Lung Malignancies PDF

Lung Malignancies Classification of Tumors • Bronchogenic lung carcinomas o Non-small cell carcinomas § Adenocarcinoma (highest-40%) § Squamous cell carcinoma (30%) § Large cell carcinoma (15%) o Small cell carcinoma • Non-bronchogenic cancers of the lungs o Metastases o Carcinoid tumor o Others (sa...

Lung Malignancies Classification of Tumors • Bronchogenic lung carcinomas o Non-small cell carcinomas § Adenocarcinoma (highest-40%) § Squamous cell carcinoma (30%) § Large cell carcinoma (15%) o Small cell carcinoma • Non-bronchogenic cancers of the lungs o Metastases o Carcinoid tumor o Others (sarcomas, lymphomas) • Cancers of the pleura o Metastases o Mesothelioma • ~10% of lung carcinomas have combined histology Bronchogenic Carcinomas Risk Factors: • Tobacco smoking (active smokers and recently stopped smokers) • Environmental factors o Radon o Second hand smoke o Asbestos o Air pollution (indoor and out door) • Infection o Tuberculosis o AIDS o HPV • Genetic Factors: EGFR mutation common • Marijuana and vapes TBD regarding risk Adenocarcinoma of the Lung • Most common primary lung CA in smokers and non-smokers • Located in periphery of lungs • Worse prognosis than SCC • May spread locally via direct infiltration • May metastasize • Tx of choice: o early stage: surgery o Advanced stage: surgery + chemo SCC of the Lung • Located in Central presentation in lungs • Diagnosis: TB, aspergillosis, lung abscess • May produce parathyroid hormone leads to hypercalcemia Large Cell Lung Carcinoma • Located peripheral in lungs • Highly anaplastic and undifferentiated • Poor prognosis Small Cell Lung carcinoma • Located Centrally in lungs • Undifferentiated • Very aggressive • Associated with paraneoplastic syndromes (ex. Cushing syndrome) Squamous and Small cell are Sentral Know locations Non-Bronchogenic Cancers in Lungs Metastatic Dz of Lungs • Most common site/reason for metastasis from lung • Common origin sites: o Breast 22% o Kidney o Head and neck o Colorectal Carcinoid Tumors • Intraluminal within bronchi: o Cough o Hemoptysis o Persistent/recurrent infections o Bronchiectasis o Atelectasis Pleural Based Malignancies Malignant Mesothelioma • Symptoms: o Chest pain o Dyspnea o Recurrent pleural effusions (bloody) • Metastasis to: o hilar nodes o liver Diagnosis and Tx in Lung Carcinoma Major Symptoms in Lung Carcinoma • Persistent Cough in 70-90% • Dyspnea in 55-87% • Weight Loss in 40% • Chest Pain in 40% • Hemoptysis (mild) in 20% Diagnostic Screening for Lung Carcinoma • Chest x-rays • Low dose CT scan • Sputum cytology Diagnosis of Lung Carcinoma • Suspicious nodes are biopsied o CT-guided transthoracic biopsy for peripheral lesions o Bronchoscopy biopsy for central lesions Treatment of Lung Carcinomas • Dependent on type, location, stage • Non-small cell lung cancers o Early: surgery (wedge resection, lobectomy, pneumonectomy) o Late: surgery + chemo • Small cell lung carcinomas o Surgery not indicated o Radiation and/or chemo • Carcinoid tumors o Early: surgery o Late: Radiation and/or chemo