LUNG 10/15 CH
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The right lobe is composed of how many lobes?
The left lobe is composed of how many lobes?
The lobes are seperated by what?
The _____ ______ consists of branched airways leading from the trachea to the microscopic air sacs (alveoli)
The bronchial tree consists of branched airways leading from the ______ to the ___________
- microscopic air sacs (alveoli)
The right and left bronchi arise from the ____ at the level of the 4th and 5th thoracic vertebrae.
The right and left bronchi arise from the trachea at the level of the ____ and _____ _____ _____
4th and 5th thoracic vertebrae.
The openings of the tubes are seperated by a ridge of cartilage called the
The ____ (right or left) bronchi are shorter than the _____(right or left) and have a more vertical slope
Because the right bronchi are shorter than the left, objects that become stuck and obstruct the airway tend to become lodged in the ____ ______
Each bronchus, accompanied by large ____ _____, enters its respective lung.
A short distance from its origin, each _____divides into secondary _____which in turn branch into finer and finer tubes.
The smaller tubes are called _____ and they continue to divide, giving rise to very thin tubes called _____ _____
- alveolar ducts
The alveolar ducts terminate in masses of microscopic air sacs called____
the _____ provide a large surface area thru which gas exchane can occur
where does gas exchange occur?
In the alveoli, _____diffuses thru the alveolar walls and enter the blood in the nearby capillaries, while _____ diffuses from the blood and enters the alveoli
- Oxygen O2
- Carbon Dioxide CO2
What diffuses thru the alveolar wall and enters the blood in the capillaries?
what diffuses from the blood and enters the alveoli>
Carbon Dioxide Co2
Each lung occupies most of the thoracic space on its side and is suspended in the cavity by attachments which include a _____ and some large ____ _____
The bronchus and blood vessels enter the lung on its medial surface thru a region called the
A layer of serous membrane, the ____ _____, is firmly attached to the surface of each lung and this membrane folds back at the hilum and beomes the _____ ______
- visceral pleura
- parietal pleura
The ____ ____ forms part of the mediastinum and lines the inner wall of the thoracic cavity
Where is the visceral pleura attached?
to the surface of each lung
Where does the visceral pleura folds back to the
hilum to become the parietal pleura
What does the parietal pleura form?
part of the mediastinum
what does the parietal pleura line?
the inner wall of the thoracic cavity
The _____ contains the thoracic duct, thymus gland, heart, and part of the esophagus
The mediastinum contains the
thoracic duct, thymus gland, heart, and part of the esophagus
Since the visceral and parietal pleural membranes are held together by surface tension,, there is normally no
actual space in the pleural cavity between them.
What happens if the thoracic wall is punctured?
atmospheric air may enter the pleural cavity and create a real space between the membranes
what is it called when the thoracic wall is punctured and atmospheric air enters the pleural cavity and creates a space between the membranes
What is the result of a pneumothorax>
what is atalectasis?
Once cancer hits the midline, what can happen?
it can cross to the other side
Which lobe does lung cancer generally start in?
Name the 6 lymph nodes
- Superior mediastinal nodes
- Inferior mediastinal nodes
- hilar nodes
- interlobar nodes
- lobar nodes
- segmental nodes
Air and food share the same pathway up until the ____
What color would you see on an xray is there is fluid in the lung?
white, because air always shows up black
Nodes are typically named by what _____ they are near
what is the #1 killer in men and women
The 5 year survival rate of lung cancer is ___ (High or low)
Lung cancer is typically caught around which stage?
At diagnosis ____ of patients have positive nodes, which means the prognosis goes down
Who has a slightly higher incidence of lung cancer ? men or women
Average onset of lung cancer is what age?
What is the #1 cause of lung cancer?
What are a few causes of lung cancer?
- Smoking #1
- exposure to combustion by products
- ionizing radiation
What is the most common side effects of radiation for lung cancer
What are a few radiation side effects for lung cancer
- Pulmonary fibrosis
- radiaiton pneumonitis
- sore throat
- spinal cord damage
- decreased blood counts
- esophagitis ( most common)
What are clinical presentations of lung cancer
- history of smoking
- unproduction cough
- hemoptysis (coughing up blood)
- weight loss
- unresolved pneumonitis
- chest wall pain
- apical tumors
- pleural effusion
What are the 2 different ways to divide lung cancer
- Small cell (oat)
- non-small cell
What are the subdivisions of non-small cell
- squamous cell
- large cell
which lung cancer has a high mortality rate and is very aggressive?
small cell (oat)
What % of lung cancers are small cell (oat)
10% of all lung cancers are
small cell (oat)
Which cancer tends to disseminate at time of diagnosis and has central lesions, is the most radiosensitive and has a 5 year survival rate of only 1%
small cell (oat)
Which lung cancer has a 1% survival rate?
- small cell (oat)\ or
- large cell
Which lung cancer has PCI indicated sometimes?
small cell (oat)
What is PCI
prophylactic cranial irradiation, which means to go ahead and irradiate the brain even if no mets are found yet because we know they will be there soon enough.
Which lung cancer is the most radio sensitve
small cell (oat)
40% of all lungs cancers are
squamous cell or adenocarcinoma
Which cancer lesions are central, metastisize early, most common in men, and most commonly associated with smoking?
squamous cell carcinoma
Which cancer has a 5 year survival rate of 20%
squamous cell and adenocarcinoma
Which cancer has peripheral lesions, metastisizes early, most common in females, less linked to cig smoking, and has a 5 year survival rate of 20%
Which cancer has peripheral lesions that that tend to metastisize early and have a 5 year surival rate of 13%
Where does lung cancer metastisize to>
brain, liver, and bone
where is the most common place for lung cancer to metastisize to?
