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Most common risk factors for lung cancer?
Tobacco Smoke
occupational exposure; nickel chromates, arsenic, beryllium, asbestos
radiation: atomic bombs, uranium miners, radon
Fibrosis/ Scarring lungs
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Central keratinization or intercellular bridging. May grow to large size and cavitate, can be associated with hypercalcemia and there is a strong association with smoking.
squamous cell carcinoma
development pmeumonia, cough, eroded epi can cause cough with secretion including blood
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Commonly in women and non-smokers. In the periphery of lung and defined with glandular differentiation or mucin production and sometimes associated with fibrous scar.
Adenocarcinoma, difficult to differentiate from metastatic carcinoma.
subtype: Bronchioloalveolar carcinoma
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Tumor along pre-exsisting alveolar septa as solitary mass, multiple nodules or diffuse process. Well differentiated and diffuse. May have abundant mucus production.
Bronchiolalveolar carcinoma
subtype of adenocarcinoma, non smokers and women most common
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Centrally located "oat cell" that has a strong association with cigarette smoking. High incidence of extra pulmonary spread at diagnosis, commonly associated with ectopic hormone production, and most malignant end of neuroendocrine lung tumors
Small cell carcinoma
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Central or peripheral non-cell carcinoma. Does not display obvious squamous or glandular differentiation.
Large cell carcinoma
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A cancer that presents with signs of hormones, may be Cushing's like (ATCH), or ADH, gonadotropins, PTH
ectopic hormone production
small cell carcinoma, can also happen in squamous cell carcinoma
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to cough up blood
hemoptysis
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Clinical manifestations of intrapulmonary growth
- -cough and or cough with blood because of bronchial irritation and mucosal erosion
- -Post-obstructive pneumonia, abscess formation, atelectasis or air trapping due to obstruction of the bronchus
- -tumor may be silent and only detected incidentally on chest xray- peripheral (subpleural)
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atelectasis
collapse of all or part of the lung
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Manifestations of extrapulmonary growth
Centrally located tumors may invade the mediastinum, superior vena cava syndrome, invasion of recurrent laryngeal nerve causing hoarseness,
peripheral tumors may cause pain by invading the pleura
Apically located tumor invasion too
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Dusky cyanosis with distention of veins of head, neck, upper extremities, veins don't collapse when patient lifts their arm
Superior vena cava syndrome compress or invade vena cava because of centrally located tumor.
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Pancoasts or Superior Sulcus Tumor
Apically located tumor, extra pulmonary manifestation includes invasion of:
- brachial plexus - arm pain
- cervical sympathetic plexus- horners syndrome
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ipsilateral enophthalmos (recession of eyeball within orbit), ptosis (eyelid droops), meiosis (pupil constriction), and anhidrosis ( loss of sweating)
Horners syndrome due to apically located tumor
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Describe metastatic growth
May be Regional: bronchopulmonary adn mediastinal lymph nodes
May be distant metastasis: to extrathorac lymph nodes, liver, bone, brain, adrenal glands, these may be the first manifestations that lead to diagnosis of a lung carcinoma
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Paraneoplastic syndromes
tumors associated with syndromes that are not attributable to growth pattern
lambert eaton syndrome, hypertrophic pulmonary osterarthropathy, myopathy
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symptoms resembling myathenia gravis
lambert eaton syndrome
neuromuscular disorder of voluntary muscles
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periostitis, clubbing of digits, arthritis
hypertrophic pulmonary osterarthropathy
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Lungs cancers that are associated with secretion of hormones.
ectopic hormone secretion: most commonly small cell carcinomas
hypercelcemia- PTH- squamous cell carcinoma
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Understanding carconigenesis in lung
usually mutational changes to oncogenes or activation
or loss of tumor suppressor genes
k-ras
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Prognosis lung carcinomas
Poor because usually not determined until stage 3.
small cell carcinoma prog is worst because of freq metastatic spread
squamous cell carcinomas grow slow
poorly differentiated tumors behave more aggressively
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patient under 40, male:female ratio the same, neuroendocrine tumor of lung, no risk factor or smoking relationship; central or peripheral
carcinoid tumor
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polypoid mass projecting into bronchus lumen infiltrating peribronchial tissue, usually do not metastasize and are low grade malignant, very vascular
Carcinoid tumors
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most frequent carcinoma of the lung as multiple nodules(most common growth patten, solitary nodules, or rarely lymphangitic spread ( diffusely infiltrate pulmonary lymphatics with or without a nodular pattern)
resembles primary tumor, high incidence pulmonary metastasis from soft tissue and bone sarcomes
metastatic tumors of the lung
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rare benign tumor that a mix of mature cartilage, fibrous tissue, and fat. Solitary nodule on chest x-ray
hamaroma; benign neoplasm
usually solitary nodule, excision is curative
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an inflammatory disease of the lungs characterized by vascular response and exudate
pneumonia
caused by bacteria, viruses, fungi, and parasites
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4 routes of pneumonia infection
aspiration, inhalation, bacteremia, direct extension(acute inflammatory process from adj organ or structure)
aspiration is most common
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4 defense mechanisms of pneumonia
reflex closure of vocal cords, cough reflex, mucociliary clearance and macrophage activity and immune competence
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6 clinical situations that can impair defense mechanisms
will increase rick of bacterial infection:
- loss of consciousness
- immunodeficiency state
- pulmonary edema
- neutropenia
- chronic airway obstruction
- viral infection
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What components make up bacterial infection exudate
edema fluid, RBCs, leukocytes, fibrin
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