms | depend on tumor's location and spread; cough or change in, hemoptysis; infection - (post obstruct); pleurisy; dyspnea
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| 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
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| Paraneoplastic syndromes | Nervous, muscle syndromes; ACTH secretion(common); PTH like subtances; other endocrine symptoms and hematologic symptoms
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| Bronchogenic Carcinoma | 95% of lung cancers arise from bronchial epithelial cells
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| Mesotheliomas | cancers arising from the pleura; most common with asbestos induced tumors
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| 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
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| Adenocarcinoma | primary, non-small cell; heterogenous peripheral mass from mucous glands; 2% from epithelial cells distal or wtihin terminal branchioles; early mestastasis; late finding
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| Large Cell | Poorly differntiated, anaplastic(uncontrolled growth) or undeifferentiated; peripherally or centrally located; early metastasis; more aggressive
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| 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.
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| Metastasis | process of spread
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| metastases | areas of tumor growth at distant sites
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| Differntial Diagnosis for abn CXR | FB; infection; TB; fungus; autoimmune(sarcoidosis); parasites(trich)
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| Prognosis | NSC: untreated-8 months, treated 5y survival-13%; SC:2-4 months
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| Treatment - surgery | only usefull in Stage I&II NSC; neoadjuvant chemotherapy for stage II, IIIA and IIIB, not usefull in SC
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| Treatment - chemotherapy | helpfull not curative, only option for SC, Platinum drugs 1st line(toxic), adds approx. 6-12wks in non resectable
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| Treatment - Radiation | external beam or internal placement(brachytherapy); palliative for NSCLC; brain is radiated for pre-emptive metastasis tx
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| 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
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| 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
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