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Unit 2 Clin Med II > L14 Lung Cancer > Flashcards

L14 Lung Cancer Flashcards

1
Q

solitary pulmonary nodule aka

A

coin lesion

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2
Q

solitary pulmonary nodule definition

A

<3 cm, isolated, rounded opacity with dense central calcification completely surrounded by pulmonary parenchyma

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3
Q

a mass is

A

> 3 cm in size→ greater chance of malignancy

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4
Q

nodules or masses in lungs are

A

considered cancer until proven otherwise

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5
Q

benign solitary nodule causes

A

Infectious granulomas (most common): TB, cocci, pulmonary abscess
Hamartoma
Vascular
Inflammatory
Fungal infection: multiple calcified lesions

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6
Q

malignant solitary nodule causes

A

lung cancer, carcinoid tumor, metastatic cancer

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7
Q

age/gender of solitary pulmonary nodule risk

A

> 60 years old = 50% risk of it being malignant

FEMALES

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8
Q

60% of solitary pulmonary nodules in arizona

A

cocci

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9
Q

if your patient has had cancer in the past and now presents with a solitary pulmonary nodule, regardless of their other risk factors, you are thinking it’s

A

malignant, metastasis

60% of the time

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10
Q

your patient has a mass >5 cm, what’s their prognosis

A

90% of the time it is cancer

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11
Q

malignant vs benign nodules monitored by CXR

A

malignant double in 20-400 days

benign show minimal growth in 2 years

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12
Q

preferred imaging of solitary pulmonary nodule

A

low radiation CT of chest without contrast, 1mm slices

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13
Q

Imaging for nodule 6-8 mm

A

follow up CT 6-12 months, repeat

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14
Q

Imaging for nodule <6 mm

A

no follow up required, optional at 6 months

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15
Q

Imaging for nodule >8 mm Low probability (<5%)

A

CT at 3 months
→ no growth→ serial CT a 9-12, 18-24 months
→ growth→ pathologic evaluation

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16
Q

Imaging for nodule >8 mm Intermediate probability (5-65%)

A

FDEG: avid→ biopsy or excision
PET/CT: if negative, unavailable, or indeterminate→ individualized management
CT surveillance: 3, 9-12, 18-24 months: alternative to biopsy

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17
Q

Management for nodule >8 mm High probability (>65%)

A

biopsy/excision +/- PET/CT for staging

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18
Q

oat cell carcinoma aka

A

small cell lung cancer

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19
Q

small cell lung cancer presentation

A

large hilar mass with bulky mediastinal adenopathy→ compression of airway, cough, dyspnea, weight loss, debility

Highly aggressive, metastasizes, short survival without treatment

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20
Q

small cell lung cancer arises from

A

From central airways

most are extensive

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21
Q

most common lung cancer

A

adenocarcinoma

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22
Q

adenocarcinoma arise from

A

mucous glands or any epithelia cell in/distal to terminal bronchioles
metastasizes to distant organs

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23
Q

adenocarcinoma presents as

A

peripheral nodules or masses

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24
Q

squamous cell carcinoma arises from

A

Arises from bronchial epithelium→ centrally or main bronchus→ intraluminal growth in bronchi
can cavitate

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25
Q

lung cancer most likely to present with hemoptysis

A

squamous cell carcinoma

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26
Q

sputum cytology can detect

A

squamous cell carcinoma

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27
Q

large cell carcinoma

A

Central or peripheral masses with rapid doubling times that metastasize to distant organs

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28
Q

can a clear chest x ray rule out cancer

A

NO

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29
Q

signs/symptoms of intrathoracic spread

A 
Pleural effusion: 
Pericardial effusion
Hoarseness
Superior vena cava syndrome
Pancoast syndrome
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30
Q

what causes hoarseness in lung cancer patients?

A

intrathoracic spread:

compression of recurrent laryngeal nerve with left sided tumors

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31
Q

lung cancer most commonly associated with superior vena cava syndrome

A

SCLC

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32
Q

superior vena cava syndrome causes

A

Compression or direct invasion from right lung, lymph nodes, or thrombosis (intravascular devices), intrathoracic malignancy

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33
Q

superior vena cava syndrome symptoms used to make a clinical diagnosis

A

symptoms of central venous obstruction: dyspnea, swelling of head/face worse when bending forward, laying down, arm swelling, cough, chest pain, dysphagia, dilated neck veins, prominent venous pattern on chest

34
Q

initial study with indwelling devices and arm swelling (SVC syndrome)

A

duplex ultrasound

35
Q

why use a CT with contrast for SVC syndrome

A

level and extent of blockage, map collateral pathways, identify underlying cause

36
Q

gold standard imaging of SVC syndrome

A

superior vena cavogram

identify obstruction and extent of thrombus formation

37
Q

treatment of SVC syndrome

A 
emergency RT: stridor from central airway obstruction or laryngeal edema, coma from cerebral edema
venous stents
\+/- chemo
removal of devices
anticoagulation
38
Q

pancoast syndrome

A

Tumor involving superior sulcus of apical chest→ compresses brachial plexus and cervical sympathetic nerves
Right shoulder, forearm, scapula, finger pain

Signs on ipsilateral side of tumor: miosis, anhidrosis, ptosis
Rib destruction
Atrophy of hand muscles
C8, T1, T2 nerve pain (down arms)

39
Q

Horner’s syndrome

A

injury of sympathetic nerves of face

under pancoast syndrome?

