Conway, E.M., Pikor, L.A., Hamilton, M.J., Lam, S.,S., Lam, W.L., & Bennewith, K.L. (2016). Macrophases, inflammation, and lungcancer. American Journal of Respiratory and Critical Care Medicine 193(2). doi: 10.1164/rccm.201508-1545CI
American Cancer Society. (2017). Lung cancer. Retrieved from https://www.cancer.org/cancer/lung-cancer.html
McCance, K.L., Heuther, S.E.., Brashers, V.L., and Rote, N.S. (2014). Pathophysiology: The biological basis for disease in adultsand children (7th ed.). St. Louis, MI: Elsevier Inc.
MSN605 Pathophysiology Across the Lifespan for ANP
Treatments
Self-care such as eating healthy foods and quitting smoking
Medications including chemotherapy, targeted therapy, andimmunotherapy
Surgery such as Pulmonary lobectomy, Wedge resection,Radiosurgery, Video-Assisted Thoracoscopic Surgery
Thoracotomy and Radiation Therapy
Cardiothoracic surgeonPhysicians
Causative Factors
Non-small Cell Lung Cancer -Inherited or acquired gene changes, such as TP53 or p16 tumor suppressor genes, and K–RAS or ALK oncogenes
Small Cell Lung Cancer-Inherited or acquired gene changes, such as TP53 and RB1 tumor suppress genes
Lung Carcinoid TumorNot much is known about the genetic implications of this tumor
Text book, exercises 34,35, 36, 37
Pathophysiologic Etiology
Chronic inflammatory conditions (such as asthma) increase cancer risk.
Lung cancer arises from respiratory epithelium. May be a response to a variety of risk factors thatincrease the potential of lung cancer, such as smoking, second hand smoking, and genetic factors.
Lung cancer tumors alter the immune system and are considered a hallmark of cancer. Lungtumors arise from chronic inflammation sites, filled with leukocytes, cytokines, chemokines, growthfactors, and matrix-degrading enzymes.
Tumor cancer cells are genetically different than the remaining cells.
Tumor-infiltrating leukocytes have tumor suppressing or tumor protecting effects. Thus, theyproliferate without any “stop” signal in their genetics.
CTLA-4 and cell death protein 1 are cytokines and immune checkpoints thought to be used toprotect lung carcinomasCTLA-4 blocking antibody with chemo revealed that squamous LC hadgreat clinical benefits.
Tumor promotes tumor associated macrophages (TAM) prevent immune system from creatinganti-tumoral response.
Common Findings
General
Cough that does not go away or gets worse
Coughing up blood or rust-colored sputum (spit orphlegm)
Chest pain that is often worse with deep breathing,coughing, or laughing
Weight loss and loss of appetite
Infections such as bronchitis and pneumonia that donot go away or keep coming back
Metastasized Lung Cancer Findings
Nervous system changes (headache, weakness,numbness of an extremity, dizziness, seizures)
Yellowing of skin and/or eyes
Lumps near the surface of the bodyBone pain
Nervous system changes (headache, weakness,numbness of an extremity, dizziness, seizures)
Yellowing of skin and/or eyes
Lumps near the surface of the body
Syndromes
Horner Syndrome (Typically in NSCLC than SCLC)
Superior Vena Cava Syndrome
Paraneoplastic SyndromesHorner Syndrome (Typicallyin NSCLC than SCLC)
Superior Vena Cava Syndrome
Risk Factors
Uranium, arsenic, beryllium, cadmium, silica, vinylchloride, nickel compounds, chromium compounds,coal products, mustard gas, chloromethyl ethers
Arsenic in drinking water
Personal or Family history of lung cancer
Diagnostic Testing
Image Testing
Diagnostic Testing
Lab Tests
Other Examinations
Tests to find Lung Cancer Spread in Chest
Endobronchial ultrasound, endoscopic esophagealultrasound, Mediastinoscopy and Mediastinotomy,Thoracoscopy, Endobronchial ultrasound, endoscopicesophageal ultrasound, Mediastinoscopy andMediastinotomy, Thoracoscopy
Blood tests for chromogranin A (CgA), neuron-specific enolase(NSE), cortisol, and substance P
Lung or Pulmonary Function Tests
Urine samples to test for 5-HIAAComplete Blood Count
Blood tests for chromogranin A (CgA), neuron-specific enolase(NSE), cortisol, and substance P
Lung or Pulmonary Function Tests
Urine samples to test for 5-HIAA
Biopsies sent to a pathology lab todiagnose disease such as cancer andclassify cancer type
Takes approximately one week forpathology report
Microscopic examination of affectedcells. May be taken by sputum cytology,thoracentesis, needle biopsy (fine needle,core biopsy), Transthoracic needlebiopsy, Bronchoscopy
Chest X-Ray, Computed Tomographyscan and/or biopsy, Magnetic ResonanceImaging scan, Positron EmissionTomography scan, and bone scan.
Non-small Cell Lung Cancer (85% of lung cancers)Small Cell Lung Cancer (10-15% of lung cancers)Lung Carcinoid Tumor (Fewer than 5% of lung cancers)
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