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COUGHING UP BLOOD WITH RAPID WEIGHT LOSS

1. Why does the patient get the puffy face ?2. Why does the patient get hoarse voices ?3. Why does the patient get facial anhidrosis, ptosis, and miosis ?4. Why do the examination of PA thoracic radiograph obtained well defined opaque mass ?

5. Why does the patient get shortness of breath, pain in the lower chest, and chest tightness when breathing ?6. Why does the patient get cough with phlegm ?7. Why does the patient get decrease of appetite and weight loss ?8. Why does after the patient run out the medicine, he suffered of cough and shortness again ?9.

How the relation about horner syndrome and and lung cancer ?

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http://www.health.am/cr/Horner-syndrome

10. What is the different tumor and cancer ?Cancer Tumor

Definition: Class of diseases occurring due to

uncontrolled growth of groups of

cells.

A tumor or tumour is the name for a

swelling or lesion formed by

anabnormal growth of cells. A tumor

can be benign, pre-malignant or

malignant, whereas cancer is

bydefinition malignant.

Treatment: Surgery, chemotherapy and

radiotherapy.

Removing a benign tumor is

relatively easy through surgery,

and the condition does not recur.

http://www.diffen.com/difference/Cancer_vs_Tumor

11. What is the different between maligna and benigna ?Benign Tumor Malignant Tumor

Mobile mass. Fixed or ulcerating mass.

Smooth and round with a surrounding fibrous capsule. Irregular shaped with no capsule.

Cells multiply slowly. Cells multiply rapidly.

Tumor grows by expanding and pushing away and against

surrounding tissue.Tumor grows by invading and destroying surrounding tissue.
http://www.health.am/cr/Horner-syndromehttp://www.health.am/cr/Horner-syndromehttp://www.diffen.com/difference/Cancer_vs_Tumorhttp://www.diffen.com/difference/Cancer_vs_Tumorhttp://www.diffen.com/difference/Cancer_vs_Tumorhttp://www.health.am/cr/Horner-syndrome

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Mass is mobile. Not attached to surrounding tissue.Mass is fixed. Attached to surrounding tissue and deeply fixed in

surrounding tissue.

Never spread to other sites (metastasize). Almost always spreads to other sites if not removed or destroyed.

Easier to remove and does not recur after excision. Difficult to remove and recurs after excision.

http://www.healthhype.com/characteristics-of-benign-and-malignant-tumors.html12. What is the pathophisiology of lung cancer ?
http://www.healthhype.com/characteristics-of-benign-and-malignant-tumors.htmlhttp://www.healthhype.com/characteristics-of-benign-and-malignant-tumors.htmlhttp://www.healthhype.com/characteristics-of-benign-and-malignant-tumors.html

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VENA CAVA SUPERIOR SYNDROME

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13. What is the etiology of lung cancer ?

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14. What is risk factor of lung cancer ?About 85% to 90% of patients with lung cancer have had direct exposure to tobacco. Many tobacco-related carcinogens have been

identified; the two major classes are the N-nitrosamines and polycyclic aromatic hydrocarbons. A dose-response relation exists between

the degree of exposure to cigarette smoke and the development of lung cancer. The age at which smoking began, the number of

cigarettes smoked per day, and the duration of smoking all influence the likelihood of developing lung cancer. Also, the intensity of

smoking, the depth of inhalation, and the composition of the cigarette influence the risk.
http://cancergrace.org/lung/files/2008/10/svc-syndrome.jpghttp://cancergrace.org/lung/files/2008/10/svc-syndrome.jpghttp://www.lung-cancer.com/images/lungcancerfacts.jpghttp://www.lung-cancer.com/images/lungcancerfacts.jpghttp://www.lung-cancer.com/images/lungcancerfacts.jpghttp://cancergrace.org/lung/files/2008/10/svc-syndrome.jpg

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All cell types of lung cancer are associated with smoking. The strongest associations are with small cell and squamous cell carcinomas.

The risk of developing lung cancer decreases over time after smoking cessation, although it never reaches that of a lifelong nonsmoker.

Cigar smoking is also an independent risk factor for developing lung cancer.2

Exposure to sidestream smoke, or passive smoking, might lead to an increased risk of lung cancer. The risk varies with the level and

duration of exposure. It is generally a much lower risk than is active smoking.3

Some suggest the risk is negligible.4

Many other risk factors have been identified (Box 1). Occupational agents are known to act as lung cancer carcinogens. Arsenic, asbestos,

and chromium have the highest risk. An estimated 2% to 9% of lung cancers are related to occupational exposures. An inherited genetic

predisposition has epidemiologic support as a risk factor, but the mechanisms are theoretical at this time.5

Women appear to have a

higher baseline risk of developing lung cancer as well as a greater susceptibility to the effects of smoking. Differences in the metabolism

of tobacco-related carcinogens and their metabolites or an effect of hormone differences are believed to account for the increased

susceptibility. 6

Box 1: Lung Cancer Risk Factors

Tobacco Smoke Exposure

Active (mainstream) Cigarette Cigar Passive (sidestream)

Occupational and Environmental Exposures

Arsenic Asbestos Beryllium Bis(chloromethyl)ether
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib2http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib2http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib3http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib4http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib4http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#b0010http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib5http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib6http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib6http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib6http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib5http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#b0010http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib4http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib3http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/#bib2

