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Lung

  1. Most common tumor — Carcinoma Q
  2. Most common benign tumor — Hamartoma Q
  3. Most common cause of recurrent hemoptysis — Bronchial adenoma Q
  4. Most common intrabronchial cause of hemoptysis -
    1. Bronchitis;
    2. Broncheictasis
  5. Lung is second most common site of visceral metastases in the body (after Liver). Q
  6. Most common source of secondaries in lung — CA Colon Q
  7. Sources of Calcified metastases in lung:
    1. Osteosarcoma
    2. CA Breast
    3. CA Ovary
    4. Cavitatory metastases:
    5. Testicular CA
    6. Colonic CA
    7. Head and neck CA

Solitary Pulmonary Nodule

  1. Also called ‘Coin lesion’.
  2. Any solitary round homogenous opacity in lung, less than 6 cm. in size.
  3. Indicators for malignancy —
    1. Size >4cm.
    2. Lesion crossing a fissure Rapid growth
    3. ill defined margins
    4. Umbilicated or notched margins
    5. Corona radiata (spiculations)
    6. Peripheral location
    7. Absence of calcification
    8. Eccentric calcification (concentric or bull’s eye calcification seen in benign lesions)
    9. Thick walled cavity.
       
  • Location—
    1. Squamous cell CA & small cell CA — Central (mnomic S S S )
    2. Adenocarcinoma, Large cell carcinoma — Peripheral
    3. Clubbing is associated with — Non small cell carcinomas
    4. Superior vena cava compression syndrome (SVCS) is a/w — Small cell carcinoma
    5. Acromegaly is a/w — Small cell carcinoma & Large cell carcinoma
    6. Pancoast tumor is a/w — Squamous cell carcinoma
    7. Hypertrophic osteoarthropathy is a/w — Adenocarcinoma
    8. GH secreted by — Large cell carcinoma
    9. GHRH secreted by — Small cell carcinoma
    10. PTH secreted by — Squamous cell carcinoma

Souamous Cell Carcinoma

  1. Centrally located (near hilum)
  2. Strongest association with smoking
  3. Cavity formation and obstructive pneumonitis are usual.
  4. Shows best prognosis among the lung carcinomas.
  5. Most common associate paraneoplas tic syndrome is PTH secretion leading to Hypercalcemia and Hypophosphatemia.
  6. Most common cause of Pancoast tumor (Carcinoma at apex of lung) Q, which may lead to-
    1. Involvement of C8, T1 & T2 nerve roots
    2. Pain along ulnar nerve distribution.
    3. Homer’s syndrome
    4. Destruction of I & II ribs
    5. Treatment is RT + Surgery
  • Adenocarcinoma
    1. Most common Q.
    2. Peripheral in location.
    3. Most common type arising from a Pulmonary scar. Q
    4. Most common type that may spread by aerosol. Q
    5. Most common type that may spread transbronchially Q.
    6. Associated with:
      1. Hypertrophic pulmonary osteoarthropathy
      2. Hematological syndrome
  • Large cell carcinoma
    1. Also known as Anaplastic carcinoma
    2. Peripheral in location
    3. Associated with —
      1. GH secretion : Acromegaly
      2. Gonadotropin secretion: Gynaecomastia
      3. CNS involvement
  • Small cell carcinoma
    1. Also known as Oat— cell carcinoma
    2. Serum marker — Neuron — specific enolase
    3. Most rapidly growing lung carcinoma Q
    4. Worst prognosis among lung carcinoma Q
    5. Central in location
    6. Early metastasizing
    7. Shows highest association with paraneoplastic syndromes and Neurologic — myopathic syndrome.
    8. Associated paraneoplastic syndromes-
      1. Ectopic ADH secretion (SIADH) leading to hyponatremia.
      2. Ectopic GHRH secretion leading to hyponatremia Acromegaly & Hyperglycemia.
      3. Ectopic ACTH secretion leading to Hypokalemia (but body habitus, changes of cushing’s syndrome do not occur).
      4. Ectopic CRH (Corticotropin releasing hormone) secretion.
      5. Ectopic HPL (human placental lactogen) secretion.
      6. Ectopic GRP (gastrin releasing peptide) secretion.
      7. Ectopic VIP secretfôn leading to WDHA syndrome (Watery diarrhoea, hypokalemia& achlorhydria).
      8. Ectopic Gastrin, somatostatin secretion.
      9. Ectopic ANP (atrial natriuretic peptide) secretion.
    9. Remember, Small cell carcinoma does not cause:
      1. GH secretion
      2. GnRH secretion
      3. Hypoglycemia
      4. Clubbing
    10. Associated neurologic - Myopathic syndrome:
      1. Myasthenic Eaton - Lambert syndrome (due to development of Antivoltage-gated channel antibodies).
      2. Cerebellar degeneration
      3. Necrotizing myo/myelopathy.

Paraneoplastic syndrome associated with all types of lung carcinoma:Q

  1. Peritheral neuropathy
  2. Opsoclonus - Myoclonus
  3. Dermatomyositis, Polymyositis
  4. Acanthosis nigricans
  5. Scleroderma
  6. Most common presenting symptom: Cough
  7. COPD may also develop with CA lung
  8. Most common site of metastasis - liver
  9. Investigation of choice - CT scan
  10. Treatment
     
    Small cell carcinoma: (are usually unresectable)
    1. CT±RT
    2. RT to whole brain for metastases.
    3. Non small cell carcinoma:
    4. Stage I & II—> resection
    5. Stage lll & IV—*RT
  • Contraindication of surgical resection of carcinoma lung :
    1. Phrenic nerve palsy
    2. Malignant pleural effusion
    3. Positive supraclavicular nodes
    4. Vocal cord palsy
    5. Cardiac tamponade
    6. Tumor located near carina
  • Predisposing Factors For Sarcomas
    1. Chemical exposure:
       
    2. Viruses:
       
    3. Immunodeficiency : congenital or acquired sarcomas.
    4. Ionizing radation 
    5. Most Common Types Q
       

    6. Spread
      1. Local invasion is characteristic of soft tissue sarcomas.
      2. M. Common mode — Hematogenous, except:
      3. Lymphatic spread is seen among:
         
        (Acronym : SERAM)
        1. Synovial sarcoma
        2. Epitheloid sarcoma
        3. Rhabdomyosarcoma
        4. Angiosarcoma
        5. Melanoma (clear cell sarcoma)
      4. Histiocytosis shows very high tendency to metastasis.
    7. Diagnosis:
      1. Inv.Of choice:
         
        CT Scan — for tumours of thorax, abdomen, retroperitoneum
         
        MRI — for tumour of Head and Neck
      2. Definitive diagnosis — by histology
      3. Desmin is the immunohistochemical marker for most soft tissue sarcomas.
      4. Most important prognostic factor for soft tissue sarcoma is histological grade.
Treatment wide local excision.




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