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S2 E059 Pulm Neoplastic Disease

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<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>

Lung Cancer

  • #1 cause of cancer related deaths
  • 85% of cases are associated with smoking
  • Multiple exposure and exposure to other toxins increases risk
  • Five year survival rate is 15%
  • Small Cell and Non Small Cell
  • Complications
    • SVC syndrome
      • Compression of the vena cava
    • Pancoast Tumor
      • Tumor at the apex of lung causing shoulder pain and and nerve damage
    • Horner syndrome
    • Hoarseness
      • Impingement of recurrent laryngeal nerve
    • Effusions
    • Carcinoid syndrome
      • Flushing
      • Diarrhea
      • Telangiectasias

Small Cell Lung Cancer (oats cell)

  • 15% of lung cancer
  • The most aggressive lung cancer
    • Early metastasis to the brain, liver, bones, kidneys and adrenal glands
  • Paraneoplastic syndrome is found in up to 20% of patients. The tumor cells may produce certain hormones including, adrenocorticotropic hormone and antidiuretic hormone. These produce Cushing’s syndrome or a syndrome of inappropriate antidiuretic hormone

Clinical Presentation

  • Weight loss
  • Anorexia
  • Cough
  • Hemoptysis
  • Chest pain

Labs, Studies and Physical Exam Findings

  • X – ray
  • Cytology of sputum
  • Bronchoscopy
  • CT – Hilar and mediastinal abnormalities
  • PET in order to look for metastasis
  • Thoracocentesis
  • Video assisted thoracic surgery (VATS)

Treatment

  • Surgical resection is rarely effective due to early metastasis
  • Chemotherapy
  • Radiation

Non Small Cell Lung Cancer

  • Squamous cell carcinoma, adenocarcinoma, large cell carcinoma
  • Less aggressive than small cell carcinoma

Squamous Cell Carcinoma (SCC)

  • Most commonly found in large central bronchi

Clinical Presentation

  • Cough
  • Chest pain
  • Dyspnea
  • Hemoptysis
  • Weight loss

Labs, Studies and Physical Exam Findings

  • X – ray
  • Cytology of sputum
  • Bronchoscopy
  • CT – Hilar and mediastinal abnormalities
  • PET in order to look for metastasis
  • Thoracocentesis
  • Video assisted thoracic surgery (VATS)

Treatment

  • Surgical resection is preferred
  • Radiation
  • Chemotherapy

Adenocarcinoma

  • Most common lung cancer in non smokers
  • Typically found in the peripheral lung
  • Usually these have metastasised on presentation

Clinical Presentation

  • Patients have fewer symptoms

Labs, Studies and Physical Exam Findings

  • X – ray
  • Cytology of sputum
  • Bronchoscopy
  • CT – Peripheral mass
  • PET in order to look for metastasis
  • Thoracocentesis
  • Video assisted thoracic surgery (VATS)

Treatment

  • Surgical resection is the best treatment though often once a patient presents with adenocarcinoma metastasis has already occurred
  • Radiation and chemotherapy may be used

Large Cell

  • Several different types of lung cancer fall into this bucket
  • Early metastasis

Clinical Presentation

  • Weight loss
  • non-productive cough

Labs, Studies and Physical Exam Findings

  • X – ray
  • Cytology of sputum
  • Bronchoscopy
  • CT
  • PET in order to look for metastasis
  • Thoracocentesis
  • Video assisted thoracic surgery (VATS)

Treatment

  • Surgical resection
  • Radiation and chemotherapy may be used

Carcinoid tumors

  • Neuroendocrine tumors most commonly found in the midgut
  • May originate in the lungs
  • Most have benign features and are symptomatic

Clinical Presentation

  • Symptoms are due to the excess hormone production
    • Flushing
    • Diarrhea
    • Abdominal cramping
    • Edema
  • Specific to carcinoid of the lungs
    • Cough
    • Hemoptysis

Labs, Studies and Physical Exam Findings

  • CT/MRI
  • Bronchoscopy
  • Microscopic examination of tissue

Treatment

  • Surgical resection of the tumor

Pulmonary nodules

  • <3cm and no other lung findings
  • Most are granulomas
  • Cancer is rare in patients under 30

Clinical Presentation

  • Incidental finding

Labs, Studies and Physical Exam Findings

  • Always compare to previous studies to determine the rate of growth
  • CT
    • Increasing size is directly correlated to risk of malignancy
    • Bad adjectives include
      • Spiculated
      • Eccentric calcifications
      • Thick walled
  • Biopsy
  • Bronchoscopy
  • VATS

Treatment

  • Watchful waiting
  • Surgical resection
  • Lobectomy

<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>