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Medicine 1 > Diagnosis, Staging and Management of Lung Cancer > Flashcards

Diagnosis, Staging and Management of Lung Cancer Flashcards

1
Q

What is a pulmonary Nodule

A

Opacity in the lung up to 3 cm

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2
Q

What is a pulmonary Mass

A

A Opacity in the lung over 3 cm

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3
Q

What is the differential for a pulmonary mass/ pulmonary nodule

A
  1. Lung Cancer- A solitary nodule / mass
  2. Metastasis- More than one nodule/ mass
  3. Benign long neoplasms- Carcinoid Tumors / Hamartomas
  4. Foci of infection- TB/ Fungi/ Bacteria
  5. Vascular Hematoma,/ Arterio Venous Malformation (AVM)
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4
Q

What is a carcinoid tumour

A

Type of tumor that grows from neuroendocrine cells + Slow growing

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5
Q

What is a harmartoma

A

Benign, Non- Cancerous tumor made up of an abnormal mixture of cells

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6
Q

What factors into staging of Lung Cancer

A
  1. CT is key to stage
  2. Performance status of patient
  3. Pulmonary Function
  4. TNM Staging
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7
Q

How can we asses Tumor Size (T)

A

PET CT
CT
Bronchoscopy

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8
Q

How do we assess Lymph Node Involvement (N)

A

PET CT
Mediastinoscopy
CT
EBUS/ EUS

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9
Q

How do we assess if the tumor has metastasized (M)

A

PET CT
CT
Bone Scan

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10
Q

T Staging

A

Tx: Primary Tumor cannot be assessed (Tumor may be lost in collapsed lung)
T0: No evidence of tumor
Tis: Carcinoma in situ
T1: <= 3cm
T2: >3cm + <=5cm / Has any of the following
i) Involves a main bronchus (But not carina)
ii) Invades visceral pleura
iii) Associated with atelectasis / obstructive pneumonitis that extends to hilar region
T3: >5cm + <=7cm / Invades : Chest wall/ Phrenic Nerve/ Parietal Pleura // Separate tumor in the same lobe as primary
T4: >7cm/ Invades: Diaphragm, Mediastinum, Heart, Great Vessels, Carina, Trachea. Recurrent Laryngeal nerve, Esophagus/ Vertebral Body // Separate tumor nodule in a different Ipsilateral Lobe

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11
Q

N staging in lung cancer

A

N0: No regional LN involvement
N1: Ipsilateral peribronchial/ hilar/ Intrapulmonary nodes
N2: Ipsilateral Mediastinal, Carinal LN
N3: Contralateral mediastinal/ Contralateral hilar/ Scalene/ Supraclavicular LN

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12
Q

common sites of metastasis of lung cancer

A 
Liver
Adrenals
Bone
Cerebral
Skin
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13
Q

Methods of sampling Tissues for Cancer diagnosis

A

EBUS
Percutaneous Image Guided Biopsy- CT/ US guided
Mediastinoscopy- To sample mediastinal nodes
Mediastinotomy- To sample anterior mediastinal nodes
VATs [Video Assisted Thoracoscopic Surgery}- Sample nodules and pleural abnormalities
Bronchoscopy
Explorative Thoracotomy ( Rare)
Fine Needle Aspirate- For neck and skin nodes
Liver biopsy (If lesions are present in the liver)
Surgical excision of biopsy

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14
Q

Differential for a Tumor in lung

A 
Infection- TB/ Lung Abscess
Benign Tumor: Hamartoma/ Carcinoid tumor
Granuloma- Sarcoidosis/ Wegners Rheumatoid Nodule/ Psuedotumours
Fibrosis- Organising pulmonary infact
Paraffinoma
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15
Q

Chest X ray findings in Lung Cancer

A
  1. Lobar Collapse
  2. Mass
  3. Pleural Effusion
  4. Mediastinal Widening
  5. Hilar lymphadenopathy
  6. Consolidation
  7. Phrenic Nerve Palsy - Raised hemidiaphragm
  8. Normal
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16
Q

This to consider in fitness for surgery

A
  1. CVS
  2. Resp function
  3. Psych
  4. other- Pulmonary hypertenstion/ Liver cirrhosis
17
Q

CVS tests done before surgery

A 
ECHO
ECG
Angiogram
CT
Exercise tolerance Test
18
Q

Resp tests done before surgery

A 
SpirometryD
Diffusion Studies
ABG on air
V/Q Scan
- lobectomy, FEV1>1
-Pneumonectomy, FEV1>2
19
Q

types of operations performed

A

Pneumonectomy
Lobectomy
Wedge Resection
Segmentectomy

20
Q

Reasons for peri operative death

A
  1. Bronchopneumonia
  2. PE
  3. Adult Resp Distress Syndrome caused by an aggravation of ILD
  4. Intrathoracic bleeding
  5. Pneumothorax
21
Q

Post op complications

A
  1. Empyema
  2. Wound Pain
  3. Wound infection
  4. Atrial Fibrillation
  5. Post op resp insufficiency
  6. Broncho- pleural Fistula
  7. Gastroparesis/ Constipation

Medicine 1 (2 decks)

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