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FRCR 2A (Crack The FRCR 2A) > 1. Chest p56-63 (Lung Cancer, Other Tumours) > Flashcards

1. Chest p56-63 (Lung Cancer, Other Tumours) Flashcards

1
Q

Solitary pulmonary nodule - definition (3)

A

Round or oval lesion <cm in diameter (>3cm = mass).
Surrounded by normal lung parenchyma.
No associated adenopathy or pleural effusion.

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2
Q

Classic benign calcification patterns (4)

A

Solid/diffuse.
Laminated.
Central.
Popcorn.

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3
Q

Benign pulmonary nodule features (3)

A

Presence of fat.
Rapid doubling time (<1 month).
Slow doubling time (>16 months)

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4
Q

Suspicious pulmonary nodule features (3)

A

Spiculated margins (corona Radiata sign).
Air bronchograms through the nodule (usually adenocarcinoma in situ).
Part solid/part ground glass lesions.

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5
Q

Solid vs ground glass nodules - suspicion (3)

A

Part solid/part ground glass is most sus.
Only ground glass is intermediate.
Totally solid is least sus.

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6
Q

when to use PET for SPNs

A

Can be used for SPNs >1cm.

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7
Q

Hot on PET - DDx (2)

A

Cancer is supposed to be hot (SUV > 2.5).
Infectious or granulomatous nodules can also be hot.

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8
Q

Ground glass nodules - PET findings (2)

A

Cold suggests cancer.
Hot suggests infection.

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9
Q

Lung cancer risk factors (5)

A

Being >30YO,
Exposure to arsenic, nickel, asbestos, chromium, beryllium, radon),
Lung fibrosis,
COPD,
FHx

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10
Q

Lung cancer - Types (4)

A

Squamous,
Small cell,
Large cell,
Adenocarcinoma

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11
Q

Squamous cell Ca - features (5)

A

Usually centrally located.
Strong smoking association.
Cavitation is common.
Ectopic PTH production.
Good prognosis, late to metastasize

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12
Q

Small cell Ca - features (5)

A

Usually central (common near main/lobar bronchi).
May only get central lymphadenopathy.
Paraneoplastic syndromes - SIADH and ectopic ACTH.
Poor prognosis.
Lambert Eaton - proximal weakness due to abnormal acetylcholine release at NMJ

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13
Q

Large cell Ca - features (2)

A

Peripheral and large (>4cm).
Poor prognosis.

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14
Q

Adenocarcinoma - features (3)

A

Usually peripheral, often upper lobes.
Commonest subtype and commonest to present as solitary pulmonary nodule.
Associated with lung fibrosis.

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15
Q

BAC (Broncho-Alveolar Carcinoma) - definition

A

Subtype of adenocarcinoma

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16
Q

Atypical adenomatous hyperplasia of the lung (AAH) - definition

A

Precursor to Adenocarcinoma of lung

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17
Q

Adenocarcinoma in Situ (ACIS) - features (2)

A

<3cm.
Multiple subtypes, commonest is non-mucinous.

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18
Q

Minimally invasive adenocarcinoma (MIA) (5)

A

<3cm with <5mm of stromal invasion (>5mm = lepidic predominant adenocarcinoma).
Usually ground glass.
Usually COLD on pet.
Fried egg sign (ground glass around nodule).
Pseudocavitation (bubble like lucencies).

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19
Q

Part solid nodules - malignancy predictor

A

Larger the solid part, the more likely to be malignant.

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20
Q

Staging threshold for unresectable lung cancer

A

3B (Implies N3 or T4 disease)

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21
Q

Lung cancer staging - multicentric tumours (3)

A

T3 - 2 lesions in same lobe
T4 - 2 lesions in different lobes (same lung)
M1a - 2 lesions in different lungs

22
Q

Non-resectable features of lung Ca (4)

A

Supraclavicular or Scalene nodes.
Contralateral mediastinal or hilar nodes.
Tumour in same lung but different lobes.
Malignant pleural effusion.

23
Q

Radiation changes - features (3)

A

Varied appearance, based on volume of lung involved, time involved and whether chemo also given.
Early (1-3 months): Homogenous or patchy ground glass opacities.
Late: Dense consolidation, traction bronchiectasis and volume loss

24
Q

Bronchopulmonary fistula - features (4)

A

Uncommon complication of pneumonectomy.
Normally: Empty space will fill with fluid.
Fistula: Empty space fills with air over time.
Can confirm with xenon NM test, shows xenon in the pneumonectomy space.

25
Q

Mets to the lungs - types (3)

A

Direct invasion,
Haematogenous,
Lymphangetic Carcinomatosis (LC)

26
Q

Direct invasion mets - sources (4)

A

Cancer of the mediastinum, pleura or chest wall.
Commonly oesophageal carcinoma, lymphoma or malignant germ cell tumour.
Rarely mets to the pleura which directly invade lung.
Even rarer - mesothelioma invading the lung.

