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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
lung cancer most likely to present with hemoptysis
squamous cell carcinoma
26
sputum cytology can detect
squamous cell carcinoma
27
large cell carcinoma
Central or peripheral masses with rapid doubling times that metastasize to distant organs
28
can a clear chest x ray rule out cancer
NO
29
signs/symptoms of intrathoracic spread
``` Pleural effusion: Pericardial effusion Hoarseness Superior vena cava syndrome Pancoast syndrome ```
30
what causes hoarseness in lung cancer patients?
intrathoracic spread: | compression of recurrent laryngeal nerve with left sided tumors
31
lung cancer most commonly associated with superior vena cava syndrome
SCLC
32
superior vena cava syndrome causes
Compression or direct invasion from right lung, lymph nodes, or thrombosis (intravascular devices), intrathoracic malignancy
33
superior vena cava syndrome symptoms used to make a clinical diagnosis
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
initial study with indwelling devices and arm swelling (SVC syndrome)
duplex ultrasound
35
why use a CT with contrast for SVC syndrome
level and extent of blockage, map collateral pathways, identify underlying cause
36
gold standard imaging of SVC syndrome
superior vena cavogram | identify obstruction and extent of thrombus formation
37
treatment of SVC syndrome
``` emergency RT: stridor from central airway obstruction or laryngeal edema, coma from cerebral edema venous stents +/- chemo removal of devices anticoagulation ```
38
pancoast syndrome
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
Horner's syndrome
injury of sympathetic nerves of face | under pancoast syndrome?
40
lung cancer most likely to present with pancoast syndrome
squamous cell carcinoma
41
Paraneoplastic syndromes
Organ dysfunction due to immune mediated or secretory effects: hematologic, endocrine, neurologic
42
Paraneoplastic syndromes symptoms
anorexia, weight loss, cachexia, fever, suppressed immunity
43
cachexia
weakness/wasting of the body due to severe chronic illness
44
hematologic paraneoplastic syndrome labs
``` Hypercalcemia Anemia: fatigue, dyspnea Leukocytosis: poor prognosis Thrombocytosis: poor prognosis Hypercoagulability ```
45
endocrine paraneoplastic syndrome
PTH-like substance secreted or Excess HCG production
46
Excess HCG production endocrine paraneoplastic syndrome most commonly seen in
large cell
47
Excess HCG production endocrine paraneoplastic syndrome symptoms
gynecomastia | milky nipple discarge
48
PTH-like substance secreted endocrine paraneoplastic syndrome most commonly seen in
squamous cell NSCLC
49
PTH-like substance secreted endocrine paraneoplastic syndrome causes
hypercalcemia
50
SIADH or Cushing’s syndrome endocrine paraneoplastic syndromes is most commonly seen in
small cell
51
SIADH symptoms
Hyponatremia | irritability, restlessness, personality changes, confusion, coma, seizure, respiratory arrest
52
Cushing's syndrome (ectopic ACTH) symptoms
muscle weakness, weight loss, HTN, hirsutism, osteoporosis
53
eaton-lambert syndrome
neurologic paraneoplastic syndrome | Immune mediated antibodies at neuromuscular junction --> defective release of ACh--> muscle weakness
54
cancer most likely to present with eaton-lambert syndrome
small cell
55
signs of liver metastasis
elevated LFTs, seen on CT/PET scan
56
signs of adrenal metastasis
asymptomatic
57
signs of bone metastasis
elevated alkaline phosphatase | back, chest, extremity pain
58
signs of brain metastasis
neuro sx: HA, N/V, seizures, confusion, personality change
59
staging of SCLS
Limited: ipsilateral hemithorax, regional nodes | Extensive (most): extends beyond hemithorax + pleural effusions
60
staging of NSCLC
T-primary tumor N-nodal involvement M-distant metastasis
61
stages of cancer
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
performance status staging
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
strongest indicator of post-op complications
FEV1 <60% predicted
64
how is PET done and why is it helpful
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
treatment of choice for NSCLC
surgical resection (if adequate pulmonary function)
66
Drainage for malignant effusions
Thoracocentesis pleurodesis pleurx catheters
67
which small cell cancers can get surgery
VERY FEW <5% | Small primary lung cancer with no evidence of spread
68
Cytoxic Chemotherapy side effects
anemia, neutropenia (infection risk), nephrotoxicity, cutaneous toxicity, N/V anorexia, weight loss, neurotoxicity (only partially reversible), fatigue, chemo brain
69
Radiation side effect
fatigue
70
who can get surgical resection without chemo
stage 1 NSCLC (but not 1B) | lobectomy
71
stage 3 NSCLC treatments
resected NSCLC with clear margin: nothing? no chemo resected NSCLC without clear margin: radiation unresected: chemotherapy
72
stage 4 cancer treatment
not curable, palliative car, chemo, trials, resection of metastasis, targeted therapy
73
which group of cancer has the worst prognosis
all small cell lung cancers
74
how to screen for lung cancer
Low dose helical CT (LDCT) noncontrast, high resolution thin slice
75
who to screen for lung cancer
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
the problems with zyban
Avoid EtOH Black box: increased suicide risk in children, adolescents, young adults Adverse rxns: seizures, agitation, weight loss
77
zyban/wellbutrin/bupropion MOA and use
Inhibits neuronal uptake of NE and DA antidepressant smoking cessation
78
OTC nicotine replacement
Nicoderm CQ Nicorette gum Commit lozenge
79
the problems with varenicline or nicotrol
Precautions: unstable cardiovascular disease | Adverse reactions: dizziness, htn, palpitations, GI
80
nicotrol is
prescription nicotine replacement nasal spray or inhaler
81
varnicline MOA
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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