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.
