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LUNG CANCER - Coggle Diagram
LUNG CANCER
Most common cause of cancer
mortality in the US; Average age 60
Sites of metastases: Liver, Adrenals, Bone, Brand
If the metastases are in lung: Multiple lesions/ From breast, colon, prostate and bladder.
Key risk factors are cigarette smoke, radon, and asbestos
Cigarette: 1st cause of lung cancer
(85% occurs in smokers related pack-years); Polycyclic aromatic hydrocarbons & arsenic
Radon:
formed by radioactive decay of uranium, which is present in soil; Accumulates in closed spaces such as basements.
2nd most frequent cause of lung carcinoma in US
Divided into 2 categories
Small cell
carcinoma 15%
Also called
oat cell carcinoma
Treated with chemotherapy and radiation
Usually not amenable to surgical resection
Amplification of
myc
oncogenes common
Location CENTRAL
May Cause
neurologic paraneoplastic Syndrome
(Lambert-Eaton Myasthenic Sx, paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration) and
endocrine paraneoplastic Syndromes
(Cushing; SIADH).
Undifferentiated → Very aggressive
Non-small cell
carcinoma 85%
:
Usually amenable
to surgical resection
Squamous cell
carcinoma
CENTRAL
Hilar mass arisingfrom bronchus
Cavitation / Cigarettes / Hypercalcemia
Keratin pearls and intercelllular bridges (desmosomes)
Large cell
carcinoma
PERIPHERAL
Highly anaplastic undifferentiated tumor
Strong association with Tobacco
smoking
May produce
hCG →ginecomastia
Less responsive to Chemotx so surgically and
Poor prognosis
.
Pleomorphic giant cells.
Adenocarcinoma
PERIPHERAL
Most common 1° lung cancer. & Most common IN NOT SMOKERS. More common in females than males.
Activating mutations include
KRAS, EGFR, and ALK
.
Associated with
hypertrophic osteoarthropathy (clubbing).
Bronchioloalveolar subtype (adenocarcinoma in situ):
CXR
often shows hazy
infiltrates
similar to pneumonia "thickening alveolar walls"
Tall columnar cells containing mucus.
Better prognosis
.
Bronchial carcinoid
tumor
CENTRAL/PERIPHERAL
Excellent prognosis
Metastasis are rare
Symptoms
due to
mass effect
(wheezing) and
carcinoid syndrome
(flushing. diarrhea)
Nest of neuroendocrine cells
* Pancoast tumor
Specific type of lung cancer that originates at the apex of the lung, which is the uppermost part of the lung.
These tumors
can be either small cell carcinoma or non-small cell carcinoma BUUUT MOST are non-small specifically of the squamous cell carcinoma or adenocarcinoma subtype
May cause Pancoast syndrome
by invading/compressing local structures
Superior vena cava →
SVC syndrome
Brachiocephalic vein →
brachiocephalic syndrome
(unilateral symptoms)
Stellate ganglion →Horner syndrome
(ipsilateral ptosis, miosis, anhidrosis)
Brachial plexus
→ shoulder pain, sensorimotor deficits
(atrophy of intrinsic muscles of the hand)
Recurrent laryngeal nerve
→ hoarseness
Phrenic nerve
→
hemidiaphragm paralysis
(hemidiaphragm elevation on CXR)
Imaging
: usually reveals a
large, spiculated mass
;
however, a
solitary nodule
('coinlesion') can be seen.
**Benign lesions may also produce a 'coin-lesion,' especially in younger patients like Granuloma by Tb or Bronchial hamartoma
Complications:
SPHERE
of complications:
S
uperior vena cava/thoracic outlet syndromes,
P
ancoast tumor,
H
orner syndrome,
E
ndocrine (paraneoplastic),
R
ecurrent laryngeal nerve compression (hoarseness),
E
ffusions (pleural or pericardial)
TNM staging:
T - Tumor size and local extension
N - spread to regional lymph nodes (hilar and mediastinal)
M - a unique site of distant metastasis is the adrenal gland.
Testing for PD-L1 expression (pembrolizumab) guides immunotherapy in advanced disease; PD-L1 may be present in any non-small cell carcinoma
Testing for 'driver mutations' guides systemic therapy in advanced disease
15% 5-year survival; lung carcinoma often presents late; Screening by low-dose CT recommended for patients with long smoking history
Symptoms Nonspecific:
cough, hemoptysis, dyspnea,
weight loss, and
post-obstructive pneumonia