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Clinical Medicine Month 1 Week 2 Neoplastic Disease
Clinical Medicine Month 1 Week 2 Neoplastic Disease
33
Medical
Graduate
05/14/2018

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Term
oncogenes
Definition
promote cell division and tumor growth
Term
how long could it take to see a nodule on x-ray
Definition
7-10 years, avg doubling size is 3-4 months (why 75% of life history of cancer is in undetectable stage)
Term
risk factors for lung cancer
Definition
smoking, second hand smoke, radon, asbestos (mesothelioma)
Term
nonsmokers who get lung cancer, demographic and cell type
Definition
typically younger, more females, adenocarcinoma
Term
recommendations for 55 to 74 year olds with greater than 30 pack year smoking
Definition
counsel, enter into registry, USPTF (55-80) perform low dose screening CT scan- current smoker or quit within last 15 years
Term
benign tumors
Definition
double much more slowly, ex stable for 2 years
Term
Chest Guidelines for lung cancer management
Definition
-single nodule <4mm- follow up CT scan in 1 year, no additional f/u
-4-6mm nodule - f/u CT 6-12mo then 18-24 mo
-6-8mm nodule - screen every 3-6 mo, then 9-12, then 24
-
Term
symptoms of lung cancer
Definition
cough, dyspnea, recurrent pneumonias, hemoptysis. secondary to locally advanced disease: chest wall pain or chest pain, dysphasia (tumor pushes on esophagus), hoarsness, pleural or pericardial effusions, cardiac tamponade due to lymphatic obstruction
Term
pancoast tumor
Definition
cancers that aris from superior sulcus or extreme apex. shoulder, scapular or finger pain, may present with weakness or Horner's syndrome (bony destruction/atrophy of the hand muscle), pain and upper extremity weakness, invasion of brachial plexus
Term
horner's syndrome
Definition
affects eye and eyelid causing facial paralysis. sympathetic trunk -> brachial plexus -> lung apex and ascends. 3 classic findings: miosis, ptosis, anhydrosis (can't sweat on one side of body)
Term
superior vena cava syndrome
Definition
mediastinal involvement- periorbital or facial edema (tumor obstructive the superior vena cava and not allowing venous return from the head and neck and causing swelling, et dilated vessels in chest
Term
symptoms of lung cancer related to distant metastisis
Definition
headache, burry vision, confusion, seizures (travels to brain and liver, bone, spine), back pain, weakness in legs, poor bowel and bladder control, cauda equine syndrome -> bowel and bladder dysfunction, weight loss, fatigue
Term
paraneoplastic syndrome
Definition
consequence of cancer in the body but not due to cancer cells. humoral factors, hormones, cytokines secreted by tumor or tumor enlarging and pressing on other structures or affecting normal tissue, can cause SIADH, cushing's syndome (ACTH secretion),hypercalcemia (due to bony metastasis and production of parathyroid like hormone factor), lambery-eaton syndrome, and hypertrophic osteoarthropathy, more common in small cell carcinoma of the lung
Term
SIADH
Definition
syndrome of inappropriate antidiuretic hormone, causes hyponatremia- anorexia, vomiting, nausea, irritability. most common in small cell lung cancer
Term
lambery-eaton syndrome
Definition
get autoantibodies that act on voltage-gated calcium channels at the neuromuscular junction, reduces the release of neurotransmitters and leads to proximal limb weakness with improvement over sustained contractions. problems climbing stairs and raising from a seated position. similar to myasthenia gravis but w myasthenia gravis weakness gets worse as the day goes by. w lambery-eaton syndrome weakness gets a bit better as day goes by
Term
hypertrophic osteoarthropathy
Definition
a rheutatological condition, clubbing of fingers and toes, enlargement of extremities, painful swollen joints, most common in thoracic malignancies,
Term
testing for lung cancer
Definition
sputum cytology, bronchoscopy with biopsy, video assisted thorascocopic surgery, transthoracic fine needle aspiration, mediastinoscopy, tissue acquisition is important, get multiple cores for testing or multiple biopsies from different sites

CT scan of chest, pelvis, addomen. PET scan bc cancer cells take up more glucose. MRI of the brain. CT of abdomen- check adrenal glands may need to do a fine needle aspiration
Term
staging for the primary tumor is done how
