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\author{xkissmekatex (kissmekate)}
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  /Title (lung-cancer.pdf)
  /Creator (Cheatography)
  /Author (xkissmekatex (kissmekate))
  /Subject (Lung Cancer Cheat Sheet)
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\noindent
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Lung Cancer Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{xkissmekatex (kissmekate)} via \textcolor{DarkBackground}{\uline{cheatography.com/33594/cs/10528/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}xkissmekatex (kissmekate) \\
  \uline{cheatography.com/kissmekate} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 14th January, 2017.\\
   Updated 16th January, 2017.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.94103 cm} x{3.03597 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Lung Cancer}}  \tn
% Row 0
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Pathology & •  Small cell lung cancer represents 25\%. {\bf{Non-small cell represents 75\%}}, and includes squamous cell carcinoma (30\%), adenocarcinoma (35\%), large cell carcinoma (5-10\%), and bronchoalveolar carcinoma. {\bf{Tissue biopsy is needed}} to distinguish the two. \tn 
% Row Count 11 (+ 11)
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Risk Factors & •  {\bf{Cigarette smoking}} (\textgreater{}85\% of patients) with a linear relationship between pack-years and risk. Adenocarcinoma has the lowest association with lung cancer. Passive smoke, redone (high levels in basements), and COPD (independent risk factor even after smoking is taken out). Asbestos (common in shipbuilding and construction, car mechanics, and painting professions) and smoking synergistically increase risk of lung cancer. \tn 
% Row Count 29 (+ 18)
% Row 2
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Local Symptoms & •  Most commonly associated with {\bf{squamous cell}}. Airway involvement can lead to cough, hemoptysis, obstruction, wheezing, and dyspnea. Recurrent pneumonia (post obstructive). \tn 
% Row Count 37 (+ 8)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Lung Cancer (cont)}}  \tn
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Constitutional Symptoms & •  Anorexia, weight loss, and weakness. Usually associated with advanced disease. \tn 
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Staging & •  NSCLC uses the TNM system. \{\{nl\}\} •  SCLC is either limited (confined to chest plus supraclavicular nodes-{}-but not cervical or axillary nodes) or extensive (outside the chest and supraclavicular nodes). \tn 
% Row Count 13 (+ 9)
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Prognosis & •  In SCLC, 5-year survival is 10-13\% for limited disease and {\bf{1-2\% for extensive disease}}. 85\% of SCLC have extensive disease at time of presentation. Overall 5-year survival for lung cancer is 14\%. \tn 
% Row Count 22 (+ 9)
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Metastatic Disease & Most common sites are brain, bone, adrenal glands, and liver. \tn 
% Row Count 25 (+ 3)
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Malignant Pleural Effusion & Occurs in 10-15\% of patients. Prognosis is very poor and equivalent to distant metastases. \tn 
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Types}}  \tn
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Features of NSCLC & •  Squamous (20-25\% of lung cancer) is {\bf{usually central and can have necrosis/cavitation}}. It is associated with {\bf{hyperCa}} and the leading cancer in nonsmokers. \{\{nl\}\} •  Adenocarcinoma (40-50\%) is often {\bf{peripheral}}, involves {\bf{pleura}} in 20\% of cases, and can be associated with {\bf{pulmonary fibrosis, clubbing, and hypertrophic osteoarthropathy}}. \{\{nl\}\} •  Large cell (5-10\%) is usually peripheral and associated with gynecomastia and galactorrhea. \tn 
% Row Count 17 (+ 17)
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Features of SCLC & •  Accounts for 10-15\% of cases. \{\{nl\}\} •  {\bf{Central}}, tend to narrow bronchi by extrinsic compression, and widespread metastases are common (50-75\% of patients at presentation).  •  Associated with {\bf{Cushing syndrome, SIADH}}, and Lambert-Eaton syndrome. \tn 
% Row Count 27 (+ 10)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Solitary Pulmonary Nodule}}  \tn