27
Q

Haematogenous mets - features (4)

A

Tends to be multiple, random distribution, favouring lower lobes.
Nodules smoother than primary neoplasm.
Squamous mets can cavitate.
Cannonball mets typically from renal cell or choriocarcinoma (testis)

28
Q

Haematogenous mets - sources (5)

A

Breast,
Kidney,
Thyroid,
Colon,
Head and neck squamous Ca.

29
Q

Feeding vessel sign (2)

A

Prominent vessel heading into a nodule. Suggests haematogenous origin.
Either due to mets or septic emboli.

30
Q

Lymphagetic carcinomatosis (LC) - sources (5)

A

Commonest is bronchogenic carcinoma invading lymphatics.
Non-lung common causes include:
- Breast
- Stomach
- Pancreas
- Prostate

31
Q

Lymphangetic carcinomatosis (LC) - features (2)

A

Nodular thickening of interlobular septa and sub-pleural interstitium.
Thickening does NOT distort the pulmonary lobule, unlike fibrosis.

32
Q

Carcinoid - classification (4)

A

By distribution:
- peripheral pulmonary
- bronchial
By histologic type:
- typical
- atypical

33
Q

Typical carcinoid - trivia (2)

A

Slow growing, locally invasive (10% met to nodes).
No smoking association.

34
Q

Typical carcinoid - features (5)

A

Occur centrally within a bronchus and cause obstructive symptoms.
Can cause haemoptysis, as they’re highly vascular.
Localised by Octreotide scan.
Pulmonary tumours cause carcinoid syndrome w/flushing.
Valvular degeneration occurs on left side (GI carcinoid tumours cause right sided valve degeneration)

35
Q

Atypical carcinoids (2)

A

Rarer, seen in older people.
More likely to be a mass.

36
Q

Adenoid cystic (cylindroma) (3)

A

Commonest bronchial gland tumour.
NOT associated with smoking.
Usually main or lobar bronchus.

37
Q

Pulmonary lymphoma - types (4)

A

Primary,
Secondary,
PTLD,
AIDS related.

38
Q

Pulmonary lymphoma - imaging (3)

A

Radiographic pattern varies.
Lymphangitic spread (uncommon),
Perihilar airspace opacities,
Mediastinal adenopathy

39
Q

Primary pulmonary lymphoma - features (3)

A

Rare, usually non-hodgkin.
Defined as lack of extrathoracic involvement for 3 months.
80% are low grade MALToma

40
Q

Secondary pulmonary lymphoma - features (4)

A

More common than primary. Pulmonary involvement of systemic lymphoma.
NHL is more common than HL (80-90% lymphoma vs 10-20%)
But NHL is less likely to involve the lungs. (45% intrathoracic, 25% parenchymal disease, vs 85% intrathoracic and 40% parenchymal)
HL affects nodes and parenchyma, NHL can just affects parenchyma.

41
Q

PTLD (Post transplant lung disease) - features (4)

A

Usually within a year of solid organ or stem cell transplant.
Late presentations (>1 year) are more agressive.
B Cell lymphoma, with relationship with EB virus.
Can get nodal and extra-nodal disease.

42
Q

PTLD - imaging (4)

A

Typically:
Well defined pulmonary nodules/mass,
Patchy airspace consolidation,
Halo sign and
interlobular septal thickening

43
Q

AIDS Related Pulmonary Lymphoma (ARL) - Features (4)

A

Second most common lung tumour in AIDS (behind Kaposi),
Almost all high grade NHL.
Relationship with EBV.
Seen in CD4 <100.

44
Q

Aids related lymphoma- imaging (2)

A

Commonest: Multiple, peripheral nodules ranging 1-5cm.
Extranodal locations are common (CNS, bone marrow, lung, liver, bowel)

45
Q

AIDS pt with lung nodules, pleural effusion and lymphadenopathy

A

Lymphoma

46
Q

Kaposi sarcoma - imaging (3)

A

Favours tracheobronchial mucosa and perihilar lung.
Flame shaped.
Bloody pleural effusion is common (50%)

47
Q

Kaposi sarcoma - trivia (5)

A

Commonest lung tumour in AIDS (requires CD4 <200),
Most common hepatic neoplasm in AIDS,
Buzzword - flame shaped opacities.
Slow growth & asymptomatic, despite lungs looking terrible.
Thallium positive, gallium negative.

48
Q

Hamartoma - imaging/features (4)

A

Macroscopic fat and popcorn calcifications.
Usually incidental.
Can cause problems if endobronchial (2%)
Can be hot on PET, still benign.

49
Q

Hamartoma - trivia

A

Commonest benign lung mass.

50
Q

Thallium vs Gallium

A

Kaposi - Thallium positive, Gallium negative
Lymphoma - Gallium positive, Thallium negative

FRCR 2A (Crack The FRCR 2A) (56 decks)

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