Respiratory 1: Thoracic Neoplasms

(T/F) Lung CA is the most common cause of CA DEATH in men and women
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(T/F) Lung CA is the most common cause of CA DEATH in men and women
True
Primarily the carcinogenic effect within cigarettes is from?
the polycyclic aromatic hydrocarbons created from the tars during combustion
The incidence of Lung CA has and continues to stabilize. What is the trend incidence for Lung CA in women?
Incidence is INCREASING; (one main reason it due to passive smoker exposure (living with a smoking spouse)
(T/F) There is conclusive data that proves a diet with increased fruits and vegetables decreases Lung CA risk
False
99% of Lung CA begins/arises from where? What chromosomal deletions are associated with lung CA?
Respiratory epithelium;
3p, 5q, 9p, 11p, 123q and 17p all of which are where tumor suppressor gene exist.
Explain how a prolong smoker can live without any respiratory complications or acquiring lung CA
With all cancers, genetics is a factor. Multiple genetic hits (mutations) are needed in order for CA to become pathogenic; In some individuals, such hits as well as personal genetics/risk factors/diet..etc these hits do not fully occur hence longevity.
Manifestations of Lung CA will most likely present with these top 5 S/S?
Cough
Weight loss
Dyspnea
wheezing
Hemoptysis;

Also remember that 10% of pts with lung CA will present as pneumonia
CENTRALLY LOCATED LESIONS are mostly what type of tumors? How will this present?
Squamous cell and small cell; Present with airway OBSTRUCTION, COUGH, HEMOPTYSIS, WHEEZING DYSPNEA AND PNEUMONIA
PERIPHERAL LESIONS are mostly what type of tumors ? How will they present?
Adenocarcinoma and Large Cell. Presentation will be asymptomatic until it invades pleura chest wall to which Chest Pain will be cc. NO COUGH!!

Adenocarcinoma makes up 40% of lung CA's. IT IS THE MOST COMMON LUNG CA in SMOKERS
In rare cases of Lung CA; a pt may only present with Paraneoplastic Syndromes to which you should think possible Lung CA. Name 3 Paraneoplastic syndromes/
SIADH (syndrome of inappropriate ADH) Excessive amounts of ADH especially with Small Cell CA
Hypercalcemia
Cushing syndrome
Myopathic and neurological syndromes
This is now the most common type of Lung CA of smokers. What % of lung tumors are malignant?Adenocarcinoma. 95% of lung tumors are malignant."Everytime I eat or drink something I cough" This could be do to what?Central Lung CA (small cell and squamous) gowing in posterior mediastinum that invades the esophagus resulting in the formation of a tracheoesophageal fistula (a connection is made linking lungs, trachea and esophagus together.Explain the superior vena cava syndromeCentral tumors grow and wrap around the SVC limiting and OBSTRUCTING venous return. (edema in face, neck,chest and engorged veins on the chest ) This is a MEDICAL EMERGENCYWhat benign skin lesion that if present on the trunk in multiple/exaggerated amounts should make you think lung CA (squamous cell mostly)Multiple Seborrheric Keratosis (brain muffin). This condition is called Lesser-Trelat SyndromeCA that has metastasized to the Lungs are mostly what type of CA's?Cancer of the bone and or liver.This diagnostic procedure works best for central lesion?Sputum Cytology; Peripheral lesions do not produce sputum (for the most part)This is the GOLD standard for radiological diagnosis of Lung CACXR; further examination may require CT or MRI but initial is CXR A percuatneous needle biopsy is also required for full diagnosis.A pt presents with a cc of arm/shoulder pain, parasthesia in the fingers with ptosis, anhydrosis and mitosis. Your diagnosis is?Pancoast tumor. Remember this tumor is located in the Superior pulmonary sulcusSmall cell or Non-small cell lung cancer which of the two is more aggressive?Small Cell lung cancerThis carcinoma occurs in major bronchi; expresses cytokeratin polypeptides, mostly correlated to smoking and makes up 35% of lung CASquamous Cell (central tumor)I have NO gland formation and lack characteristics of other lung CA. Who am ILarge Cell Carcinoma; makes up 10-20% of lung CAName 5 types of NON-SMALL CELL CARCINOMASquamous cell Large cell Adenocarcinoma Bronchioalveolar NeuroendocrineI'm mostly peripheral and attack men and women equally. I am less associated with smoking and make up 46% of lung cancers which is the most. Who am I?Adenocarcinoma; high risk for women exposed to passive or second hand smoking/environmentalA variant of adenocarcinoma, I am usually peripheral and commonly multifocal and BILATERAL. Who am IBronchioalveolar CarcinomaThis "cherry-looking" tumor presents commonly with hemoptysis in major bronchi and is NEVER biopsiedNeuroendocrine Tumor; Affects younger age groups and is an epithelial tumorA pt walks in with pytosis, Enophthalmos (miosis), and ahydrosis the trifecta of Horner's syndrome. Why do they present this way?A mass is compressing the cervical sympathetic nerves=Nerve entrapment of the upper chest and lower neck . One cause could be pancoast tumorUlnar pain and vasomotor signs in the _______ cervical and _________ thoracic nerve invasion are signs of what?8th cervical and 1st thoracic Nerve entrapment due to Pancoast tumor within the superior pulmonary sulcus pushing against the brachial plexus resulting in shoulder and upper extremity pain.A cough with an elevated diaphragm is indicative of what nerve involvement/entrapment? What cervical branch does it come off of?Phrenic nerve; C3-C5 keeps the diaphragm alive.This nerve is a branch of the Vagus nerve to which involvement/entrapment would present with hoarseness.Recurrent laryngeal nerveTumors that invade into structures such as the chest wall, superior sulcus, diaphragm and trachea are what type of tumorsT3Lung CA that have nerve involvement are late or early signs of CA?Late signs.Treatment for lung CA first involves ________ both pre-op and post-opStaging; ALL pts with CA must be stagedA T1 lesion is a tumor that is less than?3cm confined within the lung tissue (not invading the pleura)Of the staged pts. How many will typically be eligible for surgery?33% or 1/3. The rest will most likely get chemotherapy and radiationA tumor that is larger than 3cm and invades the visceral pleura is what type of tumor?T2Staging: TNM; Tumor/Size (1-3) Node involved (0-3) and M?MetastasisThe criteria for staging for lymph nodal involvementNx: lymph nodes cannot be evaluated N0: tumor cells absent from regional lymph nodes N1: REGIONAL lymph node metastasis present; (at some sites: tumor spread to closest or small number of regional lymph nodes) N2: tumor spread to an extent between N1 and N3 (N2 is not used at all sites) N3: tumor spread to more DISTANT or NUMEROUS regional lymph nodes (N3 is not used at all sites)Age, pulmonary function, cardiovascular disease and ______are preoperative assessments for surgical eligibilityExtent of resectionTo assess pulmonary function the most helpful spirometry parameter is ?FEV1 (minimum 0.8 post surgery)Pre, intra and postop goals for lung CA are?Pre-education, bronchodilation smoke cessation and infection control Intra- short anesthesia time, prevent aspiration and more bronchodilation prophylactic antibiotics Post- pain control, more pre-op goalsThis guy performed the first pneumonectomy in 1933 only to die of lung cancer.Evarts GrahamTHE MOST COMMON ARRHYTHMIA POST OP ISATRIAL FIBRILLATIONThe only chance of cure of Lung CA isSurgery. However only 33% will be eligible for it