Term
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Definition
| promote cell division and tumor growth |
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Term
| how long could it take to see a nodule on x-ray |
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Definition
| 7-10 years, avg doubling size is 3-4 months (why 75% of life history of cancer is in undetectable stage) |
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Term
| risk factors for lung cancer |
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Definition
| smoking, second hand smoke, radon, asbestos (mesothelioma) |
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Term
| nonsmokers who get lung cancer, demographic and cell type |
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Definition
| typically younger, more females, adenocarcinoma |
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Term
| recommendations for 55 to 74 year olds with greater than 30 pack year smoking |
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Definition
| counsel, enter into registry, USPTF (55-80) perform low dose screening CT scan- current smoker or quit within last 15 years |
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Term
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Definition
| double much more slowly, ex stable for 2 years |
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Term
| Chest Guidelines for lung cancer management |
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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
- |
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Term
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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 |
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Term
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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 |
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Term
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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) |
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Term
| superior vena cava syndrome |
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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 |
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Term
| symptoms of lung cancer related to distant metastisis |
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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 |
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Term
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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 |
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Term
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Definition
| syndrome of inappropriate antidiuretic hormone, causes hyponatremia- anorexia, vomiting, nausea, irritability. most common in small cell lung cancer |
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Term
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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 |
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Term
| hypertrophic osteoarthropathy |
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Definition
| a rheutatological condition, clubbing of fingers and toes, enlargement of extremities, painful swollen joints, most common in thoracic malignancies, |
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Term
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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 |
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Term
| staging for the primary tumor is done how |
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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 |
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Term
| staging using the lymph nodes is done how |
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Definition
| direct needle biopsy of cervical or supraclavicular lymph nodes, blind needle aspirations, transesophageal endoscopic ultrasound, mediastinoscopy |
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Term
| common for lung cancers to present with |
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Definition
| pleural effusion, can do thoracentesis and check that fluid for cell cytology |
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Term
| types of non small cell lung cancers |
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Definition
| 85%, squamous cell carcenoma, adenocarcinoma (least associated w smoking), large cell carcinoma |
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Term
| lung cancer stages, non-small cell |
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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 |
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Term
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Definition
| t-tumor, N-nodes, M-metastases (M0 is no metastases, M1 means you've got distant metastases) |
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Term
| Lung cancer treatment depending on stage, non-small cell |
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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) |
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Term
| lung cancer 5 year survival rates depending on stage, non-small cell |
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Definition
I- just surgery 60-80%
II- 40-50%
III- 15-25%
IV- 2% |
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Term
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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 |
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Term
| limited small cell cancer and extensive |
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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) |
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Term
| metastatic disease findings to bone, adrenal glands, brain, liver |
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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 |
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Term
| cancers that most commonly metastasize to the lungs |
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Definition
| breast, colon, prostate, bladder |
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Term
| what is a solitary pulmonary nodule |
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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 |
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Term
| for lesions less than 2cm (solitary pulmonary nodules) |
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Definition
| bronchoscopy with a lavage or biopsy or transthoracic fine needle aspirations but risk of pneumothoraces, PET scan |
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Term
| diagnostic strategies for solitary pulmonary nodules based on risk |
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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? |
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Term
| risk assessment of solitary nodules based on size, age, smoking |
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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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