Flashcards in Chapter 30 WS Deck (33)
What are the three most significant variables that affect prognosis for patients with lung cancers of the respiratory system?
1) Stage or extent of the disease
2) clinical performance status as measured with the Karnofsky performance scale,
3) weight loss, especially greater than 5% of the total body weight over 3 months.
Mesothelioma is associated with exposure to what carcinogen.
How long is the latent period between exposure and the development of mesothelioma?
what is the carina and radiographically at what vertebral level is it located?
bifurcation of the trachea
Where do oxygen and carbon dioxide exchanges take place?
Aveoli and capillaries
What is the area of the lung called where the blood, lymphatic vessels, and nerves enter and exit the lungs?
What is the significance of the carina and hilum with regards to distant spread?
This is where tumor cells gain access to the circulatory system.
What is the mediastinum and what structures/organs are located in it?
The anatomy between the lungs and contains the:
- large vessels,
- lymph nodes and
- other structures.
List three of the earliest symptoms of lung cancer?
Weight loss, cough, hemoptysis (coughing up blood)
Describe three criteria related to an individual’s tobacco exposure that appear to increase the risk of development of lung cancer.
1) An increase duration of smoking
2) An increased use of unfiltered cigarettes
3) an increased number of cigarettes consumed
What is superior vena cava syndrome and what are some of the signs?
Symptoms/signs due to the compression of the superior vena cava (can be caused by lesions in the right lob that extend into the mediastinum)
Signs include: dyspnea; facial, neck and arm edema; orthopnea; cyanosis.
List the criteria for a tumor to be considered a Pancoast tumor.
• Resides in superior sulcus with the following clinical presentation
• Pain around the shoulder and down the arm
• Atrophy of the hand muscles
• Horner syndrome
• Bone erosion of the ribs and sometimes the vertebrae
What are the manifestations of Horner Syndrome?
- Ipsilateral miosis (contracted pupil),
- ptosis (drooping eyelid),
- enophthalmos(recession of the eyeball into the orbit), and
- anhidrosis (loss of facial sweating).
What is hypertrophic pulmonary osteoarthropathy and how does it manifest?
A frequently seen phenomenon associated with lung cancer.
Manifests by clubbing of the distal phalanges of the fingers.
What is a thoracentesis?
A surgical procedure in which a needle is inserted into the pleural space to remove excess fluid.
Also called a pleurocentesis
Prior to planning treatment, a CT scan of the brain is usually done for which two types of lung cancer.?
Small cell lung cancer and adenocarcinomas.
Also undifferentiated carcinomas
What is the most common pathological type of lung cancer in the U.S.?
Where in the lung do Squamous cell carcinomas most commonly arise?
Centrally in the proximal bronchi
Where in the lung do Adenocarcinomas most commonly arise?
List three patterns of spread for lung cancer.
Direct, Lymphatic, & hematogenous
Name the two groups of lymphatics that are primarily responsible for the regional spread of bronchogenic carcinoma.
Mediastinal and intrapulmonic
Lymph is drained from the left side of the body into the _________________ before entering the circulatory system via the __________________.
left subclavian vein
Lymph is drained from the right side of the body into the __________ before entering the circulatory system via the ___________
right lymphatic duct
right subclavian vein
Where do lung cancers most commonly metastasize to? (7)
- Cervical lymph nodes,
- adrenal glands,
- kidneys, and
- contralateral lung
How do tumors spread from one lung to the other?
Cells break away from the tumor and move to the area of the carina. Pressure changes as a result of respiration or gravity may transport the cell into the other hilum and then eventually into a resting place in the other lung
List 4 critical structures that are of primary concern when treating lung cancer and list complications of each if tolerances are exceeded.
• Spinal cord: myelopathy
• Esophagus: Difficulty swallowing
• Heart: pericarditis (constrictive form due to scar formation resulting in restriction of cardiac motion, rather than fluid buildup type)
• Health lung; radiation pneumonitis (1-3 months after radiation) and fibrosis (2-4 months after radiation)
Describe what boost fields are.
Smaller field sizes used to deliver a high dose to a smaller volume. Generally delivered to the GTV only, excluding lymph nodes
List two reasons it is important to know the depth of the spinal cord in the treatment of lung cancers.
Tumorcidal doses exceed tolerance dose of the spinal cord. Because the depth of the spinal cord varies along the vertebral column, the dose calculated to one point on the spinal cord is not the same for other points.
How are patients arms usually positioned during treatment for lung cancer?
above the head