2. Bronchogenic Ca & Mesotheliomas - Banz

• Lung cancer - classification is based on location

  • central
  • small cell carcinoma
  • squamous cell carcinoma
  • peripheral
  • adenocarcinoma
  • large cell carcinoma
  • benign tumors
• Smoking cause - what kind of lung cancer?

  • small cell carcinoma
  • squamous cell carcinoma
• Non-smoker - cause what kind of lung cancer?

  • adenocarcinoma
  • benign tumors
• lung cancer - clinical presentation - peripheral growth will cause

  • pain from pleural or chest wall
  • SOB
  • tumor cavitation
• lung cancer - clinical presentation - malignant effusion will cause

  • pain
  • SOB
• Lung cancer can cause

  • pancoast or superior sulcus tumor syndrome
  • superior vena cava syndrome
• Pancoast or superior sulcus tumor syndrome - tumor growing into the apex of the lung
• Pancoast tumor affects C8-T2
• Pancoast tumor syndrome - presentation

  • shoulder pain radiating to ulnar and lower brachial plexopathy
  • also 1st and 2nd ribs
• Pancoast tumor will present with horner's syndrome

  • miosis
  • ptosis
  • anhidrosis
• superior vena cava syndrome - characterized by swelling of face and arm

  • often right side
  • elevated jugular venous distention
• Superior vena cava syndrome - treat with radiation therapy
• Squamous cell carcinoma - how does it cause symptoms

  • metastasis to lymph node will cause
  • tracheal obstruction
  • dysphagia
  • recurrent laryngeal paralysis with hoarseness
  • phrenic nerve palsy
  • SOB
  • sympathetic nerve paralysis with horner's
• How does squamous cell carcinoma cause hoarseness?

  metastasis will entrap recurrent laryngeal nerve
• Lung cancer - clinical manifestation

  • anorexia
  • night sweats
  • fever
  • weakness
• What kind of metastasis is common for lung cancer?

  extrathoracic
• Lung cancer that metastasis to the brain will cause?

  • headache
  • neurologic deficits
• lung cancer - bone metastasis can cause?

  • pain
  • pathologic fracture
  • cord compression
• Lung cancer - liver metastasis can lead to

  • hepatomegaly
  • RUQ pain
  • anorexia
• Lung cancer - clinical outcome is related to?

  stage at diagnosis
• Early detection of lung cancer involve?

  • screening tests
  • surveillance
  • early treatment
• What are unreliable tests that were used in the past to detect lung cancer?

  • CXR
  • sputum cytology
• What is a good imaging tool for imaging lung cancer?

  • CT for diagnosing stage 1
• What is required to confirm diagnosis for lung cancer?

  tissue sampling or cytology
• What is used to diagnosis peripheral lesions of lung cancer?

  VATS
• Sputum cytology is inexpensive and noninvasive but has a lower yield

  • need at least 3 sputum specimen
• Lung cancer - pulmonary function test

  • preop FEV > 2 L are at low risk of complications following lobectomy or pneumectomy
• adenocarcinoma occurs in more peripheral lung location
• Adenocarcinoma is associated with smoking
• Adenocarcinoma there is presence of

  • gland
  • papillary structure
  • bronchioalveolar pattern
  • cellular mucin
• Variant of adenocarcinoma include

  • signet ring
  • clear cell
  • mucinous pattern
• Large cell carcinoma tends to occur peripherally

  • poorly differentiated
• Large cell carcinoma is composed of sheets of larger malignant cells

  • associated with necrosis
• Large cell carcinoma is less responsive to chemotherapy

  • treatment - removed surgically
• Large cell carcinomas (non-small cell lung cancer) - there is strong association to smoking
• Staging of lung carcinoma is important for guiding treatment

  • guiding treatment
  • prognosis
  • clinical trials
• In NSCLC - the more extensive the disease --> the worse the prognosis

  • so surgical resection is the best chance of cure
• What is the best chance of cure for NSCLC in stage 1 and 2?

  surgical resection
• What labs are used for assessing staging of lung cancer

  • CBC
  • electrolytes
  • Ca2+
  • creatinine
  • liver tests
  • LDL
  • albumin
  • immunohistory
• mesothelioma - arise from surface lining of

  • pleura
  • peritoneum