Lung Cancer

Lung Cancer
Reference
Conway, E.M., Pikor, L.A., Hamilton, M.J., Lam, S.,S., Lam, W.L., & Bennewith, K.L. (2016). Macrophases, inflammation, and lung
cancer. 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 adults
and children (7th ed.). St. Louis, MI: Elsevier Inc.
Lung Cancer Concept Map
MSN605 Pathophysiology Across the Lifespan for ANP
Tabitha Agnir
Treatments
Self-care such as eating healthy foods and quitting smoking
Medications including chemotherapy, targeted therapy, and
immunotherapy
Surgery such as Pulmonary lobectomy, Wedge resection,
Radiosurgery, Video-Assisted Thoracoscopic Surgery
Thoracotomy and Radiation Therapy
Palliative Care
Physicians include:
Primary Care Provider
Oncologist
Palliative medicine
Radiologist
Pulmonologist
Cardiothoracic surgeonPhysicians
Primary Care Provider
Oncologist
Palliative medicine
Radiologist
Pulmonologist
Cardiothoracic surgeon
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 that
increase 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. Lung
tumors arise from chronic inflammation sites, filled with leukocytes, cytokines, chemokines, growth
factors, 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, they
proliferate without any “stop” signal in their genetics.
CTLA-4 and cell death protein 1 are cytokines and immune checkpoints thought to be used to
protect lung carcinomasCTLA-4 blocking antibody with chemo revealed that squamous LC had
great clinical benefits.
Tumor promotes tumor associated macrophages (TAM) prevent immune system from creating
anti-tumoral response.
Common Findings
General
Cough that does not go away or gets worse
Coughing up blood or rust-colored sputum (spit or
phlegm)
Chest pain that is often worse with deep breathing,
coughing, or laughing
Hoarseness
Weight loss and loss of appetite
Shortness of breath
Feeling tired or weak
Infections such as bronchitis and pneumonia that do
not go away or keep coming back
New onset of wheezing
Metastasized Lung Cancer Findings
Bone pain
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 (Typically
in NSCLC than SCLC)
Superior Vena Cava Syndrome
Paraneoplastic Syndromes
Risk Factors
Tobacco smoke
Radon exposure
Asbestos
Uranium, arsenic, beryllium, cadmium, silica, vinyl
chloride, nickel compounds, chromium compounds,
coal products, mustard gas, chloromethyl ethers
Diesel exhaust
Arsenic in drinking water
Radiation therapy
Air pollution
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 esophageal
ultrasound, Mediastinoscopy and Mediastinotomy,
Thoracoscopy, Endobronchial ultrasound, endoscopic
esophageal ultrasound, Mediastinoscopy and
Mediastinotomy, Thoracoscopy
Complete Blood Count
Blood Chemistry Tests
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 Chemistry Tests
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 to
diagnose disease such as cancer and
classify cancer type
Takes approximately one week for
pathology report
Microscopic examination of affected
cells. May be taken by sputum cytology,
thoracentesis, needle biopsy (fine needle,
core biopsy), Transthoracic needle
biopsy, Bronchoscopy
Chest X-Ray, Computed Tomography
scan and/or biopsy, Magnetic Resonance
Imaging scan, Positron Emission
Tomography 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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