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Respiratory > EXAM #2: LUNG NEOPLASMS AND MALIGNANCY > Flashcards

EXAM #2: LUNG NEOPLASMS AND MALIGNANCY Flashcards

1
Q

Why is the prognosis for lung cancer so poor?

A

Over half are metastatic at the time of diagnosis/ late stage diagnosis

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2
Q

What is the correlation/ association between lung cancer and smoking?

A
  • Direct association between smoking and lung cancer
  • Linear correlation

Note that more than 60% of newly diagnosed lung is in nonsmokers

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3
Q

What are the most common metastases to the lung?

A

1) Breast
2) Colon
3) Prostate
4) Bladder

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4
Q

On imaging, what indicates that a lung cancer is the result of metastasis rather than a primary tumor?

A

Presence of multiple pulmonary lesions i.e. “cannonball” lesions

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5
Q

What are the major symptoms associated with lung cancer? According to Dr. Dodge, what is the most important symptom for identifying potential lung cancer?

A

1) Cough
2) Hemoptysis
3) Dyspnea
4) Various paraneoplastic processes

AND weight loss*

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6
Q

What are the major symptoms associated with SVC syndrome?

A

1) Syncope
2) Increased jugular venous pressure, and
3) Blue discoloration in the face, arms and neck

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7
Q

In a patient that presents with a potential lung mass on imaging, what is the first thing that you should do?

A

Compare to an old film (if possible)

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8
Q

IF there is a change of the mass from an old film, or this is a new finding, what is the next best step?

A

CT scan

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9
Q

List the characteristics of a solitary lung nodule that would indicate that it is most likely benign.

A

1) Young patient (35)
2) No change from old film
3) Calcified
4) Smooth margin
5) Small (less than 2cm)
6) No lymphadenopathy

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10
Q

What is the next best step if a patient presents with a solitary lung nodule that is most likely benign?

A

Follow-up CXR in 3-6 months

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11
Q

List the characteristics of a solitary lung nodule that would indicate that it is most likely malignant.

A

1) Smoker
2) Older than 35
3) Change from old film/ new
4) No calcification
5) Larger than 2cm

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12
Q

What is the next best step if a patient presents with a solitary lung nodule that is most likely malignant?

A

1) PET scan
2) Biopsy
3) Resection

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13
Q

What are the four major types of lung carcinoma?

A

1) Small Cell
2) Adenocarcinoma
3) Large Cell
4) Squamous Cell

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14
Q

What is small cell lung cancer commonly associated with?

A

Smoking

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15
Q

Where does small cell lung cancer commonly arise?

A

Centrally

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16
Q

Describe the aggressiveness of small cell lung cancer.

A
  • Most aggressive of the lung cancers
  • Highly malignant
  • Widely metastatic
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17
Q

What is the origin of small cell lung cancer?

A

Neuroendocrine (Cells of Kulchinsky)

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18
Q

What is the mnemonic to remember the important clinical features of spuamous cell lung cancer?

A

“S”

  • Squamous
  • Smoker
  • Sentral
  • Surgical candidate
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19
Q

What is the key histological findings associated with squamous cell carcinoma?

A

Squamous “keratin pearls”

20
Q

Describe the gross appearance of squamous cell carcinoma.

A

Cavitary mass with extensive central necrosis (tumor outruns its blood supply)

21
Q

What is the number one carcinoma in non-smokers?

A

Adenocarcinoma

22
Q

What is the gender predominance associated with adenocarcinoma?

A

More common in women

23
Q

Where does adenocarcinoma typically arise?

A

Peripherally

24
Q

How does large cell lung carcinoma present?

A

Large necrotic peripheral mass.

25
Q

How is large cell lung carcinoma diagnosed?

A

Diagnosis of exclusion

26
Q

What is the difference between a Pancoast tumor causing Horner’s Syndrome and Pancoast Syndrome?

A
  • Pancoast tumor can lead to Horner’s Syndrome (PAM mnemonic)
  • Pancoast SYNDROME= Horner’s + Brachial plexus
27
Q

What is the paraneoplastic syndrome associated with squamous cell carcinoma?

A

Hyperparathyroidism

PTHrP (parathyroid hormone related peptide) by neoplastic cells can cause HYPERCALCEMIA of malignancy

28
Q

What paraneoplasic syndromes are associated with small cell lung cancer?

A

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

29
Q

What complications are associated with adenocarcinoma?

A

1) DIC
2) Thrombocytopenia
3) Microangiopathic hemolytic anemia

30
Q

What paraneoplastic syndrome is associated with large cell lung cancer?

A

Gynecomastia

31
Q

What are the most common locations of metastesis for primary lung cancer?

A

1) Liver
2) Brain
3) Bone
4) Adrenal glands

32
Q

What is required for the diagnosis of lung cancer?

A

“Tissue is the issue” i.e. tissue

33
Q

What are the indications for an annual low dose CT scan?

A

1) 55-74
2) 30 pack year history ( #ppd x years)
3) Current smoker or quit within 15 years
4) In relatively good health

34
Q

How is lung cancer staged?

A

TNM

T= tumor 
N= node 
M= metastasis
35
Q

By definition, what stage is any metastatic tumor?

A

Stage 4

*For any type of lung cancer, stage 4= less than 5% 5-year survival

36
Q

What is the treatment for stage I and II NSCLC?

A

1) Resection

2) Chemo/radiation

37
Q

What is the treatment for stage III NSCLC?

A

Chemo

38
Q

What is the treatment for stage IV NSCLC?

A

Chemo and palliative

39
Q

How is the majority of small cell lung cancer treated?

A

Chemotherapy and radiation

40
Q

What is Nivolumab/ what is it targeting?

A

Monoclonal IgG4 antibody directed against the programmed cell death RECEPTOR

41
Q

What is Pembrolizumab/ what is it targeting?

A

Monoclonal IgG4 antibody directed against the programmed cell death LIGAND

42
Q

What is Nivolumab indicated for?

A

Metastatic NSCLC that is NON-SQUAMOUS

43
Q

What is Pembrolizumab indicated for?

A

Metastatic NSCLC

44
Q

What is the most common reason for a solitary lung nodule in Iowa?

A

Histoplasmosis

45
Q

What is the most common cause of a solitary lung nodule in the world?

A

Hamartoma

Respiratory (35 decks)

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