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risk factors of cancer
Industrial hazards
Occupational carcinogens
Radon
uranium
Asbestos
Chronic lung disease
Smoking
90% of lung cancers
Genetic factors
HIV infection
alcohol abuse
environmental toxins
Passive smoking
Environmental air pollution
Lab investigations
Sputum tests
Cytology
Malignant cells
Ziehl–Neelsen stain
Rule out TB
Biopsies
Bronchoscopy
Central
CT guided needle biopsy
Peripheral
Pleural fluid analysis
Cancer has spread to the outside lining of the lungs
radiology of RS
Electromagnetic waves
show the parts of your body in different shades
Bones look white
lungs look black.
Fat and other soft tissues look gray.
Normal X-ray
short clavicles
large mediastinum
Silhouette sign
refers to the loss of normal borders between thoracic structures
pathology
Pharmacology of lung cancer
Chemotherapy
Antimetabolites
Folate antagonists
Inhibiting thymidylate synthase & DHFR
Inhibition of DNA synthesis
Pralatrexate
Pemetrexed
Pyrimidine analogs
Inhibition of DNA polymerase
Incorporation into DNA
Inhibition of ribonucleotide reductase
Inhibition of DNA synthesis
Gemcitabine
Topoisomerase inhibitors
Camptothecins
Inhibiting topoisomerase I
Arresting the cell at S phase
Irinotecan & Topotecan
Epipodophyllotoxins
Inhibiting topoisomerase Il
Arresting the cell at S phase
Etoposide
Microtubule inhibitors
Stabilizing microtubule formation
Inhibition of angiogenesis
Paclitaxel AND Docetaxel
Alkylating agents
Forming intra-strand and inter-strand cross-links
Inhibition of DNA synthesis
Cisplatin
Carboplatin
Targeted Therapy
EGFR inhibitors
inhibit cell proliferation
EGFR
inside
Tyrosine kinase inhibitors
2nd generation: Afatinib
3rd generation:Osimertinib
1st generation: Erlotinib & Gefitinib
outside
monoclonal antibodies
Necitumumab
immunomodulatory monoclonal antibodies
inhibit the binding of PD-L1 on tumor cell with PD-1 onT cell
Detecting & destroying tumor cells
Nivolumab & Pembrolizumab
VEGF inhibitors
Target the tumor blood vessel's growth
Bevacizumab
anaplastic lymphoma kinase inhibitors
inhibit ALK fusion proteins
preventing high signalling & high cell proliferation
1st generation: Crizotinib
2nd generation: Alectinib & Certinib
lung cancer
Non-small lung cancer
Squamous cell carcinoma
Central
association with smoking
strong marker
p40
Large cell Carcinoma
association with smoking
poor response to chemotherapy
Peripheral
Early metastases
Poor prognosis
Adenocarcinoma
primary lung cancer
women
nonsmokers
Peripheral
mutations
EGFR gene
ALK gene
KRAS gene
Small cell lung cancer
Symptoms
Hemoptysis
Shortness of brith
Chest pain
Complications
Distant metastasis
Bone
Brain
Liver
Pancoast tumor
Lung caner that arises in the apex of the lung
Invasion of sympathetic chain
Invasion to nearby structures
Recurrent laryngeal nerve
Hoarseness of voice
Superior vena cava
Characteristics
Small malignant cells
Metastasis
Located centrally
Aggressive subtype and account for 20% of lung cancer
Staging
TNM (Tumor-node-metastasis) staging system
ethical issues of end of life
stages if grief reaction
denial
Cannot accept diagnosis & refuses to believe that
anger
Often directed at healthcare team
bargaining
Tries to strike bargain with higher being
depression
Distant, sad & hopeless.
acceptance
normal
minor wight loss
minor sleep disturbance
supportive psychotherapy
sleep agents
abnormal
significant weight loss
significant sleep disturbance
antidepressants
anti-psychotics
decision making criteria
Advance Directives
legal documents through which competent individuals express wishes for their future health care in the event that they can’t make such decisions for themselves.
Surrogate decision-making laws
System allows family/friend (aka surrogate) to make medical decisions for pts with no advance directives
pulmonary circulation
pulmonary pressures
pulomonary arterial pressure = 25/8 mmHg
mean pulmonary capillary pressure = 7 mmHg
left atrial pressure = 5 mmHg
pulmonary capillary wedge pressure
low pulmonary reisitance
high SA
high dispensability (compliance)
pulmonary flow
PVR
capillary recruitment
capillary distensibility
effect of gravity
zone 1
present in pathological condtions only
zone 2
zone 3
HPV
compensatory mechanism to control pulmonary flow in hypoxia
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