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Pathology & Single, {\bf{well circumscribed}} nodule on CXR without associated mediastinal or hilar lymph node involvement. Has a wide differential diagnosis. \tn 
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Diagnosis & Flexible bronchoscopy for central lesions, transthoracic needle biopsy, PET scan. \tn 
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CXR & If stable for more than 2 years, likely benign. Malignant lesions grow relatively rapidly. Growth over days is usually infectious or inflammatory (not malignant). \tn 
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Indications of Benign Nodule & Younger age (50\% chance of malignancy if patient is \textgreater{}50), nonsmoker, {\bf{smaller size (\textless{}1cm)}}, {\bf{smooth/discrete borders}}, dense, central calcification (eccentric asymmetric calcification indicates malignancy), no change in size. \tn 
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Low Probability Nodules & Get serial CTs. \tn 
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Solitary Pulmonary Nodule (cont)}}  \tn
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Intermediate Probability & \textless{}1cm: serial CTs. \tn 
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Intermediate Probability \textgreater{}1cm & {\bf{PET scan}}. If positive, transthoracic needle aspiration biopsy or fiberoptic bronchoscopy, then excise the nodule. \tn 
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High Probability & Excision \tn 
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Syndromes}}  \tn
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{\bf{SVC Syndrome}} & •  Occurs in 5\% of patients and is cause by {\bf{obstruction of the SVC}} by a mediastinal tumor (most commonly SCLC). Associated with {\bf{facial fullness, dyspnea, venous congestion, facial and arm edema}}, dilated veins over the anterior chest, arms, and face, and JVD. \tn 
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Phrenic Nerve Palsy & •  Occurs in 1\% of patients: destruction of phrenic nerve by tumor, as the phrenic nerve courses through the mediastinum to innervate the diaphragm. Results in {\bf{hemidiaphragmatic paralysis}}. \tn 
% Row Count 22 (+ 9)
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Recurrent Laryngeal Nerve Palsy & •  Occurs in 3\% of patients. Causes hoarseness. \tn 
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Horner's Syndrome & •  Due to invasion of cervical sympathetic chain by an apical tumor. \{\{nl\}\} •  Symptoms include {\bf{unilateral facial anhidrosis, ptosis, and miosis}}. \tn 
% Row Count 32 (+ 7)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Syndromes (cont)}}  \tn
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Pancoast's Tumor & •  Superior sulcus tumor. \{\{nl\}\} •  Apical tumor involving C8 and T1-T2 nerve roots, causing {\bf{shoulder pain radiating down the arm}}. \{\{nl\}\} •  Usually squamous cell cancers. \{\{nl\}\} •  Symptoms include {\bf{pain, UE weakness}} due to brachial plexus invasion, supraclavicular lymph node enlargement, and weight loss. \{\{nl\}\} •  Associated with Horner's Syndrome (ipsilateral ptosis, mitosis, enopthalmos, and anhidrosis) 60\% of the time. Usually NSCLC. \tn 
% Row Count 21 (+ 21)
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Paraneoplastic Syndromes & •  {\bf{SIADH in SCLC}} (10\%).  \{\{nl\}\} •  Ectopic ACTH secretion in small cell carcinoma. PTH-like hormone secretion is squamous cell carcinoma (constipation, thirst, anorexia).  \{\{nl\}\} •  Hypertrophic pulmonary osteoarthropathy in adenocarcinoma and squamous cell carcinoma, associated with {\bf{severe long bone pain}}.  \{\{nl\}\} •  Eaton-Lambert Syndrome most common in SCLC and looks like myasthenia gravis (proximal muscle weakness/fatigablity, diminished deep tendon reflexes, paresthesias), digital clubbing. \tn 
% Row Count 45 (+ 24)
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\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Treatment}}  \tn
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Treatment of NSCLC & {\bf{Surgery is the best option}}, but patients with metastatic disease outside the chest are not candidates. Recurrence can occur even after complete resection. Radiation is important. Chemotherapy is of uncertain benefit. \tn 
