Single round or oval intrapulmonary lesion

0.5-6.0 cm diameter

most are asymptomatic

1. Bronchogenic carcinoma

2. single metastatic lesions

3. bronchial carcinoid

4. extranodal lymphoma

1. infectious granulomas (90% of benign nodules)

-TB, fungal

2. non infectious granulomas

-rheumatoid nodules, wegener's granulomatosis

3. Benign tumors

-hamatoma

1. Patient presenation risk factors

2. previous CXRs

3. Calcification = benign

4. Size and shape

-small and smooth =benign

-large, spiculated, cavities = malignant

Growth rate differences

benign vs malignant:

Benign: slowly (no growth over 2 years)

malignant: 20-400 days

Steps to determining benign vs. malignant

1. calcified vs. not calcified

2. review previous xray

3. ct scan

4. biopsy or resect

1. tobacco

2. asbestos

3. radon

4. air pollution

5. genetics

1. Risk of developing lung cancer is inc ___ fold by active smoking, and ___ by passive exposure.

2. incidence of death from lung cancer begins to exceed that of a non smoker at :

3. Quit smoking for ____ years to develop normal lungs:

1. 13 fold, and 1.5 fold

2. 10 pack pack years

3. 8-10 years

1.Carcinoma starts here and spreads where:

2. Metastasis to distal sites:

1. Originates in cells which line the bronchial tree:

Bronchial->hilar->mediastinal

2. Liver, adrenal glands, bones, brain, lung

1. adenocarcinoma (peripheral-intermed growth)

2. squamous cell carcinonma (central-late met)

3. Large cell (anaplastic) carcinoma (central-early met)

1. very rapid growth

2. centrally located with bulky adenopathy

3. often metastatic at diagnosis

4. paraneoplastic syndromes common

1. asymptomatic

2. signs and symptoms of local growth

3. Involvement of adjacent structures (pain, dysphasia, hoarseness, diaphragmatic paralysis, pleural or pericardial effusion)

4. Metastasis

5. systemic/constitutional findings

6. paraneoplastic syndromes

1. cough

2. hemoptysis

3. dyspnea, wheezing

4. pneumonia

tumor compression of SVC

Distended veins in neck, chest wall, arms

facial and arm swelling, rubor

++veins all over body core to compensate

caused by apical tumors with involve the brachial plexus and cervical sympathetic nerves

shoulder and arm pain

atrophy of arm and hand muscles

Horner syndrome

headache

Seizures

Focal deficits

Right upper quad pain

hepatomegaly

abnormal LFTs

pain

pathological fracture

spinal cord compression

cytopenias

leukoerythroblastosis

anorexia

weight loss

cachexia

fatugue

generallized weakness

fever

Due to tumor production of ACTH precursors

small cell carcinoma

paraneoplastic syndromes

tumore production of PTH-like hormone

squamous cell carcinoma

paraneoplastic syndromes

Paraneoplastic syndromes:

SIADH

tumor production of ADH which inc water reabsorption in renal tubules

often seizing

often asymptomatic

small cell carcinoma

NSCLC staging: TNM system

T= size and location of primary tumor

N= lymph node involvement

M=distant metastasis

1. tumor usually small

2. No lymoh node involvement

Stage II

1. Small tumor with limited lymoh node involvement

2. tumor invades adjacent structures

1. Larger or more invasive tumors

2. More extensive lymph node involvement

Surgical resection

-no proven role of radiation

1. concurrent chemotherapy and radiation therapy generally preferred

main goal in palliation of symptoms

chemotherapy if performance status acceptable

in general surgery is not used

limited: chemotherapyplus radiation

Extensive: chemotherapy can signinnficantly prolong life

Prophylactic radiation dec brain mets and prolongs survival

prognosis of small cell lung cancer:

Limited stage-

Median survival w/o tx = 3 mo

Median survivak w/tx = 18 mo

Small cell lung cancer prognosis;

extensive stage:

median survival w/o tx= 6-8wks

median survival w/tx = 9-12 mo