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Cadmium Chromium Nickel Polycyclic aromatic hydrocarbons

Radon Vinyl chloride

Other Factors

Chronic obstructive pulmonary disease Dietary factors Gender Genetic predisposition

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/

15. What is the symptom of lung cancer ?Box 2: Lung Cancer Manifestations

Neoplastic

Local Growth

Cough Dyspnea Hemoptysis Pain

Regional Growth
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/lung-cancer/

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Dysphagia Dyspnea Hoarseness Horner's syndrome Hypoxia Pancoast's syndrome Pericardial or pleural effusions Superior vena cava syndrome

Metastatic Disease

Headache Hepatomegaly Mental status change Pain Papilledema Seizures Skin or soft tissue mass Syncope Weakness

Paraneoplastic

Cutaneous, Skeletal

Acanthosis nigricans Clubbing Dermatomyositis Hypertrophic osteoarthropathy

Endocrine

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Cushing's syndrome Humoral hypercalcemia SIADH Tumor necrosis factor (cachexia)

Hematologic

Anemia Polycythemia DIC Eosinophilia Granulocytosis Thrombophlebitis

Neurologic

Cancer-associated retinopathy Encephalomyelitis Lambert-Eaton syndrome Neuropathies Cerebellar degeneration

Renal

Glomerulonephritis Nephrotic syndrome


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16. What is the diagnostic examination of lung cancer ?

17. What is the treatment for lung cancer ?Table 1: TNM Descriptors

Descriptor Description Criteria

Primary Tumor (T)

T1 A small tumor that is not locally advanced or

invasive

2 cm 3 cm

Surrounded by lung or visceral pleura

Does not extend into the main bronchus

T2 A larger tumor that is minimally advanced orinvasive >3 cm in diameter, 7 cm; T2a > 3 cm 5 cm; T2b > 5 cm 7 cm

Might invade the visceral pleura

Might extend into the main bronchus but remains >2 cm from the

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main carina

Might cause segmental or lobar atelectasis

T3 Any size tumor that is locally advanced or

invasive up to but not including the majorintrathoracic structures

> 7 cm or

Might involve the chest wall, diaphragm, mediastinal pleura,

parietal pericardium, main bronchus within 2 cm of the main

carina (not involving the main carina)

Might cause atelectasis of the entire lung

Presence of satellite tumor nodule(s) within the primary tumor

lobe

T4 Any size tumor that is advanced or invasiveinto the major intrathoracic structures

Any size

Invades the mediastinum, heart, great vessels, trachea,

esophagus, vertebral body, main carina

Presence of satellite tumor nodule(s) in a different ipsilateral

tumor lobe

Regional Lymph

Node Involvement

(N)

N1 Metastatic disease to nodes within the

ipsilateral lung

Direct extension to intrapulmonary nodes

Metastasis to ipsilateral peribronchial and/or hilar nodes (nodal

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stations 10 through 14)

N2 Metastatic disease to nodes beyond the

ipsilateral lung but not contralateral to the

primary tumor

Metastasis to the ipsilateral mediastinal and/or subcarinal nodes

(nodal stations 1 through 9)

N3 Metastatic disease to nodes distant to those

included in N2

Metastasis to contralateral mediastinal and/or hilar nodes

ipsilateral or contralateral scalene and/or supraclavicular nodes

Metastases (M)

M0 Local or regional disease

No distant metastases

M1 Disseminated disease

m1a Presence of satellite tumor nodule(s) incontralateral lung malignant pleural or

paranodal effusion

m1b Distant metastases present

Table 2: NonSmall Cell Lung Cancer Staging

Stage Description

IA T1a, b N0 M0

IB T2a N0 M0

IIA T1a, b N1 M0; T2a N1 M0; T2b N0 M0

IIB T2b N1 M0, T3 N0 M0

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IIIA T3 N1 M0, T(1-3) N2 M0, T4N(0-1) M0

IIIB T4 N(2-3) M0, T(1-4) N3 M0

IV T(any) N(any) M1a, b

2002 The Cleveland Clinic Foundation.

Box 3: Options for Treating Lung Cancer

NonSmall Cell Lung Cancer

Stages IA, IB, IIA, and IIB

Surgical resection is the standard of care if the patient is deemed able to tolerate it Limited resection is used if the patient is unable to tolerate larger resection Radiotherapy is used if the patient is unable to tolerate resection or chooses not to undergo resection Adjuvant radiotherapy is possibly of use if incomplete resection was performed Consider adjuvant chemotherapy

Stage IIIA

Concurrent chemoradiotherapy using a platinum-based regimen if performance status is reasonable Induction chemoradiotherapy followed by resection in select patients, ideally as part of a study protocol

Stage IIIB

Concurrent chemoradiotherapy using a platinum-based regimen if performance status is reasonable

Induction chemoradiotherapy followed by resection in highly select patients, only as part of a study protocol

Stage IV

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Platinum-based chemotherapy regimen in patients with adequate performance status

Small Cell Lung Cancer

Limited-Stage

Combination chemotherapy with concurrent hyperfractionated radiotherapy if performance status is adequate Prophylactic cranial radiation for those with a complete response to chemoradiotherapy

Extensive-Stage

Combination chemotherapy if performance status is adequate


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