Bronchogenic Carcinoma Flashcards
What are common risk factors for lung cancer?
- Smoking
- Passive smoke exposure
- Other exposures (abestos, radon, aresnic, radiation)
- Genetic predisposition
What is a small, < 3 cm, well defined lesion that is completely surrounded by pulmonary parenchyma and are typically smooth with well-defined edges and dense central calcification?
Solitary Pulmonary Nodule (SPN)
“Coin lesion”
If a lesion is > 3 cm, is this considered a nodule or mass?
Mass
Most benign nodules are due to infectious etiology from what sources?
- TB
- Cocci
- Pulmonary abscess
In approaching an SPN, what should the first step be in regards to imaging?
What findings would suggest a benign lesion?
Review old films
Benign:
- Minimal growth in 2 years
- Calcification
- Smooth, well-defined edges
In approaching an SPN and reviewing imaging, what findings would suggest an increased risk for a malignant nodule?
- Doubled in size in 20-400 days
- No calcification
- Poorly defined, irregular, spiculated
- Larger lesions, 5 cm or greater
What is the preferred imaging study to obtain when evaluating an SPN?
Helical CT of the chest w/o constrast and low dose radiation
If your patient has a solid nodule that is 6-8 mm, what should your management plan be?
Follow up with CT at 6-12 months then repeat as indicated
If your patient has a solid nodule that is < 6 mm, what should your management plan be?
- Do not usually require follow-up
- CT at 12 months is optional
What are some indications for referral regarding a patient with a nodule/lesion?
- New or enlarging lesion
- Lesion is not stable, not calcified, irregular, > 3 cm
- Lesion is indeterminate
What is the primary type of Small Cell Lung Cancer (SCLC)?
Oat cell carcinoma
Where does SCLC typically arise from?
Typically arises in central airways
Is the following presentation more consistent with SCLC or NSCLC?
- Large hilar mass with bulky mediastinal adenopathy
- Cough, dyspnea, weight loss
- Highly aggressive (70% present with metastatic disease)
- Strongly associated with smoking
Small Cell Lung Cancer
What is the prognosis of SCLC if not treated?
6-18 week survival
What type of NSCLC is the following presentation and manifestation most consistent with?
- Presents as peripheral nodules or masses
- Metastasizes to distant organs
- Most cases due to smoking
Adenocarcinoma
What type of NSCLC is the following presentation and manifestation most consistent with?
- Occurs centrally or in the main bronchus
- Cough
- More likely to cause hemoptysis
- Likely to metastasize to regional lymph nodes
- May cavitate
Squamous cell carcinoma
What type of NSCLC is the following presentation and manifestation most consistent with?
- Occurs as central or peripheral masses
- Metastasizes to distant organs
- Aggressive course with rapid doubling times
Large Cell Carcinoma
What symptoms are commonly associated with a primary lesion?
- Cough (more common in Squamous and Small cell)
- Weight loss
- Dyspnea
- Chest pain
- Hemoptysis (more common in Squamous Cell)
What are symptoms of intrathroacic spread?
- Pleural effusion
- Pericardial effusion
- Hoarseness (more common with left-sided tumors; compression of recurrent laryngeal nerve)
- SVC syndrome
What is the most common intrathoracic malignant cause of SVC syndrome?
Non-small Cell Lung Cancer (NSCLC)
The following symptoms are associated with what syndrome which can be a complication from malignancy?
- Dyspnea
- Facial swelling/head fullness
- Dilated neck veins
- Prominent venous patter on chest
- Arm swelling, cough, chest pain
SVC syndrome
If your patient presents with possible symptoms of SVC syndrome including arm swelling, but also has an indwelling medical device, what should be the initial study that you order?
Duplux Ultrasound
What is the Gold Standard diagnostic test for SVC syndrome?
Superior vena cavogram
What are treatment options for SVC Syndrome?
- Emergency RT
- Venous stent
- Chemo if indicated
- Removal of devices and anticoagulation