Definition
flexible bronch with forceps biopsy, do pulmonology, bronchoscopy, lavage. if tumor is close to the surface can do a fine needle biopsy with CT guided or ultrasound guided needle
Term
staging using the lymph nodes is done how
Definition
direct needle biopsy of cervical or supraclavicular lymph nodes, blind needle aspirations, transesophageal endoscopic ultrasound, mediastinoscopy
Term
common for lung cancers to present with
Definition
pleural effusion, can do thoracentesis and check that fluid for cell cytology
Term
types of non small cell lung cancers
Definition
85%, squamous cell carcenoma, adenocarcinoma (least associated w smoking), large cell carcinoma
Term
lung cancer stages, non-small cell
Definition
IA- 1 tumor less than 3cm in size w no regional lymph nodes
IB- 1 tumor greater than 3cm in size, involves the main bronchus, maybe some spread to the visceral pleura, but no regional lymph node involvement
IIA- tumors less than= 5cm w metastases to the ipsilateral intrapulmonary (same side) or greater than 5cm w/o lymph node involvement
IIB- tumor >5cm but <7cm w ipsilateral intrapulmonary nodes or >7cm or w direct invasion w/o node involvement or separate tumor nodules in same lobe w/o nodes
IIIA- tumor of any size with ipsilateral mediastinal nodes
IIIB- tumor of any size w mets to contralateral nodes or supraclavicular nodes (other size)
IV- any tumor with pleural effusion, mult nodes and contralateral lung, or any distant metastases
Term
TNM
Definition
t-tumor, N-nodes, M-metastases (M0 is no metastases, M1 means you've got distant metastases)
Term
Lung cancer treatment depending on stage, non-small cell
Definition
IA or B-/IIA or B chemotherapy or surgery
III- radiation and chemotherapy
IV- chemotherapy or palliative care (2 or 3 drug platinum-drug based chemotherapy)
Term
lung cancer 5 year survival rates depending on stage, non-small cell
Definition
I- just surgery 60-80%
II- 40-50%
III- 15-25%
IV- 2%
Term
small cell cancer
Definition
more aggressive than non-small cell cancer, spread more aggressively, more responsive to chemotherapy but higher recurrence rates, frequently in smokers or former smokers, usually present with a central mass an lymphadenopathy, surgery is generally not a treatment option
Term
limited small cell cancer and extensive
Definition
tumor involvement and lymph nodes in one area of the lung, the mediastinum, and ipsilateral or contralateral supraclavicular nodes, or disease that's encompassed in a single radiotherapy port. (in an area you could get with one radiation beam), extensive disease is everything else (would need to use chemotherapy)
Term
metastatic disease findings to bone, adrenal glands, brain, liver
Definition
to bone: back pain, chest pain, extremity pain, alk phos and serum calcium levels may be elevated.
to adrenal gland: asymptomatic
to brain: headaches, vomiting, visual changes, CNS defects
to liver: few s/s, AST and ALT elevated
Term
cancers that most commonly metastasize to the lungs
Definition
breast, colon, prostate, bladder
Term
what is a solitary pulmonary nodule
Definition
coin lesion, less than 3cm, surrounded by lung parenchyma, mostly benign but can be malignant or metastases, 90% are incidental findings, diff dx includes lung cancer, infection, inflammation, vascular lesions, post-traumatic, congenital, lung cysts, amyloidosis, rheumatoid nodules, sarcoidosis, nipple shadow. a 30% increase in volume indicates doubling and a malignant tumor would double in a month to a year, stable for 2 years suggests benign
Term
for lesions less than 2cm (solitary pulmonary nodules)
Definition
bronchoscopy with a lavage or biopsy or transthoracic fine needle aspirations but risk of pneumothoraces, PET scan
Term
diagnostic strategies for solitary pulmonary nodules based on risk
Definition
low risk- radiographic follow up
intermediate risk- CT scan or PET scan
high risk/high pretest probability- CT scan followed by biopsy or surgery
have to incorporate many factors-smoking history, family history, diameter of nodule, spiculated, localized, calcified, location?
Term
risk assessment of solitary nodules based on size, age, smoking
Definition
<1.5 cm, under 45, never smoked = low risk
1.5-2cm, over 45, current smoker or quit less than 7 years ago = intermediate risk
>2.3cm, over 60, smoker and never quit = high risk
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