What can the work up include for lung cancer patient
- physical exam
- chest xray
- ct thorax and abdomen (to see if liver is invovled)
- pet/ct scan to look at whole body
- pulmonary function test
- needle biopsy
- sputum cytology ( take phlegm and do analysis)
- bronchoscopy with biopsy (where you go down the nose to the lung to get biopsy)
- bone and liver scan to rule out metastasis
- CT if brain is small cell
If we are treating an upper lobe lesion, where would we be most interested in>
super clav and mediastinum
If we are treating an upper lobe lesion, what all would take the risk of being hit?
- brachial plexus
- spinal cord
- more of the lung
which beam would you use to treat an upper lobe
Upper lobe tumors are sometimes called
What are tumors that present in the apex of the lung and grow by local extension to involve the 8th cervical and the 1st thoracic nerve?
pancoast tumor (upper lobe)
Pancoast tumors that present in the apex of the lung and grow by local extension to involve the _____ _____ and the ___ ____ _____
- 8th cervical
- 1st thoracic nerve
Which syndrome is characterized by shoulder pain, which radiates down the arm, atrophy of the hand muscles, horner's syndrome (ipsilateral miosis (small pupils), ptosis (droppy eyelid), enophthalmos (recession of the eye ball), anhydrosis (inability to sweat normally) and bone erosis of the rib an vertebrea ( rib pain)
Pancoast tumor (upper lobe)
what is miosis
what is ptosis
What is enophthalmos
recession of the eyeball
what is anyhydrosis
If you hear Horner's syndrome, what should you first think of?
Apical tumor or pancoast tumor
To treat the middle lobe of the right lung, it is kind of the same as treating the upper lung, but you can either include the super clav or not, which beam would you use?
To treat the lower lobe you have to treat a larger field and use which beam
What dose do the lymphnodes receive?
What dose does the NSCLC receive?
- 6000-7500 cGy (180-200 daily)
- If getting chemo as well, then you stay at the lower end to 6000
What dose does the SCLC receive
4500-6000 cGy (180-200 daily)
What dose does the bronchogenic carcinomas receive?
- 6000-7500 cGy
- these are tumors in the alveoli tissue
what are tumors in the alveoli tissue called?
What are the boost fields for lung cancer/
- 4000-4500 cGy
- you could give the boosters obliquely
- RAO right anterior oblique
- LPO left posterior oblique
What is the difference between oblique and tangent?
With the oblique, the flash is no longer needed. You only need flash for tangent if treating skin like on the breast and ribs
What are the treatment techniques for treating lung cancer
- AP/PA, obliques, laterals, IMRT
- vac loc, wing board to support arms
- breathing techniques which is why we need the 2 cm around the tumor to account for the tumor moving when they breathe.
What is IMRT
IMRT is when you outline the tumor with small margins but lots of different fields. You come at the tumor from all different types of directions. This can take the beam into about 15 different segments so dose hits the tumor but not as much of the surrounding structures. Sort of like sculpting the dose.
For example, the spinal cord can only receive 4500 cGy which is why you have to change fields to limit the exposure to the cord. You can treat APPA until roughly 4000 cGy and the other 2000 booster can be hit angled with an oblique beam.
what is SVC?
Superior vena cava
SVC syndrome is when a lung tumor compresses the SVC which breaks off the O2 and the patient will turn blue and cannot breathe. You need to give more than the normal daily dose because this is an emergency so that we can get the patients air way unblocked. What is the daily dose for SVC syndrome
300-400 cGy and given in 3-4 fractions and then you can continue conventional treatment of the 180-200 cGy daily.
What is the TD 5/5 for the cord
What is the TD 5/5 for the esophagus
What is the TD 5/5 for normal lung
30% < 2000 cGy
What is the TD 5/5 for the heart
What is the TD 5/5 for the brachial plexus
What is the TD 5/5 for the skin
What is the TD 5/5 for the liver
What is the TD 5/5 for the bone
When is surgery a valid treatment option?
Typically stage I or II
What are viable surgery options for lung cancer?
- Thoracotomy (removing the lung lobe affected)
- VAT video assisted thoracotomy (using video to help remove the lung lobe)
- Wedge resection ( removing a partial lobe only)
when is a tumor unresectable?
- when it is attached to the chest wall or other structure
- Pleural effusion when there is fluid already in the lung.
- When it has already metastisized
- SVC syndrome (straight to radiation)
- tracheal wall invasion
- small cell histology ( once it comes back positive for small cell, they know right away that it has more than likely already spread)
During radiation therapy what is definitive cure>
When you are trying to cure the disease
When do you use pallative care?
- This is just to alleviate symptoms
- obstruction of bronchi
- hemoptysis ( to dry up the blood so they are no longer couging up blood)
- esophageal compression (open up to breathe)
What is the most common chemotherapy drug
What is the diff between visceral and pareietal pleura?
Visceral pleura coats the lung and the parietal pleura lines the thoracic wall and diaphragm
What is the most common type of lung cancer?
What is the most common symptom of lung cancer?
What is the syndrome that is a rare disorder that occurs when certain nerves that travel from your brain to your eyes and face are damaged. This is less of a disorder and more of a sign of another medical prob. Normally associated with pancoast tumors which presents in the apex of the lung and grow by local extension to involve the 8th cervial and 1st thoracic nerve.
What is the brachial plexus
a network of nerves formed by the cerival and thoracic spinal nerves and supplying the arm and parts of the shoulder
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