Pulm Cancer

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countchocula58
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297079
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Pulm Cancer
Updated:
2015-02-27 22:02:52
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pulm cancer
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pulmy
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  1. Small Cell Carcinoma Histology
    • Neuroendocrine
    • Salt and pepper chromatid and nuclear moulding
    • Central
    • Little to no cytoplasm
    • High mitotic rate (most aggressive)
    • Frequent necrosis
    • Stains for neurosecretory granules
    • Absent or faint nucleolus
    • Derived from pluripotent bronchial stem cell or neuroendocrine cell of bronchus
    • BCL2 (antiapoptotic) in IHC
  2. Small Cell Carcinoma Patients
    • Smoking
    • Metastases at presentation often
    • Paraneoplastic syndromes (neurosecretory)
  3. Small Cell Carcinoma Treatment
    • Cannot do surgery
    • Initially highly sensitive to chemotherapy and radiation (Limited stage)
    • Limited stage is when all masses encompassable in one radiographic port
    • Extensive stage (everything else) only chemotherapy
  4. Non Small Cell Lung Cancer Treatment
    • Stage 1 is surgery
    • Stage 2 surgery/chemotherapy
    • Don’t do surgery if hypercapnic, cor pulmonale, or predicted post surgery FEV1<1.2 L
    • Stage 3 radiation and chemotherapy
    • Stage 4 chemotherapy and paliative
    • Treatment of advanced depends on performance status (PS) give 2 drugs 4-6 cycles
    • Adjuvant therapy is post surgical chemotherapy (but is it good?)
  5. Adenocarcinoma Histology
    • Pattern can be acinar, papillary, lepidic or solid (thus solid areas or ground glass areas)
    • Gross pleural puckering with solid yellow necrosis, due to peripheral locus with fibrosis retracting (most common)
    • Can also be central, difuse pneumonia like or pleural, or peripheral base
    • Derived from Clara cell, so mucin producing
    • Also can be derived from type 2 pneumocyte
  6. Adenocarcinoma Patients
    • Women more than men
    • non smokers (somatic mutation)
    • or smokers
    • 100% 5 year survival if completely resected
  7. Squamous Histology
    • Kertain producing, intracellular bridges and solid pattern
    • Central, involving major bronchi
    • Hypercalcemia
    • Certain protein targets for immunohistochemistry
  8. Squamous Patients
    Smoking
  9. Large Cell
    • Neuroendocrine
    • Prominent nucleoli with lots of cytoplasm
    • Can be multinucleate
    • Central or peripheral
    • Really just an “other” category
  10. Carcinoid
    • Often nested
    • Neuroendocrine
    • Usually asymptomatic so found incidentally
    • Hemoptysis or cough
    • Cushing’s syndrome only when metastatic
    • MEN1 is rare syndrome
    • Typical has no mitosis
    • Atypical has some mitosis
    • If more than 10 mitoses it’s large cell
  11. Lung cancer Screening
    • Don’t do sputum
    • Don’t do CXR
    • Do low dose CT if 30 pack years recent/current smoker over 55-80
    • Reduced lung cancer mortality 20%, all cause 7%
  12. Erlotinib
    • Inhibits tyrosin kinase associated with EGFR
    • Don’t know the mechanism
    • 33% improvement in overall survival
  13. Gefitinib
    • Study showed better than other chemodrugs in progression free survival at the one year mark
    • Use with EGFR M+ patients
  14. Crizotinib
    • Shrinks tumors in ALK patients
    • Adenocarcinoma
  15. Pancoast’s Tumor
    • Superior sulcus (apex)
    • Usually squamous cell
    • Pain/upper extremity weakness
    • Invades brachial plexus
    • Horner’s Syndrome: ptosis, miosis, anhidrosis
  16. Superior Vena Cava Syndrome
    • Facial fullness, edema, dilated veins over anterior chest wall
    • Usually goes away when you treat cancer
  17. Paraneoplastic Syndromes
    • 20% of patients
    • SIADH (too much ADH)
    • Cushing (ACTH)
    • Hypocalcemia (calcitonin)
    • Hypercalcemia (PTH-like factor)
    • Lambert-Eaton (similar to myasthenia gravis)
    • Hypertrophic Osteoarthopathy pain and clubbing, most common with adenocarcinoma
  18. Thymoma
    • Men and women in their 50s and 60s
    • Most asymptomatic
    • 1/3 have chest pain, cough, dyspnea, SVC syndrome
    • Up to half associated with myasthenia gravis (make sure this is under control before you treat)
  19. Thymoma Histology
    • Grossly lobular and anterior and superior mediastinum
    • Epithelial, spindle, and lymphocytes
    • Spindle is good prognosis (even with epithelial)
    • As you get more epithelial and less lymphocytic, the prognosis gets worse
    • Thymic carcinoma epithelial resembling other tissue types
  20. Thymoma Staging
    • WHO Type A Spindle-Good
    • AB Spindle and epithelial/lymphocytes-Good
    • B1 Lymphocytes and scattered epithelial-Good
    • B2 Lymphocytes and epithelial-Fair
    • B3 Scattered lymphocytes and epithelial rich-Fair
    • C Thymic Carcinoma-Poor
    • Masaoka Stage 1 non invasive of capsule of thymus (macro/microscopically)
    • Stage 2 invasive of fatty tissue outside thymus or microscopically invades capsule of thymus
    • Stage 3 macroscopically invades neighboring organs
    • Stage 4 metastases or hematologic spread
  21. Thymoma treatment
    • Surgery for non invasive
    • Surgery and radiation with or without chemo for invasive
    • Treat thymic carcinoma like carcinoma (aggresively)
  22. Hodgkins Lymphoma patients and treatment
    • Young females
    • Often asymptomatic
    • B cell symptoms (fever, night sweats, weight loss)
    • Low stage is chemo readiation
    • High stage is chemotherapy
    • Excellent prognosis if early stage
    • Acute lymphoblastic leukemia
  23. Hodgkins lymphoma histology
    • Primarily B cells
    • Reed sternberg (looks back at you)
    • Grossly nodular and sclerosing
  24. Acute lymphoblastic leukemia patients and treatment
    • Most common non-hodgkins lymphoma
    • Boys and adolescent males
    • Respiratory distress
    • SVC syndrome
    • Rapidly progressive to leukemic phase
    • Intense chemotherapy with or without bone marrow has improved dismal prognosis
  25. Acute lymphoblastic luekemia histology
    • Starry sky appearance
    • Mostly T cell
  26. Teratoma
    • Anterior for children and young adults
    • Bening or cystic
    • Asymptomatic
    • Mature can be calcified like teeth and incidental on CXR
    • Immature occur mostly in children, presenting with chest pain, cough dyspnea
    • Good prognosis mature and immature
    • Worse prognosis if other germ cell elements or immature elements or somatic malignancy
  27. Seminoma (germinoma)
    • Males 20s through 40s
    • Radiosensitive
    • Good prognosis
  28. True thymic hyperplasia
    • Weight of organ higher than expected for age
    • Rebound after stressful event (burns, surgery, illness)
  29. Follicular thymic hyperplasia
    • B, T, and lymphoid follicles
    • 75% with myasthenia gravis
  30. Light’s criteria
    • pleural protein/serum protein>.5
    • pleural LDH/serum LDH>.6
    • pleural LDH>2/3 normal serum
    • Any of these means exudate
  31. Parapneumonic pleural effusion criteria
    • Complicated if pH <7.1
    • LDH>1,000 IU/L
    • Glucose<40 mg/dl
    • New loculations
    • Uncomplicated: pH>7.3
    • if pH 7.1-7.3 take serial effusions

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