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Clinical Med II > Bronchogenic Carcinoma > Flashcards

Bronchogenic Carcinoma Flashcards

1
Q

What are common risk factors for lung cancer?

A
  • Smoking
  • Passive smoke exposure
  • Other exposures (abestos, radon, aresnic, radiation)
  • Genetic predisposition
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2
Q

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?

A

Solitary Pulmonary Nodule (SPN)

“Coin lesion”

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3
Q

If a lesion is > 3 cm, is this considered a nodule or mass?

A

Mass

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4
Q

Most benign nodules are due to infectious etiology from what sources?

A
  • TB
  • Cocci
  • Pulmonary abscess
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5
Q

In approaching an SPN, what should the first step be in regards to imaging?

What findings would suggest a benign lesion?

A

Review old films

Benign:

  • Minimal growth in 2 years
  • Calcification
  • Smooth, well-defined edges
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6
Q

In approaching an SPN and reviewing imaging, what findings would suggest an increased risk for a malignant nodule?

A
  • Doubled in size in 20-400 days
  • No calcification
  • Poorly defined, irregular, spiculated
  • Larger lesions, 5 cm or greater
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7
Q

What is the preferred imaging study to obtain when evaluating an SPN?

A

Helical CT of the chest w/o constrast and low dose radiation

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8
Q

If your patient has a solid nodule that is 6-8 mm, what should your management plan be?

A

Follow up with CT at 6-12 months then repeat as indicated

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9
Q

If your patient has a solid nodule that is < 6 mm, what should your management plan be?

A
  • Do not usually require follow-up

- CT at 12 months is optional

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10
Q

What are some indications for referral regarding a patient with a nodule/lesion?

A
  • New or enlarging lesion
  • Lesion is not stable, not calcified, irregular, > 3 cm
  • Lesion is indeterminate
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11
Q

What is the primary type of Small Cell Lung Cancer (SCLC)?

A

Oat cell carcinoma

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12
Q

Where does SCLC typically arise from?

A

Typically arises in central airways

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13
Q

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
A

Small Cell Lung Cancer

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14
Q

What is the prognosis of SCLC if not treated?

A

6-18 week survival

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15
Q

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
A

Adenocarcinoma

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16
Q

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
A

Squamous cell carcinoma

17
Q

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
A

Large Cell Carcinoma

18
Q

What symptoms are commonly associated with a primary lesion?

A
  • Cough (more common in Squamous and Small cell)
  • Weight loss
  • Dyspnea
  • Chest pain
  • Hemoptysis (more common in Squamous Cell)
19
Q

What are symptoms of intrathroacic spread?

A
  • Pleural effusion
  • Pericardial effusion
  • Hoarseness (more common with left-sided tumors; compression of recurrent laryngeal nerve)
  • SVC syndrome
20
Q

What is the most common intrathoracic malignant cause of SVC syndrome?

A

Non-small Cell Lung Cancer (NSCLC)

21
Q

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
A

SVC syndrome

22
Q

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?

A

Duplux Ultrasound

23
Q

What is the Gold Standard diagnostic test for SVC syndrome?

A

Superior vena cavogram

24
Q

What are treatment options for SVC Syndrome?

A
  • Emergency RT
  • Venous stent
  • Chemo if indicated
  • Removal of devices and anticoagulation
25
Q

What is the most common malignant cause of Pancoast Syndrome?

A

Squamous Cell Carcinoma (NSCLC)

26
Q

What is Pancoast Syndrome due to?

A

Tumor involving superior sulcus which compresses the brachial plexus and cervical sympathetic nerves

27
Q

The following presentation is most consistent with what syndrome?

Signs are on the same side of the tumor with pain being the worse closest to the tumor and then descending down (rib destruction, atrophy of hand muscles, pain C8, T1, T2 nerve roots)

Horner’s syndrome: Injury of sympathetic nerves of face:

  • Miosis
  • Anhidrosis (lack of sweating)
  • Ptosis
A

Pancoast Syndrome

28
Q

What is the common site of distant mets?

A

Liver

29
Q

What is the staging for SCLC?

A
  1. Limited disease
    - Tumor limited to ipsilateral hemithorax
  2. Extensive disease
    - Tumor extends beyond hemithorax
30
Q

What is the staging for NSCLC?

A

“T” - Primary tumor
“N” - Nodule involvement
“M” - Distant metastases

31
Q

What imaging study is superior to detect metastasis?

How does it work?

A

PET scan

Uses fluorodeoxyglucose (FDG) which will accumulate and light up in metabolically active cells such as cancer cells

32
Q

What is the management for SCLC?

A
  • Chemotherapy regardless of stage
  • Radiation
  • Prophylactic cranial radiation
  • Surgery only option for < 5%
33
Q

What is the management for Stage 1 NSCLC?

A

Surgical resection
- Lobectomy preferable

Stage 1B
- Surgical resection + chemotherapy

34
Q

What is the management for Stage 2 NSCLC?

A

Surgical resection + chemo

35
Q

What is the management for Stage 3 NSCLC?

A

Unresected:
- Concurrent chemoradiotherapy

Resected:

  • Adjuvant chemo
  • Clear resection margin: No RT
  • Positive or uncertain resection margin: Do RT
36
Q

What is the management for Stage 4 NSCLC?

A

Not curable

  • Palliative care
  • Resection of metastasis
  • Epidermal Growth Factor Receptor inhibitors (“Targeted Therapy”)
37
Q

If your patient has a solid nodule that is > 8 mm with low probability, what should your evaluation plan be?

A

Obtain CT at 3 months

  • No growth = serial CT at 9-12 and 18-24 months
  • Growth = pathological evaluation
38
Q

If your patient has a solid nodule that is > 8 mm with intermediate probability, what should your evaluation plan be?

A

FDG PET/CT and/or Biopsy

CT surveillance at 3, 9-12, and 18-24 months as an alternate to biopsy

39
Q

If your patient has a solid nodule that is > 8 mm with high probability, what should your evaluation plan be?

A

Biopsy or excision with referral to oncology

Clinical Med II (17 decks)

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