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 ?

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

10. What is the different tumor and cancer ?

Cancer
Definition: Class of diseases occurring due to uncontrolled growth of groups of cells.

Tumor
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. Removing a benign tumor is relatively easy through surgery, and the condition does not recur.

Treatment:

Surgery, chemotherapy and radiotherapy.

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

11. What is the different between maligna and benigna ? Benign Tumor Mobile mass. Smooth and round with a surrounding fibrous capsule. Cells multiply slowly. Fixed or ulcerating mass. Irregular shaped with no capsule. Cells multiply rapidly. Malignant Tumor

Tumor grows by expanding and pushing away and against Tumor grows by invading and destroying surrounding tissue. surrounding tissue.

Mass is mobile. Not attached to surrounding tissue. Never spread to other sites (metastasize). Easier to remove and does not recur after excision.

Mass is fixed. Attached to surrounding tissue and deeply fixed in surrounding tissue. Almost always spreads to other sites if not removed or destroyed. Difficult to remove and recurs after excision.

http://www.healthhype.com/characteristics-of-benign-and-malignant-tumors.html 12. What is the pathophisiology of lung cancer ?

VENA CAVA SUPERIOR SYNDROME

http://cancergrace.org/lung/files/2008/10/svc-syndrome.jpg

13. What is the etiology of lung cancer ?

http://www.lung-cancer.com/images/lungcancerfacts.jpg

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.

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

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

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

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

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

16. What is the diagnostic examination of lung cancer ?

17. What is the treatment for lung cancer ? Table 1: TNM Descriptors Descriptor Primary Tumor (T) T1 A small tumor that is not locally advanced or invasive <3 cm in diameter; T1a 2 cm; T1b > 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 or invasive >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 Description Criteria

main carina Might cause segmental or lobar atelectasis T3 Any size tumor that is locally advanced or invasive up to but not including the major intrathoracic 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 invasive into 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

stations 10 through 14) N2 Metastatic disease to nodes beyond the ipsilateral lung but not contralateral to the primary tumor Metastatic disease to nodes distant to those included in N2 Metastasis to the ipsilateral mediastinal and/or subcarinal nodes (nodal stations 1 through 9) Metastasis to contralateral mediastinal and/or hilar nodes ipsilateral or contralateral scalene and/or supraclavicular nodes

N3 Metastases (M) M0

Local or regional disease No distant metastases

M1

Disseminated disease m1a Presence of satellite tumor nodule(s) in contralateral lung malignant pleural or paranodal effusion m1b Distant metastases present

Table 2: NonSmall Cell Lung Cancer Staging Stage IA IB IIA IIB Description T1a, b N0 M0 T2a N0 M0 T1a, b N1 M0; T2a N1 M0; T2b N0 M0 T2b N1 M0, T3 N0 M0

IIIA IIIB IV

T3 N1 M0, T(1-3) N2 M0, T4N(0-1) M0 T4 N(2-3) M0, T(1-4) N3 M0 T(any) N(any) M1a, b

2002 The Cleveland Clinic Foundation. Box 3: Options for Treating Lung Cancer NonSmall Stages IA, IB, IIA, and IIB

Cell

Lung

Cancer

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

Platinum-based chemotherapy regimen in patients with adequate performance status Cell Lung Cancer

Small 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

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