EXAM #2: LUNG NEOPLASMS AND MALIGNANCY Flashcards
Why is the prognosis for lung cancer so poor?
Over half are metastatic at the time of diagnosis/ late stage diagnosis
What is the correlation/ association between lung cancer and smoking?
- Direct association between smoking and lung cancer
- Linear correlation
Note that more than 60% of newly diagnosed lung is in nonsmokers
What are the most common metastases to the lung?
1) Breast
2) Colon
3) Prostate
4) Bladder
On imaging, what indicates that a lung cancer is the result of metastasis rather than a primary tumor?
Presence of multiple pulmonary lesions i.e. “cannonball” lesions
What are the major symptoms associated with lung cancer? According to Dr. Dodge, what is the most important symptom for identifying potential lung cancer?
1) Cough
2) Hemoptysis
3) Dyspnea
4) Various paraneoplastic processes
AND weight loss*
What are the major symptoms associated with SVC syndrome?
1) Syncope
2) Increased jugular venous pressure, and
3) Blue discoloration in the face, arms and neck
In a patient that presents with a potential lung mass on imaging, what is the first thing that you should do?
Compare to an old film (if possible)
IF there is a change of the mass from an old film, or this is a new finding, what is the next best step?
CT scan
List the characteristics of a solitary lung nodule that would indicate that it is most likely benign.
1) Young patient (35)
2) No change from old film
3) Calcified
4) Smooth margin
5) Small (less than 2cm)
6) No lymphadenopathy
What is the next best step if a patient presents with a solitary lung nodule that is most likely benign?
Follow-up CXR in 3-6 months
List the characteristics of a solitary lung nodule that would indicate that it is most likely malignant.
1) Smoker
2) Older than 35
3) Change from old film/ new
4) No calcification
5) Larger than 2cm
What is the next best step if a patient presents with a solitary lung nodule that is most likely malignant?
1) PET scan
2) Biopsy
3) Resection
What are the four major types of lung carcinoma?
1) Small Cell
2) Adenocarcinoma
3) Large Cell
4) Squamous Cell
What is small cell lung cancer commonly associated with?
Smoking
Where does small cell lung cancer commonly arise?
Centrally
Describe the aggressiveness of small cell lung cancer.
- Most aggressive of the lung cancers
- Highly malignant
- Widely metastatic
What is the origin of small cell lung cancer?
Neuroendocrine (Cells of Kulchinsky)
What is the mnemonic to remember the important clinical features of spuamous cell lung cancer?
“S”
- Squamous
- Smoker
- Sentral
- Surgical candidate
What is the key histological findings associated with squamous cell carcinoma?
Squamous “keratin pearls”
Describe the gross appearance of squamous cell carcinoma.
Cavitary mass with extensive central necrosis (tumor outruns its blood supply)
What is the number one carcinoma in non-smokers?
Adenocarcinoma
What is the gender predominance associated with adenocarcinoma?
More common in women
Where does adenocarcinoma typically arise?
Peripherally
How does large cell lung carcinoma present?
Large necrotic peripheral mass.
How is large cell lung carcinoma diagnosed?
Diagnosis of exclusion
What is the difference between a Pancoast tumor causing Horner’s Syndrome and Pancoast Syndrome?
- Pancoast tumor can lead to Horner’s Syndrome (PAM mnemonic)
- Pancoast SYNDROME= Horner’s + Brachial plexus
What is the paraneoplastic syndrome associated with squamous cell carcinoma?
Hyperparathyroidism
PTHrP (parathyroid hormone related peptide) by neoplastic cells can cause HYPERCALCEMIA of malignancy
What paraneoplasic syndromes are associated with small cell lung cancer?
Note that this is a NEUROENDOCRINE tumor; this it is associated with the most paraneoplastic syndromes
1) Cushing’s syndrome due to excessive ACTH secretion
2) SIADH due to excessive anti-diuretic hormone (ADH) secretion, which can lead to hyponatremia
3) Lambert-Eaton myasthenia syndrome, which is a disorder of muscle weakness due to auto-antibodies directed against neuronal pre-synaptic calcium channels
What complications are associated with adenocarcinoma?
1) DIC
2) Thrombocytopenia
3) Microangiopathic hemolytic anemia
What paraneoplastic syndrome is associated with large cell lung cancer?
Gynecomastia
What are the most common locations of metastesis for primary lung cancer?
1) Liver
2) Brain
3) Bone
4) Adrenal glands
What is required for the diagnosis of lung cancer?
“Tissue is the issue” i.e. tissue
What are the indications for an annual low dose CT scan?
1) 55-74
2) 30 pack year history ( #ppd x years)
3) Current smoker or quit within 15 years
4) In relatively good health
How is lung cancer staged?
TNM
T= tumor N= node M= metastasis
By definition, what stage is any metastatic tumor?
Stage 4
*For any type of lung cancer, stage 4= less than 5% 5-year survival
What is the treatment for stage I and II NSCLC?
1) Resection
2) Chemo/radiation
What is the treatment for stage III NSCLC?
Chemo
What is the treatment for stage IV NSCLC?
Chemo and palliative
How is the majority of small cell lung cancer treated?
Chemotherapy and radiation
What is Nivolumab/ what is it targeting?
Monoclonal IgG4 antibody directed against the programmed cell death RECEPTOR
What is Pembrolizumab/ what is it targeting?
Monoclonal IgG4 antibody directed against the programmed cell death LIGAND
What is Nivolumab indicated for?
Metastatic NSCLC that is NON-SQUAMOUS
What is Pembrolizumab indicated for?
Metastatic NSCLC
What is the most common reason for a solitary lung nodule in Iowa?
Histoplasmosis
What is the most common cause of a solitary lung nodule in the world?
Hamartoma