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Treatment of SCLC & For limited disease, {\bf{combo chemoradiation}} therapy used initially. For extensive disease, chemotherapy alone as the initial treatment. If the patient responds, prophylactic radiation decreases incidence of brain metastases and prolongs survival. Usually unresectable. \tn 
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\begin{tabularx}{5.377cm}{x{1.9908 cm} x{2.9862 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Testing}}  \tn
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CXR & {\bf{Most important study for diagnosis}}. Demonstrates abnormal findings in nearly all patients. \{\{nl\}\} •  Stability of an abnormality over a 2 year period is almost always associated with a benign lesion.\{\{nl\}\} •  May show pleural effusion, which should be tapped and examined for malignant cells. \tn 
% Row Count 13 (+ 13)
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CT Scan & With {\bf{IV contrast}}. Very useful for standing and accurate in revealing LAD in mediastinum. Can demonstrate extent of local and distant metastasis. \tn 
% Row Count 20 (+ 7)
% Row 2
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Cytology of Sputum & Diagnoses {\bf{central tumors}} in 80\% of cases but not peripheral lesions. Provides highly variable results. If negative and clinical suspicion is high, further tests are indicated. \tn 
% Row Count 28 (+ 8)
% Row 3
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Bronchoscopy & Can only be inserted as far as secondary branches of bronchial tree. Useful for diagnosing {\bf{central visualized tumors}} but not peripheral lesions. The larger and more central a lesion, the higher the diagnostic yield. For visible tumors, bronchoscopy is diagnostic in \textgreater{}90\% of cases. \tn 
% Row Count 40 (+ 12)
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\begin{tabularx}{5.377cm}{x{1.9908 cm} x{2.9862 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Testing (cont)}}  \tn
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PET Scan & Provides additional information that primary tumor is malignant, detect lymph node and intrathoracic and distant metastases. \tn 
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Transthoracic Needle Biopsy & Highly accurate and useful for {\bf{diagnosing peripheral lesions}} as well. Under fluoroscopic or CT guidance. Invasive procedure only used in selected patients. \tn 
% Row Count 13 (+ 7)
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Mediastinoscopy & Allows direct visualization of superior mediastinum. Identifies patients with advanced disease who would not benefit from surgical resection. \tn 
% Row Count 19 (+ 6)
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\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Mediastinal Mass}}  \tn
% Row 0
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Causes & {\bf{Metastatic cancer}} is the most common cause in older patients. If anterior, thyroid, teratogenic tumors, thymoma, or lymphoma. If middle, lung cancer, lymphoma, aneurysms, cysts, or Morgagni hernia. If posterior, neurogenic tumors, esophageal masses, enteric cysts, aneurysms, or Bochdalek's hernia. \tn 
% Row Count 12 (+ 12)
% Row 1
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Clinical Presentation & Usually asymptomatic. If symptoms are present, usually due to compression or invasion. {\bf{Cough from compression of trachea or bronchi, sometimes with hemoptysis}}. Chest pain, dyspnea, post obstructive pneumonia, dysphasia (esophageal compression), {\bf{SVC syndrome, hoarseness (compression of recurrent laryngeal)}}, Horner's (compression of sympathetic ganglia), diaphragm paralysis (compression of phrenic). \tn 
% Row Count 28 (+ 16)
% Row 2
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Germ Cell Tumors & {\bf{Anterior mediastinal mass with elevated levels of BhCG and AFP}}. Occur primarily in young male patients and are locally invasive. BhCG occurs in both seminomatous and nonseminomatous germ cell tumors, but only the latter makes AFP. Diagnosis confirmed with biopsy. Usually primary tumors and not metastatic from the testicles. \tn 
% Row Count 41 (+ 13)
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\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Mediastinal Mass (cont)}}  \tn
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Diagnosis & CT is test of choice. Usually discovered incidentally on CXR. \tn 
% Row Count 3 (+ 3)
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% That's all folks
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