40
Q

lung cancer most likely to present with pancoast syndrome

A

squamous cell carcinoma

41
Q

Paraneoplastic syndromes

A

Organ dysfunction due to immune mediated or secretory effects: hematologic, endocrine, neurologic

42
Q

Paraneoplastic syndromes symptoms

A

anorexia, weight loss, cachexia, fever, suppressed immunity

43
Q

cachexia

A

weakness/wasting of the body due to severe chronic illness

44
Q

hematologic paraneoplastic syndrome labs

A 
Hypercalcemia
Anemia: fatigue, dyspnea
Leukocytosis: poor prognosis
Thrombocytosis: poor prognosis
Hypercoagulability
45
Q

endocrine paraneoplastic syndrome

A

PTH-like substance secreted
or
Excess HCG production

46
Q

Excess HCG production endocrine paraneoplastic syndrome most commonly seen in

A

large cell

47
Q

Excess HCG production endocrine paraneoplastic syndrome symptoms

A

gynecomastia

milky nipple discarge

48
Q

PTH-like substance secreted endocrine paraneoplastic syndrome most commonly seen in

A

squamous cell NSCLC

49
Q

PTH-like substance secreted endocrine paraneoplastic syndrome causes

A

hypercalcemia

50
Q

SIADH or Cushing’s syndrome endocrine paraneoplastic syndromes is most commonly seen in

A

small cell

51
Q

SIADH symptoms

A

Hyponatremia

irritability, restlessness, personality changes, confusion, coma, seizure, respiratory arrest

52
Q

Cushing’s syndrome (ectopic ACTH) symptoms

A

muscle weakness, weight loss, HTN, hirsutism, osteoporosis

53
Q

eaton-lambert syndrome

A

neurologic paraneoplastic syndrome

Immune mediated antibodies at neuromuscular junction –> defective release of ACh–> muscle weakness

54
Q

cancer most likely to present with eaton-lambert syndrome

A

small cell

55
Q

signs of liver metastasis

A

elevated LFTs, seen on CT/PET scan

56
Q

signs of adrenal metastasis

A

asymptomatic

57
Q

signs of bone metastasis

A

elevated alkaline phosphatase

back, chest, extremity pain

58
Q

signs of brain metastasis

A

neuro sx: HA, N/V, seizures, confusion, personality change

59
Q

staging of SCLS

A

Limited: ipsilateral hemithorax, regional nodes

Extensive (most): extends beyond hemithorax + pleural effusions

60
Q

staging of NSCLC

A

T-primary tumor
N-nodal involvement
M-distant metastasis

61
Q

stages of cancer

A

Stage 1: localized
Stage 2: spread in lymph nodes at top of lung
Stage 3: spread into chest wall
Stage 4: spread to another part of the body

62
Q

performance status staging

A

0= fully active
1=strenuous physical activity restricted
2=capable of all self care, no work activity, up and about > 50% of waking hours
3=capable of only limited self care, confined to bed/chair >50% of waking hours
4= completely disabled

63
Q

strongest indicator of post-op complications

A

FEV1 <60% predicted

64
Q

how is PET done and why is it helpful

A

aids diagnosis and staging
Uses fluorodeoxyglucose which lights up in metabolically active cancer cells
→ better than CT for metastasis
→ false positives: infections
→ does not detect all cancer: bronchoalveolar

65
Q

treatment of choice for NSCLC

A

surgical resection (if adequate pulmonary function)

66
Q

Drainage for malignant effusions

A

Thoracocentesis
pleurodesis
pleurx catheters

67
Q

which small cell cancers can get surgery

A

VERY FEW <5%

Small primary lung cancer with no evidence of spread

68
Q

Cytoxic Chemotherapy side effects

A

anemia, neutropenia (infection risk), nephrotoxicity, cutaneous toxicity, N/V anorexia, weight loss, neurotoxicity (only partially reversible), fatigue, chemo brain

69
Q

Radiation side effect

A

fatigue

70
Q

who can get surgical resection without chemo

A

stage 1 NSCLC (but not 1B)

lobectomy

71
Q

stage 3 NSCLC treatments

A

resected NSCLC with clear margin: nothing? no chemo
resected NSCLC without clear margin: radiation
unresected: chemotherapy

72
Q

stage 4 cancer treatment

A

not curable, palliative car, chemo, trials, resection of metastasis, targeted therapy

73
Q

which group of cancer has the worst prognosis

A

all small cell lung cancers

74
Q

how to screen for lung cancer

A

Low dose helical CT (LDCT) noncontrast, high resolution thin slice

75
Q

who to screen for lung cancer

A

every patient with suspected lung cancer
High risk patients:
55-74 with 30 year pack history/quit within 15 years/20 year pack history+1 risk factor

76
Q

the problems with zyban

A

Avoid EtOH
Black box: increased suicide risk in children, adolescents, young adults
Adverse rxns: seizures, agitation, weight loss

77
Q

zyban/wellbutrin/bupropion MOA and use

A

Inhibits neuronal uptake of NE and DA
antidepressant
smoking cessation

78
Q

OTC nicotine replacement

A

Nicoderm CQ
Nicorette gum
Commit lozenge

79
Q

the problems with varenicline or nicotrol

A

Precautions: unstable cardiovascular disease

Adverse reactions: dizziness, htn, palpitations, GI

80
Q

nicotrol is

A

prescription nicotine replacement nasal spray or inhaler

81
Q

varnicline MOA

A

Blocks alpha4-beta2 nicotinic acetylcholine receptors

Smoking cessation: after 7 days, continue prescription 12-24 weeks

Unit 2 Clin Med II (7 decks)

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