Approach to Lung Cancer Flashcards
- 72F, smoker
- Referred to you because she has an abnormal chest x-ray
Relevant positives:
• Active smoker, >70py
• Mild SOBOE. Mild expiratory wheezing, no lymphadenopathy.
Relevant negatives:
- No hemoptysis, chronic cough
- Weight unchanged, appetite preserved
- No new bony pains
- No new headache, gait disturbances or other neurological changes
What’s your approach to this CXR?
Looks like a Solitary Pulmonary Nodule: A lung lesion that is a discrete opacity, 3cm or
less in size, completely surrounded
by lung parenchyma, does not touch the
hilum or mediastinum, and is not associated
with adenopathy, atelectasis, or pleural
effusion
definition of solitary pulmonary nodule
A lung lesion that is a discrete opacity, 3cm or
less in size, completely surrounded
by LUNG PARENCHYMA, does not touch the
hilum or mediastinum, and is not associated
with adenopathy, atelectasis, or pleural
effusion
t/f a solitary pulmonary nodule can is a discrete opacity and can infiltrate the hilum
false. does not touch the
hilum or mediastinum, and is not associated
with adenopathy, atelectasis, or pleural
effusion
T/F a solitary pulmonary nodule is associated wtih adenopathy infiltration
false. is not associated
with adenopathy, atelectasis, or pleural
effusion
DDX of solitary pulmonary nodule.
outline the types of lung cancer and the subtypes
- small cell
- non small cell
- adenocarcinoma
- squamous cell
- large cell
___ cell carcioma is a highly aggressive cancer that arisses from ___ cells.
SMALL CELL CARCINOMA. Arises from neuroendocrine cells. majority are central and metastasize early. poor prognosis. there’s a 15% long term survival rate. treated with chemotherapy and radiotherapy.
Tx for small cell carcinoma
SMALL CELL CARCINOMA. Arises from neuroendocrine cells. majority are central and metastasize early. poor prognosis. there’s a 15% long term survival rate. treated with chemotherapy and radiotherapy.
usual stage of small cell carcinoma at diagnosis
most are at stage 4. basically incurable.
usual stage of non-small cell carcinoma at time of diagnosis
usually stage 4 too, but stage 1 and 2 are also detected at a higher rate compared to small cell
• Physiologic Evaluation of lung cancer
– Cardio Pulmonary function testing
• PFTs/Spirometry
- Sometimes echocardiogram
- Rarely exercise tolerance test – VO2max
LOCAL symptoms of lung cancer
resp: cough, hemoptysis, shortness of breath
tumor: pain, obstruction
METASTATIC causes of lung cancer
Common sites: CNS, MSK, adrenal, can go anywhere.
- weightloss, anorexia, fatigue, pain, neurologic
diagnostic staging tools (3 non-invasive, 2 invasive)
T/F lung cancer surgery makes the patient feel better
false. unlike other cancers where a patient has many symptoms alleviated afterwards, cutting out lung makes a patient feel worse.
The gold standard diagnostic tetst for LC
chest CT
- provides info about lesion and structures
- size, spiculation, calcification, nodes, other organs.
sensitivity and specificty of PET scan
95% sensitivity and 80%
specificity
___ imaging is done on the brain for Stage II and higher
CT/MRI. looks for extrathoracic mets.
tissue diagnosis:
Bronchoscopy: valuable in
__ lesions.
Bronchoscopy: valuable in
central lesions. Not good for small noduesl on the periphery, you wouldn’t see it.
a bronchoscopy can assess ___ invation and look at __- lesions. it can determine mainstem/carina involvement. Allows you to obtain a tissue diagnosis as well as biopsy lymph nodes via needle aspiration
a bronchoscopy can assess PROXIMAL invation and look at CENTRAL lesions.
Endobronchial US:
Very useful for evaluating for ___ nodes
• done if nodes enlarged,___on PET or stage II or higher –
Needle biopsy of abnormal nodes can be done
under direct vision
Very useful for evaluating for mediastinal nodes
• done if nodes enlarged, hot on PET or stage II or higher – Needle biopsy of abnormal nodes can be done
under direct vision
Schema for most Cancer Treatment
