Lung+Cancer

toc =Types of Lung Cancer= > ==Bronchogenic Carcinoma== >>* Arise from hilus of lung >>* adenocarcinmas may arive frfrom alveolar septal cells >> **Gross** >>* may fungate into bronchial tree >>* may grow as intraparencymal mass >>* usually grey-white and firm >>* focal hemoorhage, necrosis may cause spottiness >>* possible necrotic cavitation

>> ===Squamous Cell Carcinoma=== >>>* more common in men >>>* smoking strong risk factor >>>* often arise from central bronchi >>>* metastasize relatively late >>> **histology** >>>* keratin, intercellular bridges >>>* squamous metaplasia, epithelial dysplasia, carcinoma in situ

>> ===Adenocarcinoma=== >>>* most common cancer in women, nonsmokers >>>* often peripheral >>>* smoking also a risk factor >>> **histology** >>>** can be solid maces with few mucin-producing cells, or well-differentiated with obvious glandular elements >>>** **bronchoalveolar carcinoma** is a subtype >>>*** grow along pre-existing strucutre, alveolar walls >>>*** do not invade >>>*** //lepidic// growth, like butterflies on fence

>> ===Small Cell Carcinoma=== >>>* highly malignant >>>* smoking risk factor >>>* often arises centrally >>>* **early metastasis** causes poor prognosis >>> **histology** >>>** Small amount of cytoplasm packs nucleii together--//nuclear molding// >>>** 'lymphoid' appearance >>>** smaller than lymphocytes >>>** high mitotic count >>>** some secrete polypeptide hormones >>>*** suggests neuroendocrine origin > ==Mesotheliomas== >> ===Benign Mesotheliomas=== >> ===Malignant Mesotheliomas=== > ==Other Neuroendocrine Neoplasms== >> ===Carcinoids=== >>> *Push aside other tissues rather than invdaing tyrhough them

=Symptoms= > ==Cough== > ==Dyspnea== > ==Chest Pain== > ==Hemoptysis== > ==Hoarseness== > ==Paraneoplastic Syndromes==

=Diagnosis= > ==Sputum Cytology== > ==Fiberoptic Cytology== > ==Transthoracic Needle Aspiration==
 * Size
 * Extent of spread (contiguous, lymphatic)
 * Histology
 * margins

=Prognosis= > ==Metastases== > ==Metastatic Carcinoma In The Lung==

Common Mediastinal Tumors

Football Lung cancer Common problem 15% survivalusualy not surgical candidates Early detection Uphill battle\chronic bronchitis Metastaic change to squamous Then potential for dysplasia Squamous cell Some cells can exfoliate Cough up Possible detection method Rare to find early though…pt not present Cells increase in number Hyperchormoaic

Squamous cancer Assoc smoking 50-60 Cells invadinbg Fibrous response Desmoplasia Breast cancer…palpate breast cancer Hard, gritty Squamous carcinoma Keratin ccurls Keratin structures Calssify Small cell….chemo Non-small cancer Adenocarcinoma

Sqwuamous cell carcinoma Desmosomes Normal cells Looks like cancer [ppleomorphism Mitotic figvbures Arisis in main order bronchi Tumor invades connective tissue Irritates mucosa Nothing u8nu8sal about cough Other presentation…hemoptysis Wheezing Obstruction Broniectasis Metastasize late compared to adenocarcinomaas Bronchogenic carcinoma Cal also be glands, alveoli Best example of squamous cell carcinoima

Slide with two diseases….emphysema Spiral CTs Still working on detection Proliferation neoplastic cells Classify as adenocarcinoma Side-by-side Well-ordered columnar cells

Lung cancer increasingly common in women Also seen from radon Adenocarcinoma Few cm Metastasize early Surface has hemorrhage Diagnosis with aspiration Peripheral Adenocarcinoma Glands Doesn’t metastasize Lopidecus Like butterflies on a sense Goes through lung

Cough up bnbronchorrhea Water itnto bvronchii Bronchoaveolar metastases Fills up lungs Doesn’t invade Bronchialveolar carcinoma

Small cell carcinoma Neuroendocrine Small cell carcinoma Normal in Kolchiskty cell Cancer cells Confied to mucosa basement membrane Lymphocyte like Dysplasia Often in younger people Tumor proliferates amazingly Little cytoplasm Salt and peper Small cell carcinoma Metastasis to liver Bad ass tumor Nmedian survival time in weeks Makes no sense to remove lung Better treatment in chemotherapy…5-9 weeks to 2 years Systemic

Others, not as common Benign cousin… Carcinoid Like cancer, but not really Malignant neoplasm Remove 80% Young people don’t smoke Same colchinsky cells Cells orderly Metastasizing Good prognosis…respectable Atypical carcinoid….more aggressive…50% mortality Uniform nuclei Makes polypeptides,…ACTH Carcinoidism Also in GI tract

Wastebasket term No mucin, no ACTH Non-small cell carcinoma… ‘large-cell carcinoma’ Wastebasket term

Mesothelioma 400000 Lung disease Only recognized few years ago Covered by cells With asbestos, neoplastic syndrome Don’t look like neoplasticcells Microcapillaryu cells Look like star Desmoplastic mesothelioma Majority with asbestos exposure Tumor Over surface of lung Bio[sy of chest Painful Perfusion Uniformly lethal disease Palliative care

Brakelights Spraying something Carcinoma Cause cough Obstruct whole lumen Mucosa Obstrcutced Localized bronchiectasis Dilated bronchi Gets inflamed, Pneumonia Don’t get better Obstructive pneumonia Cavitate Hemoptysis Uncommon Erode into large artery Uncontrollable hemotpsysis Tracheoesophageal fistula Usually late stage disease No early warning signs Questions?\ Diagnosis Bronchoscopy Chunks of tissue Diagnostic piece Needle aspiration Small cell carcinoma Crushed DNA Cytology specimen Tumor all nuclei Easily crushed

Cough up squamous cell Doesn’t localize Useful if already have aradiograph anomaly

Treatment, prognisis indicators: Tumor size Extent of tumor spread(lymphatic, contiguous) Histologic cell type Surgical margin status Melanoma, renal cell carcinoma Filters out from other Extra shadow behind heart Rare….hamartoma