Clin Med: Pulmonary Neoplasia Flashcards
Lung cancer screening guidelines
Adults aged 50-80 years who have a 20 pack-year smoking history and currently or have quit within the past 15 years
What imaging do we use for lung cancer screening
LDCT every year
Solitary Pulmonary nodule are more prevalent in
high risk pts - smokers, COPD, older pts
Benign vs Malignant types of nodules:
More likely to be benign
diffuse
central popcorn
concentric
size < 3cm
Benign vs Malignant types of nodules:
More likely to be malignant
Ground-glass
eccentric
size > 3cm
Solitary Pulmonary nodules are primarily _______ lung nodules
benign
What constitutes a Solitary Pulmonary nodule?
Discrete, round, size < 3 cm
“coin lesions”
not fixed to the pleura or chest wall
NO lymphadenopathy, infiltrate, atelectasis
Anything greater than 3 cm is called a
mass
Anything smaller than 3 cm is called a
nodule
Definitive dx of pulm nodules =
bx - CT guided fine needed, bronchoscopy with bx, excisional, etc.
80% of benign nodules are
infectious granulomas
High risk for a solitary pulmonary nodule
hx of smoking
+ Fhx of lung cancer
carcinogen exposure
upper lobe nodule
emphysema
pulmonary fibrosis
If found on CXR you need to follow up with a
Chest CT
Bronchogenic Carcinomas is the traditional “______”
lung cancer
#1 cause of cancer deaths
Bronchogenic Carcinomas are rare prior to the age of
40
Bronchogenic Carcinomas risk factors
85-90% secondary to smoking
+FHx
Pre-existing pulmonary disease
Exposure-related risks
Bronchogenic Carcinomas are divided into 2 types of cancer
small-cell (aka oat cell)
non-cell cancer types
Non small cell includes
adenocarcinoma
squamous cell carcinoma
Large cell carcinoma (everything else)
Bronchogenic Carcinomas:
Small cell =
neuroendocrine cells
Small cell carcinoma has a strong association with
smoking
Presentation of small cell carcinoma
rapid onset of sx (8-12 wks)
paraneoplastic syndromes common
mets common at presentation
central (bronchial) masses
Adenocarcinoma is m/c in
non-smokers
Presentation of Adenocarcinoma
Often found incidentally
paraneoplastic syndromes rare
peripheral masses
Squamous cell carcinoma has a strong association with
smoking
Presentation of squamous cell carcinoma
Often presents with hemoptysis
central (bronchial) masses
Large cell carcinoma is a dx of exclusion and may present _______? (where are the masses located)
as peripheral or central masses
Bronchogenic Carcinomas:
Squamous cell =
bronchial epithelial cells
Bronchogenic Carcinomas:
Adenocarcinoma =
glandular (mucous) cells
Bronchogenic Carcinomas:
Large cell =
undifferentiated (cell types that don’t fit others)
Bronchogenic Carcinomas workup after diagnosis
PET scan
CT abdomen and pelvis +/- bone scan
MRI of chest if concern for adjacent structures
Head CT/MRI
Lymph node bx
Staging:
small cell lung cancer=
non-small cell lung cancer=
limited disease or extensive disease
follows the TMN staging (tumor size, lymph node, mets)
Treatment of Bronchogenic Carcinomas
chemo + radiation for small cell carcinoma
non-small cell depends on stage:
- resection alone
- +chemo
- unresectable: chemo +/- radiation
- +/- adjunctive immunotherapy
Carcinoid tumors are a ______ and _________ tumor
rare
malignant neuroendocrine
Two different types of carcinoid tumors
typical and atypical
Carcinoid tumor presens where in the body
central masses (bronchial masses)
Carcinoid tumor Sx
usually due to bronchial obstruction:
cough
wheezing
hemoptysis
atelectasis, PNA
carcinoid syndrome
Carcinoid syndrome presents with
facial flushing
SOB
HTN
wt gain
hirsutism
asthma
Carcinoid tumor workup
Chest CT is modality of choice
CBC, CMP
test for endocrine dysfunction
Carcinoid tumor on Chest CT usually looks like
well defined, round, maybe lobulated nodule
+/- calcifications
Carcinoid tumor treatment
resection (lobectomy) preferred
+/- chemo and/or radiation
possible use of octreotide for hormonal control
Pulmonary metastases is primarily through the
pulmonary artery
Where does primary lung cancer metastasize to
bones
liver
brain
lymph nodes
adrenal glands
Work up for pulmonary mets
CXR most common initial test
helical chest CT if the BEST test
+/- PET for concern
+/- bronchoscopy if a central metastasis
Pulmonary mets: on CT scan
spherical, fairly well defined, varying in size (m/c will find multiple)
Treatment for pulmonary mets
solitary pulmonary nodule - resection
mets limited to the lung and few in # - consider resection
multiple nodules, multiple met sites, unreachable - palliative care (rad and/ or chemo)
Mesothelioma is nearly always secondary to
asbestos exposure
Mesothelioma arises from
mesothelial tissue (pleura)
Presentation of mesothelioma
through screening
ssx: dyspnea, non-pleuritic CP most common
pleural effusion is present 95% of the time
Work up for Mesothelioma
CXR commonly done
CT for further differentiation
Thoracentesis for pleural effusion
Pleural bx
CT, MRI, PET, bronchoscopy for staging
Mesothelioma treatment
resection +/- chemotherapy +/- radiation
no single treatment significantly improves mortality
supportive treatments
median survival 9-12 months
