| What is lung cancer? | leading cause of cancer death worldwide, 5 year survival rate is very low (17%).
We are having progress with screening and intervention
2 Types: small cell and non-small cell lung carcinoma |
| What are the risk factors of lung cancer? | Most imp is smoking (any smoking type, even passive smokers -second hand)
The higher pack years the more risk of getting it
Other risk factors are environmental toxins (Asbestosis, metals...), radiation, pulmonary fibrosis, HIV infection, family history and alcohol abuse. |
| What are symptoms associated with lung carcinoma? | Dyspnea, chest pain (parietal pleura involvement/ metastatic pain)
Cough and hemoptysis
Anorexia, weight loss, fatigue
Diffuse pain is possible.
important to note that all these may be absent. |
| How is diagnosis and staging of lung cancer? | It is important to answer 2 questions, what cell type and what stage it is.
Evaluation done by hx taking and PE, CBC, serum chemistries and CT scan of chest
Usually we catch it in a late stage with metastasis to other organs or paraneoplastic syndrome
Symptoms of both types are similar.
PET scans are useful in assessing unsuspected mediastinal involvement... giving us the right path to go through |
| How to get a definitive dx of lung cancer? | Histopathology, single invasive test may be enough.
Strategy depends on size, location, patient condition and expertise to get the definitive dx.
Mediastinal and central lesions: bronchoscopy
Small peripheral lesions: transthoracic needle aspiration |
| Describe small cell lung cancer. | 15% of total lung cancers, occurs strictly for smokers, typically central airways affected with lymphadenopathy and distant metastasis at dx.
Associated with paraneoplastic syndrome (hypoNa - inappropriate ADH, hypertrophic pulmonary osteoarthropathy, inflammatory myopathy, cushing (ectopic hormone secretion) ...) |
| What are the types on non-small cell lung cancer? | Adenocarcinoma (usually occurs with non-smokers, usually located at lung parenchyma as a mass/nodule, metastasizes in other places)
Squamous cell carcinoma (Second most common type of NSCLC, occurs for smokers, central airways, present with cough, hemoptysis, post obstructive pneumonia, collapse)
Large cell carcinoma (Presents as peripheral mass) |
| How is immunotherapy in non-small cell lung carcinoma? | Testing for EGFR (epidermal GFR), ALK receptor, ROSI... target the mutation kills only cancer cells
Example is keritruda mostly for adenocarcinoma |
| How is staging mechanism of lung cancers? | Based on TNM staging system (tumor, lymph node involvement, metastasis)
SCLC is limited disease (one hemithorax, ipsilateral lymph node involvement) |
| What are the other types of pulmonary neoplasms? | Carcinoid tumors (1-2%, involve neuro-endocrine cells, smoking not a risk factor, occurs at proximal airways causing obstruction and obstructive symptoms with bleeding, surgical resection)
Adenoid cystic carcinoma (salivary gland tumor at lower respiratory tract, surgical resection)
Hamartomas (most common benign tumor, calcified, combines fats, proteins, cartilage epithelium..., smooth bordered nodules) |
| What is mesothelioma? | Rare carcinoma metastatic starts at pleura, could be small nodules to confluent sheets that encase the lung.
Ass with inhalation of asbestos, advanced disease.
Suspected when we see pleural thickening or recurrent exudative pleural effusion with hx of asbestos exposure
Dx requires biopsy (cytology study is not sensitive)
Tx acc to condition (surgery + chemo + radiation)
Very poor prognosis (survival 6-9 months) |
| Where are most common sites of metastasis of lung cancer? | Lymph nodes, brain, bone, liver, adrenals, pleura.. |
| What is the treatment course of action for lung cance? | Depends on cancer type (SCLC usually radio and chemo, others maybe surgery + others...)
+ symptomatic tx (pain-->anelgesics, oxygen, cough treatment, metastasis tx, pleural drainage, interventional bronchoscopy...) |
| What are pulmonary nodules? | Small radio opacities (<3cm in size) surrounded by normal lung parenchyma.
Asymptomatic found incidentally.
If larger than 3 cm --> malignant and should be tested.
Evaluated by imaging history estimating malignancy.
Guidelines according to size, characteristics of the largest nodule (if more than one is present) |
| How should we screen for lung cancer? | Smokers screened annually for 3 years have reduced mortality of lung cancer 20%.
Done for aged 50-80 years with no symptoms and at least 20-packyear/ current smokers/ quit less than 15 years ago
Done by low-dose CT scan
+ test if a nodule seen (indeterminate)/ If suspicious further testing and biopsy is needed |
